Current Therapy In Colon And Rectal Surgery ~UPD~
Surgery is the removal of the tumor and some surrounding healthy tissue during an operation. It is often called surgical resection. This is the most common treatment for colorectal cancer. Part of the healthy colon or rectum and nearby lymph nodes will also be removed. While both general surgeons and specialists may perform colorectal surgery, many people talk with specialists who have additional training and experience in colorectal surgery. A surgical oncologist is a doctor who specializes in treating cancer using surgery. A colorectal surgeon is a doctor who has received additional training to treat diseases of the colon, rectum, and anus. Colorectal surgeons used to be called proctologists.
Current Therapy in Colon and Rectal Surgery
Laparoscopic surgery. Some patients may be able to have laparoscopic colorectal cancer surgery. With this technique, several viewing scopes are passed into the abdomen while a patient is under anesthesia. Anesthesia is medicine that blocks the awareness of pain. The incisions are smaller and the recovery time is often shorter than with standard colon surgery. Laparoscopic surgery is as effective as conventional colon surgery in removing the cancer. Surgeons who perform laparoscopic surgery have been specially trained in that technique.
Colostomy for rectal cancer. Less often, a person with rectal cancer may need to have a colostomy. This is a surgical opening, or stoma, through which the colon is connected to the abdominal surface to provide a pathway for waste to exit the body. This waste is collected in a pouch worn by the patient. Sometimes, the colostomy is only temporary to allow the rectum to heal, but it may be permanent. With modern surgical techniques and the use of radiation therapy and chemotherapy before surgery when needed, most people who receive treatment for rectal cancer do not need a permanent colostomy. Learn more about colostomies.
Radiofrequency ablation (RFA) or cryoablation. Some patients may have surgery on the liver or lungs to remove colorectal cancer that has spread to those organs. Optional treatments include using energy in the form of radiofrequency waves to heat the tumors, called RFA, or to freeze the tumor, called cryoablation. Not all liver or lung tumors can be treated with these approaches. RFA can be done through the skin or during surgery. While this can help avoid removing parts of the liver and lung tissue that might be removed in a regular surgery, there is also a chance that parts of tumor will be left behind.
Radiation therapy is the use of high-energy x-rays to destroy cancer cells. It is commonly used for treating rectal cancer because this kind of tumor tends to recur near where it originally started. A doctor who specializes in giving radiation therapy to treat cancer is called a radiation oncologist. A radiation therapy regimen, or schedule, usually consists of a specific number of treatments given over a set period of time.
Stereotactic radiation therapy. Stereotactic radiation therapy is a type of external-beam radiation therapy that may be used if colorectal cancer has spread to the liver or lungs. This type of radiation therapy delivers a large, precise radiation dose to a small area. This technique can help save parts of the liver and lung tissue that might otherwise have to be removed during surgery. However, not all cancers that have spread to the liver or lungs can be treated in this way.
Other types of radiation therapy. For some people, specialized radiation therapy techniques, such as intraoperative radiation therapy or brachytherapy, may help get rid of small areas of cancer that can not be removed with surgery.
Brachytherapy. Brachytherapy is the use of radioactive "seeds" placed inside the body. In 1 type of brachytherapy with a product called SIR-Spheres, tiny amounts of a radioactive substance called yttrium-90 are injected into the liver to treat colorectal cancer that has spread to the liver when surgery is not an option. Limited information is available about how effective this approach is, but some studies suggest that it may help slow the growth of cancer cells.
Radiation therapy for rectal cancer. For rectal cancer, radiation therapy may be used before surgery, called neoadjuvant therapy, to shrink the tumor so that it is easier to remove. It may also be used after surgery to destroy any remaining cancer cells. Both approaches have worked to treat this disease. Chemotherapy is often given at the same time as radiation therapy to increase the effectiveness of the radiation therapy. This is called chemoradiation therapy.
Chemoradiation therapy is often used in rectal cancer before surgery to avoid colostomy or reduce the chance that the cancer will recur. One study found that chemoradiation therapy before surgery worked better and caused fewer side effects than the same radiation therapy and chemotherapy given after surgery. The main benefits included a lower rate of the cancer coming back in the area where it started, fewer patients who needed permanent colostomies, and fewer problems with scarring of the bowel where the radiation therapy was given.
Radiation therapy is typically given in the United States for rectal cancer over 5.5 weeks before surgery. However, for certain patients (and in certain countries), a shorter course of 5 days of radiation therapy before surgery is appropriate and/or preferred.
A newer approach to rectal cancer is currently being used for certain patients. It is called total neoadjuvant therapy (or TNT). With TNT, both chemotherapy and chemoradiation therapy are given for about 6 months before surgery.
Each of these types of therapies is discussed below in more detail. A person may receive 1 type of medication at a time or a combination of medications given at the same time. They can also be given as part of a treatment plan that includes surgery and/or radiation therapy.
Chemotherapy may be given after surgery to eliminate any remaining cancer cells. For some people with rectal cancer, the doctor will give chemotherapy and radiation therapy before surgery to reduce the size of a rectal tumor and reduce the chance of the cancer returning.
Chemotherapy may cause vomiting, nausea, diarrhea, mouth sores, or neuropathy, which is tingling or numbness in feet or hands. However, medications to prevent these side effects are available. Because of the way drugs are given, these side effects are less severe than they have been in the past for most people. In addition, patients may be unusually tired or fatigued, and there is an increased risk of infection. Major hair loss is an uncommon side effect with many of the drugs used to treat colorectal cancer, although it is more common with chemotherapy regimens that include irinotecan.
Bevacizumab (Avastin). When bevacizumab is given with chemotherapy, it can help people with advanced colorectal cancer live longer. In 2004, the FDA approved bevacizumab along with chemotherapy as the first treatment, or first-line treatment, for advanced colorectal cancer. Recent studies have shown it is also effective as second-line therapy along with chemotherapy. There are 2 drugs similar to bevacizumab, bevacizumab-awwb (Mvasi) and bevacizumab-bvzr (Zirabev), that have also been approved by the FDA to treat advanced colorectal cancer. These are called biosimilars.
HER2-targeted therapy (updated 01/2023). Some tumors express a protein called HER2 that can be targeted by specific medications. If this happens, the cancer is called HER2-positive. For people with HER2-positive advanced colorectal cancer, treatment with a combination of tucatinib (Tukysa) and trastuzumab (Herceptin and other brand names) may be an option. This combination may only be used if there are no mutations in the RAS gene, surgery is not an option, and chemotherapy has stopped working and/or caused side effects that require stopping treatment. It also appears that HER2-targeted therapies do not work as well in tumors with PIK3CA mutations, so if your cancer has this, discuss with your doctor whether HER2-targeted therapy is right for you.
Tumor-agnostic treatment. Larotrectinib (Vitrakvi) and entrectinib (Rozlytrek) are types of targeted therapy that are not specific to a certain type of cancer but focus on a specific genetic change called an NTRK fusion. This type of genetic change is rare but is found in a range of cancers, including colorectal cancer. These medications are approved as treatment for colorectal cancer that is metastatic or cannot be removed with surgery and has worsened with other treatments.
Pembrolizumab (Keytruda). Pembrolizumab targets PD-1, a receptor on tumor cells, preventing the tumor cells from hiding from the immune system. Pembrolizumab is used to treat unresectable or metastatic colorectal cancers that have a molecular feature called microsatellite instability (MSI-H) or mismatch repair deficiency (dMMR) (see Diagnosis). Unresectable means surgery is not an option.
Nivolumab (Opdivo). Nivolumab is used to treat people who are 12 or older and have MSI-H or dMMR metastatic colorectal cancer that has grown or spread after treatment with chemotherapy with a fluoropyrimidine (such as capecitabine and fluorouracil), oxaliplatin, and irinotecan.
Nivolumab and ipilimumab (Yervoy) combination. This combination of checkpoint inhibitors is approved to treat patients who are 12 or older and have MSI-H or dMMR metastatic colorectal cancer that has grown or spread after treatment with chemotherapy with a fluoropyrimidine, oxaliplatin, and irinotecan.
Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional and spiritual support, and other therapies. You may also receive palliative treatments similar to those meant to get rid of the cancer, such as chemotherapy, surgery, or radiation therapy. 041b061a72