Colorectal cancer is treatable if it is detected early.(iStock)
Colorectal cancer is treatable if it is detected early.(iStock)

Diagnosed with colorectal cancer? An expert is here to guide you

Your overall health and the stage of your colorectal cancer will help your doctor create a treatment plan.
By By Dr. Venkata Pradeep Babu Koyyala
UPDATED ON MAR 26, 2020 08:57 AM IST

Being diagnosed with colorectal cancer can be frightening, but the fact is that it is treatable if detected early. Even in certain stage 4 colon cancers with liver limited spread, both organs can be treated with curative intent.

Dr. Venkata Pradeep Babu Koyyala
Dr. Venkata Pradeep Babu Koyyala

The treatment measures have also come a long way for more advanced cases of colon cancer. According to the SEER database, the average survival rate for stage 4 colon cancer is around 30 months. This is up from the average during the ‘90s, which was 6 to 8 months.

What are the treatment options for colorectal cancer?

The treatment depends on a variety of factors. Your overall health and the stage of your colorectal cancer will help your doctor create a treatment plan.

Surgery

In the earliest stages of colorectal cancer, it might be possible for your surgeon to remove cancerous polyps through surgery. If the polyp hasn’t attached to the wall of the bowels, you are likely to have an excellent outlook.

If your cancer has spread into your bowel walls, your surgeon may need to remove a portion of the colon or rectum, along with any neighbouring lymph nodes. If possible, your surgeon will reattach the remaining healthy portion of the colon to the rectum.

If this isn’t possible, they may perform a colostomy. This involves creating an opening in the abdominal wall for the removal of waste. A colostomy may be temporary or permanent.

Chemotherapy

Chemotherapy involves the use of drugs to kill cancer cells. In the case of colorectal cancer, chemotherapy is a common treatment after surgery to destroy any remaining cancerous cells. Chemotherapy also controls the growth of tumours.

While chemotherapy provides some symptom relief in late-stage cancer, it often comes with side effects that need to be controlled with additional medication.

Radiation

Radiation uses a powerful beam of energy, like the one used in X-rays, to target and destroy cancerous cells. Radiotherapy plays a more integral role in rectal than colon cancer.

Targeted therapy

There are various targeted therapies that can be used along with chemotherapy backbone, particularly in advanced stage colon cancer. Some of the targeted therapies used are cetuximab, panitumumab, Bevacuzimab, and Regorafenib.

Immunotherapy

It has a novel mechanism of stimulating intrinsic cellular immunity against tumor cells. Drugs like Nivolumab and Pembrolizumab are approved in advanced colon cancer if a certain genetic test (MSI) on biopsy is positive.

What is immunotherapy?

All of us are susceptible to cancer. At the same time, we have inherent anti-cancer mechanisms such as tumour surveillance by T-cells, which takes care of cells transforming to cancer. However, cancer cells have several mechanisms to escape this surveillance and manifest as tumours. Immunotherapy is a broad term covering various therapies which activate the immune system against the tumour, either by boosting the already existing anti-tumor immune mechanisms or by counteracting the inhibitory mechanisms.

Are more and more people embracing immunotherapy or they are hesitant in going against the conventional chemotherapy?

Although there is lot of enthusiasm about embracing immunotherapy over chemotherapy, these therapies in many clinical settings are not competitive but complimentary options. Immunotherapy, for now, has approvals in advanced stages of cancers, and chemotherapy still has an important role in early as well as advanced cancers.

Is there a distinction between the treatments offered in India and those in abroad?

Now that almost all targeted therapies and immunotherapies are available in India, and all medical oncologists follow international guidelines in the selection of therapies and administration of such therapies, there is no distinction between abroad and India concerning to colon cancer treatment. However, there may be clinical trials with newer therapies which may be promising, but still not available in market. There are many oncology institutions in India, where clinical trials are available. The information can be obtained here: www.ctc.gov.in.

Know more about colorectal cancer here.

This article has been written by Dr. Venkata Pradeep Babu Koyyala, MD (Gen.Med) DNB (Medical Oncology) Consultant, Medical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi.

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