Treatments

Most people who have colorectal cancer are treated with surgery. If the cancer hasn’t spread, surgery alone often cures the disease. Our surgeons have expertise in surgery for early, locally advanced, and recurrent colon and rectal cancers. We are often able to remove tumors encroaching onto other organs or those which have spread, particularly to the liver. Increasingly, we are now able to provide a cure to selected patients in this situation.

Depending on the location and stage of your cancer, your doctor may recommend chemotherapy (medication treatment), radiation therapy, or both either before or after surgery.

Surgery

Surgery is an operation to remove a tumor, surrounding tissue, and possibly lymph nodes. Our colorectal surgeons have the highest level of expertise in endoscopic and surgical procedures for colorectal cancer. Our experience with technological innovations such as robotic surgery and transanal endoscopic microsurgery (TEMS) allows for a minimally invasive approach in many circumstances, even locally advanced cancers, providing faster recovery times, better outcomes, and improved quality of life.

Our surgeons have a special expertise in techniques that avoid a permanent ostomy even for advanced, rare, and complex cancers related to the intestine, colon, and rectum.

Colonoscopy

During this screening, your doctor uses a flexible tube with a light and camera in it to examine your entire colon. If they find a polyp, they’ll remove it by inserting another instrument through the tube. Then, the polyp is sent to a pathologist to examine it for precancerous potential or (rarely) cancer. If a precancerous polyp is found, follow-up colonoscopies should be done sooner than every 10 years. If cancer is found and confined within the polyp, you may not need more treatment. But this should be reviewed with your doctor, and frequent follow-up colonoscopies are recommended.

Endoscopic/Endoluminal Resection

If cancer is confined within a polyp that can be completely removed through the colonoscope or by TEMS, no other therapy may be necessary. However, follow-up colonoscopies at one- to three-year intervals are advised.

Colectomy or Proctectomy

Most people who develop invasive colon cancer need surgical removal of part of their colon or rectum. This is called a colon resection or colectomy. During the operation, your surgeon often removes eight to 12 inches of your colon. Your colon is on average five feet long. Tumors can develop anywhere along its length, so the segment your surgeon removes will be specific to you.

They also remove a membrane that connects your intestine to your abdomen, called adjoining mesentery, plus blood vessels and lymph nodes. They remove these tissues because colon cancers can spread to them.

After the surgery, the two remaining ends of the bowel are joined together to reconnect the intestine. This reconnection is called an anastomosis.

Your surgeon can perform this procedure laparoscopically using small incisions and special miniature instruments. They can also do it via open surgery called laparotomy.

Because the colon is on average five feet long and because tumors can develop anywhere along its length, the segment to be removed will vary from patient to patient. Our experience with complex and reoperative abdominal and pelvic surgery also facilitates the surgical management of recurrent and locally advanced cancer as well as salvage operations in challenging situations.

The only tumor location that might prohibit anastomosis is the very distal rectum, within a finger's reach of the anus. Patients with tumors in this uncommon location have a number of treatment options available, which include surgery, chemotherapy, and radiation therapy. Our surgical team is specialized in complex procedures such as intersphincteric proctectomy, colonic J pouch, and coloplasty, which often allow preservation of the sphincter and minimize the need for a permanent ostomy even in difficult situations.

Laparoscopic Surgery

Laparoscopic surgery is the standard of care for most colorectal procedures. Our surgeons at New York-Presbyterian/Columbia University Irving Medical Center use these techniques for 90% of colon surgeries. Laparoscopic surgery uses small incisions and miniature tools, including a camera that allows your surgeon to visualize the area to be removed. This surgery usually results in less pain after surgery (and less pain medication), faster healing for a quicker return home, and less noticeable scars than open abdominal surgery.

Our surgeons have earned international and national recognition for their expertise in minimally invasive and laparoscopic surgery and routinely train other surgeons across the country. Our overall surgical outcomes are better than national averages.

During laparoscopic surgery, the surgeon utilizes a small incision through which a "port" is placed to inflate the abdominal cavity with gas. A camera is then introduced through the port to help visualize the inside of the abdominal cavity on a television monitor. Surgery is performed with instruments through additional ports placed via small incisions in the abdominal wall.

After the surgery, the two remaining ends of the bowel are joined together to reconnect the intestine. This reconnection is called an anastomosis.

Robotic Surgery

Our surgeons are also experts in robotic colorectal surgery, a new technology which is currently unavailable in most surgical centers. Robotic surgical technology helps your surgeon identify and preserve nerves in your pelvis that control sexual and bladder function.

During robotic surgery, your surgeon uses a high-definition computer screen and controls that manipulate the surgical instruments. The instruments and a tiny camera are inserted into your abdomen through two to four small incisions in your abdomen. Your surgeon controls the robotic arms and instruments from across the room, using an excellent magnified view to carefully perform each step of the operation.

Advanced and Recurrent Cancer

Colon or rectal cancer that invades other adjacent structures (locally advanced cancer) or comes back (recurrent cancer) but has not spread in many distant sites may be curable provided the tumor can be removed with clear margins (“clearance”). Removal of such locally advanced or recurrent cancer poses special challenges and needs specific expertise.

When advanced or recurrent tumors are surgically resected, your surgeon may need to remove a portion or all of the adjacent involved organ to achieve clearance. This is a difficult surgery, and your surgeon will work to both minimize damage to other organs and preserve the function of other nearby organs.

Even in some such instances a permanent ostomy (stoma) may be avoidable. In some cases with extensive cancers, our surgeons work collaboratively with radiation oncologists to administer radiation, called intraoperative radiation therapy (IORT), or chemotherapy (intraperitoneal chemotherapy) at the time of surgery. These techniques help precisely target the radiation or chemotherapy directly to the specific area(s) of the cancer in the abdomen and pelvis and allow us to maximize the dose of the therapy while minimizing collateral damage to other areas. Columbia Cancer surgeons and oncologists have extensive experience with these techniques that are available at few other centers.

Colorectal Cancer with Distant Spread

When colorectal cancer spreads to distant locations in the body, those areas are called metastases. In several instances, even colorectal cancer with distant spread can be managed with surgery combined with other therapies. Our colorectal surgeons work closely with world-class hepatic surgeons for liver metastases and thoracic surgeons for lung metastases who are able to remove the tumors in these sites in addition to the primary tumor in the colon and rectum. You will have a multidisciplinary team of surgeons, radiation oncologists, and medical oncologists, working together to determine the best option and course of treatment personalized for you.

Stomas

You might have heard the term colostomy or ileostomy—also known as a stoma. A stoma is an artificial opening your surgeon creates in your abdominal wall that allows you to eliminate stool after your operation if it interrupts passage to your anus.

The stoma may be temporary to give your colon a chance to heal. In 10–15% of cases, the stoma is permanent, particularly when the lower part of the rectum is removed. Your surgeon should be able to tell you if you’ll need a stoma before your surgery.

If you need a stoma, you’ll receive care from specially trained nurses called enterostomal therapists. They teach you about stoma care, skin care, and appliance management. They can also introduce you to other people with stomas—stomates—so you can learn from them and get support.

Learn More About Colorectal Surgery

Medication

Chemotherapy

Chemotherapy is the most commonly known cancer treatment. Chemotherapy uses medications (chemicals) to stop cancer growth and spread and to prevent cancer from recurring by causing rapidly dividing cancer cells to become damaged and die.

Chemotherapy is “systemic” medicine—it interferes with all fast-dividing cells in your body. This is why it causes side effects like hair loss.

Chemotherapy is often given through an IV in our infusion center, but it can sometimes be given with pills.

You may have chemotherapy before surgery (neoadjuvant) to shrink the tumor so it can be removed with less extensive surgery. Or, you may have chemotherapy after surgery (adjuvant) to address cancer cells that might have been left behind or may have spread, but cannot be detected, even on imaging tests.

Chemotherapy can be used to treat colorectal cancers that have spread to your liver or your lungs.

Chemotherapy drugs are usually given in cycles, with each period of treatment followed by a period of rest, allowing the body time to recover. These drugs are often used in combination to treat colorectal cancer:

  • 5-Fluorouracil (5-FU), often given with the vitamin folinic acid
  • Capecitabine (Xeloda®), in pill form
  • Irinotecan (Camptosar®)
  • Oxaliplatin (Eloxatin®)

Immunotherapy

Immunotherapy uses the power of your own immune system to fight cancer. A type of immunotherapy called checkpoint inhibitors work by ‘taking the brake off’ of the immune system, allowing your immune system to recognize and attack the cancer cells. Checkpoint inhibitors can be used for people whose colorectal cancer is a specific type called microsatellite high metastatic disease. We test the microsatellite status on all patients, allowing us to find the best therapies available to you. We also offer a wide range of clinical trials, many of which include new immunotherapies, often only available at academic medical centers like ours.

Targeted Therapies

Targeted therapies focus on the gene and protein changes in cells that cause cancer. They work differently from standard chemotherapy drugs because they aim specifically at genes and proteins involved in cancer instead of all fast-dividing cells. Like chemotherapy, these drugs reach almost all areas of the body through the bloodstream, making them useful against cancers that have spread to other parts of the body. Your doctor may recommend this type of therapy based on your specific type of colorectal cancer.

Radiation Therapy

Radiation therapy causes cancer cells to break or die by targeting the DNA with high-energy particles, such as X-rays, gamma rays, electron beams, or protons. Radiation oncology specialists direct these particles to the tumor site from outside of your body to precisely target cancer cells, often sparing nearby tissue. You might hear this called external beam radiation therapy.

Not all people with colorectal cancer need radiation treatments. Your personal care team will determine if radiation therapy is right for you. If they recommend it for you, your radiation oncologist will create a course of treatment. You might have outpatient treatments daily Monday through Friday for one week, five weeks, or even during your surgery. You don’t see or smell radiation; it is just like getting an X-ray, but a typical outpatient treatment may last a few minutes because it is specialized to your unique tumor.

If radiation treatment is recommended, a radiation oncologist will work with our radiation oncology team to create an optimal course of treatment specifically for you. At Columbia University Irving Medical Center, treatment modalities available and most commonly used for this cancer are external beam radiation therapy, 3D conformal radiotherapy, and intensity modulated radiation therapy (IMRT).

Our radiation therapists also work with our colorectal surgeons to deliver intraoperative radiotherapy (IORT) if this is the best course of treatment for you. IORT is used during surgery on the area where the tumor was in order to kill any cancer cells that are left behind. It can reduce the chance of a recurrence, shorten the time of radiation therapy after surgery, and reduce the risk to healthy tissue compared to external radiation. If you have advanced or recurrent colorectal cancer, your care team may discuss this as an option for you.

Clinical Trials

You may qualify to participate in a clinical trial, which is a research study to learn more about promising new treatments or supportive care therapies. The hope is to improve the quality of life and survivorship of colorectal cancer patients. Columbia Cancer offers dozens of colorectal cancer clinical trials. You can talk to your care team about whether a clinical trial is an option for you.

Learn More About Cinical Trials