Many people with colorectal cancer want to take an active part in making decisions about their medical care. It is natural to want to learn all you can about your disease and treatment choices. However, shock and stress after the diagnosis can make it hard to think of everything you want to ask your doctor. It often helps to make a list of questions before an appointment.

 

To help remember what your doctor says, you may take notes or ask whether you may use a tape recorder. You may also want to have a family member or friend with you when you talk to your doctor – to take part in the discussion, to take notes, or just to listen. You do not need to ask all your questions at once. You will have other chances to ask your doctor or nurse to explain things that are not clear and to ask for more details.

 

Your doctor may refer you to a specialist who has experience treating colorectal cancer, or you may ask for a referral. Specialists who treat colorectal cancer include gastroenterologists (doctors who specialize in diseases of the digestive system), surgeons, medical oncologists, and radiation oncologists. You may have a team of doctors.

 

Methods of treatment

The choice of treatment depends mainly on the location of the tumor in the colon or rectum and the stage of the disease. Treatment for colorectal cancer may involve surgery, chemotherapy, biological therapy or radiation therapy. Some people have a combination of treatments. These treatments are described below.

 

Colon cancer sometimes is treated differently from rectal cancer. Treatments for colon and rectal cancer are described separately below.

 

Your doctor can describe your treatment choices and the expected results. You and your doctor can work together to develop a treatment plan that meets your needs.

 

Cancer treatment is either local therapy or systemic therapy:

 

Local therapy. Surgery and radiation therapy are local therapies. They remove or destroy cancer in or near the colon or rectum. When colorectal cancer has spread to other parts of the body, local therapy may be used to control the disease in those specific areas.

Systemic therapy. Chemotherapy and biological therapy are systemic therapies. The drugs enter the bloodstream and destroy or control cancer throughout the body.

 

Because cancer treatments often damage healthy cells and tissues, side effects are common. Side effects depend mainly on the type and extent of the treatment. Side effects may not be the same for each person, and they may change from one treatment session to the next. Before treatment starts, your health care team will explain possible side effects and suggest ways to help you manage them.

 

At any stage of disease, supportive care is available to relieve the side effects of treatment, to control pain and other symptoms, and to ease emotional concerns.

 

You may want to talk to your doctor about taking part in a clinical trial, a research study of new treatment methods. "The Promise of Cancer Research" has more information about clinical trials.

 

You may want to ask your doctor these questions before treatment begins:

      - What is the stage of the disease? Has the cancer spread?
      - What are my treatment choices? Which do you suggest for me? Will I have more than one kind of treatment?
      - What are the expected benefits of each kind of treatment?

What are the risks and possible side effects of each treatment? How can the side effects be managed?
      - What can I do to prepare for treatment?
      - How will treatment affect my normal activities? Am I likely to have urinary problems? What about bowel problems, such as diarrhea or rectal bleeding? Will treatment affect my sex life?
      - What will the treatment cost? Is this treatment covered by my insurance plan?

 

Surgery

Surgery is the most common treatment for colorectal cancer.

 

Colonoscopy. A small malignant polyp may be removed from your colon or upper rectum with a colonoscope. Some small tumors in the lower rectum can be removed through your anus without a colonoscope.

Laparoscopy. Early colon cancer may be removed with the aid of a thin, lighted tube (laparoscope). Three or four tiny cuts are made into your abdomen. The surgeon sees inside your abdomen with the laparoscope. The tumor and part of the healthy colon are removed. Nearby lymph nodes also may be removed. The surgeon checks the rest of your intestine and your liver to see if the cancer has spread.

Open surgery. The surgeon makes a large cut into your abdomen to remove the tumor and part of the healthy colon or rectum. Some nearby lymph nodes are also removed. The surgeon checks the rest of your intestine and your liver to see if the cancer has spread.

 

When a section of your colon or rectum is removed, the surgeon can usually reconnect the healthy parts. However, sometimes reconnection is not possible. In this case, the surgeon creates a new path for waste to leave your body. The surgeon makes an opening (stoma) in the wall of the abdomen, connects the upper end of the intestine to the stoma, and closes the other end. The operation to create the stoma is called a colostomy. A flat bag fits over the stoma to collect waste, and a special adhesive holds it in place.

 

For most people, the stoma is temporary. It is needed only until the colon or rectum heals from surgery. After healing takes place, the surgeon reconnects the parts of the intestine and closes the stoma. Some people, especially those with a tumor in the lower rectum, need a permanent stoma.

 

People who have a colostomy may have irritation of the skin around the stoma. Your doctor, your nurse, or an enterostomal therapist can teach you how to clean the area and prevent irritation and infection. The "Rehabilitation" section has more information about how people learn to care for a stoma.

 

The time it takes to heal after surgery is different for each person. You may be uncomfortable for the first few days. Medicine can help control your pain. Before surgery, you should discuss the plan for pain relief with your doctor or nurse. After surgery, your doctor can adjust the plan if you need more pain relief.

 

It is common to feel tired or weak for a while. Also, surgery sometimes causes constipation or diarrhea. Your health care team monitors you for signs of bleeding, infection, or other problems requiring immediate treatment.

 

You may want to ask your doctor these questions before having surgery:

 

What kind of operation do you recommend for me?

Do I need any lymph nodes removed? Will other tissues be removed? Why?

What are the risks of surgery? Will I have any lasting side effects?

Will I need a colostomy? If so, will the stoma be permanent?

How will I feel after the operation?

If I have pain, how will it be controlled?

How long will I be in the hospital?

When can I get back to my normal activities?

 

Chemotherapy

Chemotherapy uses anticancer drugs to kill cancer cells. The drugs enter the bloodstream and can affect cancer cells all over the body.

 

Anticancer drugs are usually given through a vein, but some may be given by mouth. You may be treated in an outpatient part of the hospital, at the doctor's office, or at home. Rarely, a hospital stay may be needed.

 

The side effects of chemotherapy depend mainly on the specific drugs and the dose. The drugs can harm normal cells that divide rapidly:

 

Blood cells. These cells fight infection, help blood to clot, and carry oxygen to all parts of your body. When drugs affect your blood cells, you are more likely to get infections, bruise or bleed easily, and feel very weak and tired.

Cells in hair roots. Chemotherapy can cause hair loss. Your hair will grow back, but it may be somewhat different in color and texture.

Cells that line the digestive tract. Chemotherapy can cause poor appetite, nausea and vomiting, diarrhea, or mouth and lip sores.

 

Chemotherapy for colorectal cancer can cause the skin on the palms of the hands and bottoms of the feet to become red and painful. The skin may peel off.

 

Your health care team can suggest ways to control many of these side effects. Most side effects usually go away after treatment ends.

 

Biological therapy

Some people with colorectal cancer that has spread receive a monoclonal antibody, a type of biological therapy. The monoclonal antibodies bind to colorectal cancer cells. They interfere with cancer cell growth and the spread of cancer. People receive monoclonal antibodies through a vein at the doctor's office, hospital, or clinic. Some people receive chemotherapy at the same time.

 

During treatment, your health care team will watch for signs of problems. Some people get medicine to prevent a possible allergic reaction. The side effects depend mainly on the monoclonal antibody used. Side effects may include rash, fever, abdominal pain, vomiting, diarrhea, blood pressure changes, bleeding, or breathing problems. Side effects usually become milder after the first treatment.

 

You may want to ask your doctor these questions before having chemotherapy or biological therapy:

 

What drugs will I have? What will they do?

When will treatment start? When will it end? How often will I have treatments?

Where will I go for treatment? Will I be able to drive home afterward?

What can I do to take care of myself during treatment?

How will we know the treatment is working?

Which side effects should I tell you about?

Will there be long-term effects?

 

Radiation therapy

Radiation therapy (also called radiotherapy) uses high-energy rays to kill cancer cells. It affects cancer cells only in the treated area. Since this type of treatment has become more popular, radiation therapy schools in PA and around the world are now more prevalent.

 

Doctors use different types of radiation therapy to treat cancer. Sometimes people receive two types:

 

External radiation. The radiation comes from a machine. The most common type of machine used for radiation therapy is called a linear accelerator. Most patients go to the hospital or clinic for their treatment, generally 5 days a week for several weeks.

Internal radiation (implant radiation or brachytherapy). The radiation comes from radioactive material placed in thin tubes put directly into or near the tumor. The patient stays in the hospital, and the implants generally remain in place for several days. Usually they are removed before the patient goes home.

Intraoperative radiation therapy (IORT). In some cases, radiation is given during surgery.

 

Side effects depend mainly on the amount of radiation given and the part of your body that is treated. Radiation therapy to your abdomen and pelvis may cause nausea, vomiting, diarrhea, bloody stools, or urgent bowel movements. It also may cause urinary problems, such as being unable to stop the flow of urine from the bladder. In addition, your skin in the treated area may become red, dry, and tender. The skin near the anus is especially sensitive.

 

You are likely to become very tired during radiation therapy, especially in the later weeks of treatment. Resting is important, but doctors usually advse patients to try to stay as active as they can.

 

Although the side effects of radiation therapy can be distressing, your doctor can usually treat or control them. Also, side effects usually go away after treatment ends.

 

You may want to ask your doctor these questions about radiation therapy:

 

Why do I need this treatment?

When will the treatments begin? When will they end?

How will I feel during treatment?

How will we know if the radiation treatment is working?

What can I do to take care of myself during treatment?

Can I continue my normal activities?

Are there any lasting effects?

 

Treatment for colon cancer

Most patients with colon cancer are treated with surgery. Some people have both surgery and chemotherapy. Some with advanced disease get biological therapy.

 

A colostomy is seldom needed for people with colon cancer.

 

Although radiation therapy is rarely used to treat colon cancer, sometimes it is used to relieve pain and other symptoms.

 

Treatment for rectal cancer

For all stages of rectal cancer, surgery is the most common treatment. Some patients receive surgery, radiation therapy, and chemotherapy. Some with advanced disease get biological therapy.

 

About 1 out of 8 people with rectal cancer needs a permanent colostomy.

 

Radiation therapy may be used before and after surgery. Some people have radiation therapy before surgery to shrink the tumor, and some have it after surgery to kill cancer cells that may remain in the area. At some hospitals, patients may have radiation therapy during surgery. People also may have radiation therapy to relieve pain and other problems caused by the cancer.

 

Nutrition and physical activity

It is important to eat well and stay as active as you can.

 

You need the right amount of calories to maintain a good weight during and after cancer treatment. You also need enough protein, vitamins, and minerals. Eating well may help you feel better and have more energy.

 

Eating well can be hard. Sometimes, especially during or soon after treatment, you may not feel like eating. You may be uncomfortable or tired. You may find that foods do not taste as good as they used to. You also may have nausea, vomiting, diarrhea, or mouth sores.

 

Your doctor, dietitian, or other health care provider can suggest ways to deal with these problems.

 

Many people find they feel better when they stay active. Walking, yoga, swimming, and other activities can keep you strong and increase your energy. Whatever physical activity you choose, be sure to talk to your doctor before you start. Also, if your activity causes you pain or other problems, be sure to let your doctor or nurse know about it.

 

Rehabilitation

Rehabilitation is an important part of cancer care. Your health care team makes every effort to help you return to normal activities as soon as possible.

 

If you have a stoma, you need to learn to care for it. Doctors, nurses, and enterostomal therapists can help. Often, enterostomal therapists visit you before surgery to discuss what to expect. They teach you how to care for the stoma after surgery. They talk about lifestyle issues, including emotional, physical, and sexual concerns. Often they can provide information about resources and support groups.

 

Follow-up care

Follow-up care after treatment for colorectal cancer is important. Even when the cancer seems to have been completely removed or destroyed, the disease sometimes returns because undetected cancer cells remained somewhere in the body after treatment. Your doctor monitors your recovery and checks for recurrence of the cancer. Checkups help ensure that any changes in health are noted and treated if needed.

 

Checkups may include a physical exam (including a digital rectal exam), lab tests (including fecal occult blood test and CEA test), colonoscopy, X-rays, CT scans, or other tests.

 

If you have any health problems between checkups, you should contact your doctor.

 

Complimentary medicine

It is natural to want to help yourself feel better. Some people with cancer say that complementary medicine helps them feel better. An approach is called complementary medicine when it is used along with standard treatment. Acupuncture, massage therapy, herbal products, vitamins or special diets, and meditation are examples of such approaches.

 

Talk with your doctor if you are thinking about trying anything new. Things that seem safe, such as certain herbal teas, may change the way standard treatment works. These changes could be harmful. And some approaches could be harmful even if used alone.

 

You may want to ask your doctor these questions before you decide to try complementary medicine:

 

What benefits can I expect from this approach?

What are its risks?

Do the expected benefits outweigh the risks?

What side effects should I watch for?

Will this approach change the way my cancer treatment works? Could this be harmful?

Is this approach under study in a clinical trial?

How much will it cost? Will my health insurance pay for this approach?

Can you refer me to a complementary medicine practitioner?

 

Sources of support

Living with a serious disease such as colorectal cancer is not easy. You may worry about caring for your family, keeping your job, or continuing daily activities. Concerns about treatments and managing side effects, hospital stays, and medical bills are also common. Doctors, nurses, and other members of your health care team can answer questions about treatment, working, or other activities. Meeting with a social worker, counselor, or member of the clergy also can be helpful if you want to talk about your feelings or concerns. Often, a social worker can suggest resources for financial aid, transportation, home care, or emotional support.

 

Support groups also can help. In these groups, patients or their family members meet with other patients or their families to share what they have learned about coping with the disease and the effects of treatment. Groups may offer support in person, over the telephone, or on the Internet. You may want to talk with a member of your health care team about finding a support group.

 

The promise of research

Doctors all over the country are conducting many types of clinical trials (research studies in which people volunteer to take part). Doctors are studying new ways to prevent, detect, and treat colorectal cancer.

 

Clinical trials are designed to answer important questions and to find out whether the new approach is safe and effective. Research already has led to advances, and researchers continue to search for more effective approaches.

 

People who join clinical trials may be among the first to benefit if a new approach is shown to be effective. And if participants do not benefit directly, they may still make an important contribution to medicine by helping doctors learn more about the disease and how to control it. Although clinical trials may pose some risks, researchers do all they can to protect their patients.

 

If you are interested in being part of a clinical trial, talk with your doctor.

 

Research on prevention

Research is being done to test whether certain dietary supplements or drugs may help prevent colorectal cancer. For example, researchers across the country are studying vitamin D and calcium supplements, selenium supplements, and the drug celecoxib, in people with polyps.

 

Research on screening and diagnosis

Scientists are testing new ways to check for polyps and colorectal cancer. NCI-supported researchers are studying virtual colonoscopy. This is a CT scan of the colon. It makes X-ray pictures of the inside of the colon.

 

Research on treatment

Researchers are studying chemotherapy and biological therapy. They are studying new drugs, new combinations, and different doses. In addition, researchers are looking at ways to lessen the side effects of treatment.