What Are the Treatment Options After a Colon Cancer Diagnosis?

“It’s cancer” is perhaps the most terrifying two-word phrase in the English language.

While it’s easy to start fearing the worst, Dr. Daniel Fish, a colorectal surgeon at Baystate General Surgery, encourages patients to not panic.

Speaking specifically of colorectal cancer, he says, “Almost all types are treatable, most are curable, and even in the case of those that can’t be cured, a lot of patients live successfully with it for many years.”

What happens when you’re diagnosed with colon cancer

Dr. Ziad Kutayli, also a colorectal surgeon at Baystate General Surgery, has a very specific approach to dealing with colon cancer. “The phrase I like to use is ‘Plan your work, then work your plan.’”

For Dr. Kutayli, planning his work begins with going on a fact-finding mission about each patient’s situation.

“We want to learn everything we can about a patient’s cancer and other health factors before we create a plan. The first step is what’s called staging. This involves looking at how the cancer is behaving, whether it has spread, and if it has, how far it has spread. This insight helps us determine the best treatment.”

Understanding the stages of cancer

As Dr. Fish explains, colon cancer always starts in the inner lining of the colon. “As it grows,, it can move into the wall of the colon. Once it’s through the wall of the colon it spreads into the surrounding lymph nodes. When a cancer moves beyond lymph nodes and into other organs, it’s said to have metastasized. Metastasized colon cancer most often spreads into the liver or lungs and, less frequently, the abdominal cavity, lymph nodes elsewhere in the body, the brain, or bones. The spread of the cancer is then defined by using what’s called TNM Staging.”

TNM staging uses those three letters, which stand for tumor, node and metastasis. The TMN system is used to define stages 0-4, which describe how far the cancer has progressed. Here’s what the different stages indicate:

• Stage 0: a cancer or Tumor that is non-invasive and contained within the colon
• Stage 1: a minimally invasive cancer or Tumor that has penetrated the colon wall
• Stage 2: an invasive cancer that has grown outside the colon but not spread to lymph Nodes
• Stage 3: an invasive cancer that has spread to the lymph Nodes
• Stage 4: an invasive cancer that has Metastasized, or spread to other organs

Dr. Kutayli notes that a patient’s staging is key to “planning the work,” or treatment that lies ahead (see Treatment Options for Colon Cancer below). “Thanks to major advances in staging and treatment, survival rates for colon cancer—especially early cancers but even Stage 4—are increasing.”

How is colon cancer staged?

There are several tests that can help determine a cancer’s stage. These include:

• CAT scan
• Rectal MRI
• Genetic testing
• A CEA (carcinoembryonic antigen) blood test

Dr. Fish notes, “A CAT scan is really the best option for determining if a cancer has spread to other organs, its precise location, and its risk of invading other organs. While a CAT scan is non-invasive, it does require an IV and some blood work to ensure an injection that improves the scan is safe.”

For rectal cancers, the preferred test is a rectal MRI. “This offers more precise information on the location and the risk of any invasion of other pelvic organs or spread to lymph nodes,” says Dr. Fish, adding that a CAT scan is also performed to look for spread to other parts of the body.

For patients with certain risk factors, both Drs. Fish and Kutayli will perform genetic testing. Risk factors that might prompt a test include:

• A diagnosis of cancer in patients younger than 50
• A strong family history of colon cancer
• The appearance of two or more colon cancers at once
• A colonoscopy that shows more than 20 polyps
• A biopsy that reveals features associated with genetically inherited cancer

Another blood test, carcinoembryonic antigen (CEA), looks for a specific molecule in the blood made by cancer. This information can help your doctor plan and monitor your treatment, including indicating how well you are responding to treatment or if cancer has returned.

Treatment options for colon cancer

Treatments for colon and rectal cancer vary based upon the individual patient and the stage of cancer. Here’s how treatments are typically dictated by staging:

• Stage 0-1: Surgery alone
• Stages 2-3: Many potential options including surgery alone, surgery followed by chemotherapy, or a combination of chemotherapy, radiation therapy and surgery, depending on the specifics
• Stage 4: Chemotherapy, although sometimes surgery or radiation to control symptoms or for a cure if cancer responds well .

Dr. Kutayli notes that many patients are hesitant about colon surgery fearing their post-surgical life will be impacted or limited by a colostomy bag. He reminds them that, “The goal of surgery is to completely remove the tumor, affected lymph nodes and other organs it may have invaded. Whenever possible, we reconnect the healthy ends of the colon. In some circumstances, an ostomy, or what people refer to as a bag, may be needed—sometimes temporarily, sometimes permanently. It all depends on how much colon has to be removed to address the cancer issue. That said, ostomies have come a long way in recent years. People worry about odor or leakage. Neither of those should be concerns at all. In fact, some patients who were experiencing incontinence prior to surgery are happy to have the freedom to return to activities and social events they had given up prior to their ostomy."

Colon surgery options and recovery

The scope and invasiveness of colon surgery is determined by the cancer.

Dr. Fish says, “What we think of classic open surgery with a large incision is sometimes necessary for larger, more complicated tumors or when other medical issues, including previous surgeries, demand it.”

For most colon surgeries, the Baystate team uses minimally invasive surgery that allows for faster recovery and decreased risks. Baystate is home to a Da Vinci robotic surgical system which gives surgeons a 3D view into the body at 10X magnification and allows for the highest level of surgical precision.

“Most colon surgeries take 3-6 hours,” says Dr. Fish, “with patients staying in hospital for 3-7 days. Many are able to return to non-physical activities, including desk work, within 3-4 weeks of surgery. Within 2 months, they’re often fully recovered and can return to all activities.”

The most common post-surgical symptoms include:

• Weight loss
• Change to appetite
• Short-term diarrhea

Another surgical option for cancers diagnosed in the earliest stages is what’s called colonoscopic or transanal surgery. This is primarily used for early-stage rectal cancer located near the anus opening but has not spread to the anus or sphincter.

Side effects of colon cancer non-surgical treatments

In some cases, surgery for colon cancer is supplemented with chemotherapy and/or radiation therapy.

“Chemotherapy is given to prevent cancer cells from growing,” explains Dr. Fish. “While it can be very effective at knocking down cancer cells, it can impact other healthy cells and organs.”

He says the chemotherapy typically involves 3-week cycles of infusion followed by a period of rest for a total of 3-12 cycles depending upon the individual patient. Common side effects include:

• Nausea
• Diarrhea
• Fatigue
• Numbness
• Tingling
• Sores on fingers and toes

Radiation therapy is often prescribed for rectal cancer specifically, given prior to surgery. Treatments take 30-60 minutes and are typically given every weekday for 5-6 weeks. Side effects include:

• Pain
• Diarrhea
• Temporary fecal incontinence
• Sexual or urinary dysfunction

Life after colon cancer

Recurrence of colon cancer most often happens in the first two years after surgery. Given that, patients are encouraged to be vigilant for symptoms and get screened regularly.

Most post-colon cancer patients who undergo treatment will receive labs and CT scans quarterly. Additional screenings are then scheduled based on findings.

Dr. Kutayli adds, “If nothing is found after 5 years, the cancer is considered cured. However,” he cautions, “screenings are still encouraged.”

Colon cancer: a diagnosis, not a death sentence

One of the most common types of cancer is also one of the easiest to prevent and detect. At the Baystate Regional Cancer Program, we're dedicated to helping you find colorectal cancers early, and, if necessary, treating them with the most advanced options available to ensure your complete recovery.

To learn more, or to schedule a screening, contact the Baystate Regional Cancer Team.