Colorectal cancer medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [4] Associate Editor(s)-in-Chief: Saarah T. Alkhairy, M.D.; Elliot B. Tapper, M.D.
Overview
Chemotherapy is used to reduce the likelihood of metastasis developing, shrink tumor size, and slow tumor growth. Chemotherapy is often applied after surgery (adjuvant), before surgery (neo-adjuvant), or as primary therapy if surgery is not indicated (palliative). Other therapies include radiation and support therapies.
Medical Therapy
The following table indicates which treatment should be performed for each stage of colorectal carcinoma.[1][2][3][4][5]
| Stage | Treatment |
| 0 (Carcinoma in situ) | Local excision or simple polypectomy; resection and anastomosis when the tumor is too large to remove by local excision |
| 1 | Resection and anastomosis |
| 2 | Resection and anastomosis which may be followed by chemotherapy |
| 3 | Resection and anastomosis which may be followed by chemotherapy; clinical trials of new chemotherapy regimens after surgery |
| 4 (and recurrent colon cancer) | Local excision for tumors that have recurred; resection with or without anastomosis; surgery to remove parts of other organs where the cancer may have recurred or spread (chemotherapy can be given to shrink the tumor, radiofrequency ablation or cryosurgery for patients who can not have surgery, chemoembolization of the hepatic artery); radiation therapy or chemotherapy may be offered as palliative therapy, chemotherapy and/or targeted therapy with a monoclonal antibody or an angiogenesis inhibitor; clinical trials of chemotherapy and/or targeted therapy |
Chemotherapy
Chemotherapy is used to reduce the likelihood of metastasis developing, shrink tumor size, and slow tumor growth. Chemotherapy is often applied after surgery (adjuvant), before surgery (neo-adjuvant), or as the primary therapy if surgery is not indicated (palliative). The treatments listed here have been shown in clinical trials to improve survival and/or reduce mortality rate and have been approved for use by the US Food and Drug Administration.
Stage 2
The main options for adjuvant chemotherapy for this stage include 5-FU and leucovorin (alone) OR capecitabine, but other combinations may also be used
Stage 3
The main options for adjuvant chemotherapy for this stage are (5-FU, leucovorin and oxaliplatin) OR (capecitabine and oxaliplatin) are used most often, but some patients may receive 5-FU and leucovorin OR capecitabine alone based on their age and health needs
Stage 4
Most patients with stage IV cancer will get chemotherapy. The most commonly used regimens include the following[6]:
- Leucovorin, 5-FU, and oxaliplatin
- Leucovorin, 5-FU, and irinotecan
- Capecitabine and oxaliplatin
- Any of the above combinations plus either bevacizumab or cetuximab (but not both)
- 5-FU and leucovorin, with or without bevacizumab
- Capecitabine, with or without bevacizumab
- Leucovorin, 5-FU, oxaliplatin, and irinotecan
- Irinotecan, with or without cetuximab
- Cetuximab alone
- Panitumumab alone
- Regorafenib alone
Targeted therapy
VEGF targeted drugs These drugs are given by IV infusion every 2 or 3 weeks. Side effects include high blood pressure, fatigue, bleeding, leukopenia, headaches, mouth sores, loss of appetite, and diarrhea
EGFR targeted drugs These drugs are given by IV infusion either once a week or every other week. Side effects include an acne-like rash on the face and chest during treatment, headaches, fatigue, fever, and diarrhea
- Cetuximab is used as first-line treatment (it is used either with irinotecan or by itself)
- Panitumumab is used after other treatments have been tried
Other target drugs This drug is given in pill form. Side effects include fatigue, decreased appetite, hand-foot syndrome, diarrhea, sores in the mouth and throat, weight loss, voice change, infections, and high blood pressure. Some serious side effects that can occur include liver damage, severe bleeding, and perforations in the stomach or intestines.
- Regorafenib - a kinase inhibitor
In clinical trials for treated/untreated metastatic disease[7]
Radiation therapy
Radiotherapy is not used routinely in colon cancer since it could lead to radiation enteritis. It is also difficult to target specific portions of the colon. It is more commonly performed in rectal cancer since the rectum does not move as much as the colon and is easier to target.
Indications include:
- Pain relief and palliation
- Targeted at metastatic tumor deposits if they compress vital structures and/or cause pain
- Neoadjuvant - given before surgery in patients with tumors that extend outside the rectum or have spread to regional lymph nodes in order to decrease the risk of recurrence following surgery or to allow for less invasive surgical approaches
- Adjuvant - where a tumor perforates the rectum or involves regional lymph nodes (AJCC T3 or T4 tumors or Duke's B or C tumors)
- Palliative - to decrease the tumor burden in order to relieve or prevent symptoms
Sometimes chemotherapy agents are used to increase the effectiveness of radiation by sensitizing tumor cells if present.
Support therapies
Cancer diagnosis very often results in an enormous change in the patient's psychological well-being. Various support resources are available from hospitals and other agencies which provide counseling, social service support, cancer support groups, and other services. These services help to mitigate some of the difficulties of integrating a patient's medical complications into other parts of their life.
References
- ↑ [1]
- ↑ Yasmine Samir Galal, Tarek Tawfik Amin, Abdulelah Khalid Alarfaj, Abdulaziz Abdullah Almulhim, Abdullah Abdulmohsen Aljughaiman, Abdulrhaman Khaled Almulla & Rehab Ahmed Abdelhai (2016). "Colon Cancer among Older Saudis: Awareness of Risk Factors and Early Signs, and Perceived Barriers to Screening". Asian Pacific journal of cancer prevention : APJCP. 17 (4): 1837–1846. PMID 27221862.
- ↑ Samir Pathak, Sanjay Pandanaboyana, Ian Daniels, Neil Smart & K. R. Prasad (2016). "Obesity and colorectal liver metastases: Mechanisms and management". Surgical oncology. 25 (3): 246–251. doi:10.1016/j.suronc.2016.05.021. PMID 27566030. Unknown parameter
|month=ignored (help) - ↑ Masato Watanabe, Masanori Tada, Takafumi Satomi, Daichi Chikazu, Masashi Mizumoto & Hideyuki Sakurai (2016). "Metastatic rectal adenocarcinoma in the mandibular gingiva: a case report". World journal of surgical oncology. 14 (1): 199. doi:10.1186/s12957-016-0958-6. PMID 27473859. Unknown parameter
|month=ignored (help) - ↑ Vivek Subbiah & Howard Jack West (2016). "Jaundice (Hyperbilirubinemia) in Cancer". JAMA oncology. 2 (8): 1103. doi:10.1001/jamaoncol.2016.1236. PMID 27416009. Unknown parameter
|month=ignored (help) - ↑ [2]
- ↑ [3]