Cary B. Aarons, MD, a colon and rectal surgeon at Penn Medicine discusses surgical treatment of colorectal cancer.

Colorectal cancer is the third most common type of cancer diagnosed in the United States. Fortunately, the overall prognosis for treating colorectal cancer is quite favorable if it is discovered early. In fact, up to 90% of patients whose colorectal cancer is diagnosed and treated in the early stages can be cured.

A Team Approach

The management of colorectal cancer requires a team approach. From the time of diagnosis, comprehensive treatment demands a coordinated effort between:

• The patient
• The patient’s family
• A gastroenterologist
• An oncologist
• A surgeon
• Experienced patient navigators

At Penn’s Abramson Cancer Center, every patient receives a multidisciplinary approach to their cancer care, meaning every member of the team involved in their care works together under one roof.

Colorectal Cancer Treatment Options

The treatment recommended primarily depends on the stage of the cancer, or the extent to which the cancer has spread. There are currently two different forms of treatment available:

Local Treatments

Local treatments include any kind of treatment that is used to target the tumor without affecting the rest of the body. There are three different types of local treatments available including:

1. Surgery – The type of surgery recommended will depend on whether it’s colon cancer or rectal cancer. The different types of surgery available include:

• Polypectomy and local excisions - used for both colon and rectal cancer. This procedure is used when either cancer is in its early stages to remove polyps.
• Colectomy - a procedure for patients with colon cancer in which all or part of the colon is removed along with the nearby lymph nodes.
• Diverting Colostomies - performed on patients with colon cancer to remove blockage of the colon caused by tumors.
• Local transanal resections - performed on patients with early stages of rectal cancer and involves having layers of the rectal wall cut to remove the cancer.
• Transanal Endoscopic Microsurgery (TEM) - used for patients with early stages of rectal cancer. This procedure differs from the local transanal resection in that it is used for those with cancers higher in the rectum where special magnifying scopes and equipment is used to allow the surgeon to perform the procedure with great precision and accuracy.
• Low Anterior Resection (LAR) - used by patients with stage I, II, or III rectal cancer. The LAR is used to remove cancers in the upper part of the rectum. The part of the rectum containing the tumor is also removed.
• Proctectomy with Colo-Anal Anastomosis –used in patients with stage I, II, or III rectal cancer in the middle or lower third of the rectum that requires the removal of the entire rectum.
• Abdominoperineal Resection (APR) – This procedure is similar to the LAR, but more extensive. It is used in patients with stage I, II, or III rectal cancers in the lower part of the rectum and meant to target cancers that may be growing into the sphincter muscle.
• Pelvic Exenteration – An extensive procedure that may be recommended to a patient with rectal cancer if the surgeon finds that the cancer is growing into nearby organs including the bladder, prostate, or uterus. It will involve the removal of both the rectum and the effected organs.

2. Radiation Therapy – Used in rare instances including after surgery if the cancer has spread to other organs, the bones, or the abdomen. It may also be used in patients who are not healthy enough for surgery or used after surgery to prevent the cancer from returning.

3. Ablation and Embolization for Colorectal Cancer – When a patient’s cancer has spread to other organs and cannot be cured, ablation and embolization may be among the best treatment options available. Ablation works to destroy tumors with removing them. Embolization involves the use of substances that are injected into a patient’s body in an effort to block or reduce the blood flow to cancer cells in the liver.

Systemic Treatments

Systemic treatments are treatments that are performed with the use of drugs that can reach cancer cells anywhere in the body. There are three different types that are most often used by patients with colorectal cancer including chemotherapy, targeted therapy, and immunotherapy drugs.

When choosing the best treatment option(s) for your colorectal cancer, it’s important to consult with your treatment team. By following through with a team approach for your colorectal cancer treatment plan, you will increase your chances of having a positive outcome.