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The treatment recommended  by your cancer physician, the oncologist, depends on which type of colorectal cancer you have, the spread of the disease and your own treatment preferences. In consultation with you, the oncologist will suggest a treatment which is based on proven scientific treatment concepts, so called  Standards of Clinical Practice (SOP). Should you require treatment from more than one medical specialisation, i.e. surgery, medical oncology, radiation oncology, your doctor will ask relevant clinical specialists to take part in this discussion. Based on the best treatment option, you will either be admitted to hospital or you will be offered treatment in the CIO Outpatients Department. To keep all treatment options transparent and clear to you, our medical staff and the Patient Navigators will gladly answer all your questions. 

In general, there are four different treatment options available for colorectal cancer that may be combined as required:

The Operation

The surgical procedure will be guided by the size and location of the tumor. The aim of surgery is to remove the entire tumor. For more detailed information on the surgical management of colorectal cancer, please select one of the following:   

• Colon cancer
• Rectal cancer

Colon Cancer

The operation will be explained by our clinical specialists during a consultation session. This session also provides an opportunity to clarify your personal concerns and fears.

During the operation the tumor and neighbouring parts of the colon and lymph nodes will be removed. This will ensure that all of the malignant cells that may have migrated from the primary tumor via the lymphatic system are removed. The pathologist examines the excised lymph nodes for any evidence of cancer. This is important for deciding whether chemotherapy is required after surgery, so called adjuvant chemotherapy.

As a rule, even where a large part of the colon has been removed as part of the operation, the remaining intestine can be sutured together. Hence, in most cases it is not necessary to create an artificial anus. However, if there is a danger of straining the fresh intestinal suture too much (rupture), a temporary artificial anus is made until the suture line has completely healed.

Rectal Cancer 

Tumors of the terminal part of the ‘colon’ before the anus, can be considered, under certain circumstances, to be ‘low risk carcinomas’ and are managed by what is termed ‘minimally invasive’ surgery. Minimally invasive means: the tumor is being removed by key-hole surgery (microsurgery) and not through a conventional abdominal incision. As there is no significant abdominal incision, there is only a small scar. 

If a colon tumor is not in the low risk group, e.g. because it has spread to other organs, minimal invasive surgery is not possible and access through an abdominal incision is necessary.  

The adjacent parts on both sides of a tumor of the colon, as well as associated lymph nodes are removed. To allow healing of the intestinal suture, an artificial anus (stoma) may be created. The stoma may be reversed by rejoining the intestinal ends in a seperate operation either after healing of the original surgery, or where appropriate, after  the completion of an additional chemo- or radiation therapy. 

If the tumor is located close to the anus, the question arises as to whether  an operation can retain the sphincter muscle. If the tumor is too close to the sphincter the danger of a subsequent faecal incontinence is too great, so that an artificial anus is created. The majority of patients with rectal cancer, however, do not require this procedure.

Radiation Therapy (ionising Irradiation)

The aim of radiation therapy is to destroy cancer cells by subjecting them to electromagnetic waves of energy administered externally. To allow healthy tissues to recover from the effects of radiation treatment is spread over several sessions with smaller dosis. Radiation therapy is usually administered in the outpatient setting and the actual exposure to radiation lasts only a few minutes.

Prior to a radiation therapy session, our experts will discuss with you in detail what treatment is necessary and which side effects you may experience. You have ample opportunity to raise and discuss any issues you may have with your medical oncologist and the radiation oncologist.

Chemotherapy

Chemotherapy is the treatment of a malignant disease with drugs which inhibit the  growth of fast developing cells. Cancer cells belong to this group of fast growing and proliferating cells.

In the treatment of colon or rectal cancer, a chemotherapy is administered after surgery when there is a risk that the cancer has already spread. Your oncologist calls this an ‘adjuvant chemotherapy’.  Chemotherapy administered before an operation aims to reduce the tumor size in order to remove the tumor successfully. This is called a 'neoadjuvant chemotherapy'. A chemotherapy is given over several treatment sessions which are called ‘cycles’.  Each cycle generally lasts 21-28 days and the initial therapy comprises typically 4-6 cycles. Each chemotherapy cycle is followed by a recovery phase.   

Chemotherapy agents (drugs) are usually administered into a vein by an infusion, so that the drugs are distributed throughout the body via the blood stream, which may lead to side effects. However, your attending physician will discuss with you possible side effects before starting chemotherapy, and will explain counter measures to ease any symptoms. If you would like to seek additional advice or comfort from colorectal cancer self-help groups or services offered by HausLebenswert, please contact our Patient Navigators for specific information.

Targeted Cancer Therapies with ‚Biologicals‘

Impressive progress in our understanding of the human genome has contributed to the development of a new class of cancer drugs. These target mechanism specific to cancer cells, hence they are called ‘Targeted Drugs’. 

The targeted cancer therapy with so called ‘Biologicals’ is a new approach in the treatment of malignant disease, and is based on the particular characteristics and properties of cancer cells which distinguish them from healthy cells. Scientists have discovered that cancer cells mainly show changes in their genetic material called ‘mutations’. Based on this knowledge, drugs are being developed which only target cancerous (mutated) cells and spare the healthy cells. Nonetheless, these new drugs also have side effects.  Depending on the particular changes found in your cancer, biologicals may be used. Your oncologist will inform you of the options associated with the treatment of biologicals and discuss the advantages and disadvantages of these treatment options.

More information on targeted cancer therapies can be found here. Targeted Cancer Therapy Colon