Metastatic Colorectal Cancer

What are the recommended treatment options for colorectal cancer?

A number of tests performed before the actual treatment help the doctor decide on the most appropriate treatment plan.

Before deciding on the actual treatment plan, a variety of tests are performed to assess one’s general health and nature/stage of cancer. Once a treatment plan is decided by your doctor, one or more of the following treatment options may be recommended:

I. Surgery

Based on the extent to which cancer might have spread beyond the colon wall, the doctor could opt for one or more of: colectomy (removal of part of the colon with cancer), lymphadenectomy (removal of affected lymph nodes) or metastatectomy (removal of site where cancer would have metastasized).

II. Chemotherapy

Most chemotherapy drugs for colon cancer are given through the bloodstream. In some cases, hepatic arterial infusion (HAI) is also done in cases of cancer which would have spread to the liver. Commonly used chemotherapy regimens include 5-fluorouracil/leucovorin, Capecitabine, Capecitabine/oxaliplatin, FOLFIRI (folinic acid, fluorouracil and irinotecan), FOLFOX (Folinic acid, fluorouracil and oxaliplatin), etc.

III. Targeted therapy

In targeted therapy, the treatment specifically targets and kills the specific cancer cells. Different targeted therapies work in different ways. They either stop the growth of new blood vessels (thereby starving the cancer cells) and/or stop the cancer cells from receiving signals to grow. During this form of therapy, there is little or no harm to normal cells. Currently existing targeted therapeutics to treat colon cancer include Bevacizumab, Ramucirumab, Ziv-aflibercept, Cetuximab, Panitumumab, Regorafenib and Vemurafenib. However, not everyone with colon cancer can benefit from targeted therapy as it depends upon the molecular nature of the cancer cell type itself.

IV. Immunotherapy

Immunotherapy increases the activity of one’s immune system, thereby improving the body’s ability to find and destroy cancer cells. Drugs called checkpoint inhibitors are a type of immunotherapy used in colon cancer treatment. Some examples are Ipilimumab, Nivolumab and Pembrolizumab.

V. Radiation therapy

In radiation therapy high energy beams are used to kill or stop growth of new cancer cells. It may be given before or after surgery. To increase effectiveness, radiation therapy may be given along with chemotherapy (called ‘chemoradiation therapy’).

VI. Ablation & Embolization

During ablation treatment, small tumours are destroyed using radiation/alcohol/cryosurgery, without removing the tissue surgically. During embolization, chemical substances are injected into blood vessels to try to block or reduce blood flow to cancer cells. Both these techniques help in destroying small spots of cancers that might have spread or recurred, without actually removing them.

What possible treatment management measures can be taken?

Coping with the disease

Based on the treatment plan prescribed by the doctor, side effects vary. These include hair loss, mouth sores, nausea, loss of appetite, bleeding etc. Talking to one’s doctor will help to know more on the side-effects associated with a particular kind of treatment regimen. Given this, not everyone experiences the same side effects in the same measure.

One must talk to one’s doctor for any kind of inconvenience felt right from the day of therapy. He/she could lower the drug dose, postpone a particular treatment session or prescribe medication to manage side effect(s). Most of the side effects related to chemotherapy usually go away with time.