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Treatments for colon and rectal cancer are based on the stage of the cancer at time of diagnosis as well as your age, other medical conditions, and your attitude toward the available options. Your physician will recommend an individualized treatment plan that may include surgery, chemotherapy, or radiation therapy, or several of these options used in combination. The use of multiple treatments is known as combined modality therapy.

Treatment approaches are different for colon and rectal cancer and are described separately below:

Surgical Treatment for Colon Cancer

For patients with early-stage colon cancer, surgery alone may offer a complete cure. For more advanced colon cancer that is still "resectable" (conducive to surgical removal), postoperative chemotherapy may be administered.

John Muir Health offers the full complement of advanced surgical techniques, including the latest laparoscopic approaches, and techniques focused on preservation of bowel, bladder, and sexual function.

For early-stage colon cancer, the tumor can be removed using minimally invasive laparoscopic techniques. During the surgery - known as laparoscopic colectomy - the surgeon removes the cancerous tissue, along with small areas ("margins") of healthy tissue, and then connects the two ends of the remaining colon. After recovery, the bowel functions normally and there is usually no need for a permanent colostomy. (A colostomy is a procedure performed when the colon and rectum do not function normally. An opening called a stoma is created in the abdominal wall, through which stools are expelled from the body into an external bag.)

For patients with advanced cancer, a more extensive surgical procedure known as a hemicolectomy may be necessary. Several inches of the colon may be removed, along with adjacent lymph nodes. The two ends of the remaining colon are reconnected, and normal bowel function is usually restored. If the two ends cannot be reattached due to the length of colon removed, a colostomy may be necessary.

Chemotherapy for Colon Cancer

Chemotherapy - or the use of drugs that kill cancer - is sometimes employed after surgery for patients with more advanced cancer, or those at high risk of local recurrence. When chemotherapy is administered after surgery, it is known as adjuvant therapy.

Patients with metastatic colon cancer who cannot undergo surgery may receive chemotherapy as the primary treatment. The newest chemotherapy agents, including camptosar and oxaliplatin, are available at John Muir Health. Through its active research program, with regional and national affiliations, John Muir Health can also provide patients with access to investigational agents.

Radiation Therapy for Colon Cancer

Although surgery and chemotherapy are the most common treatments for colon cancer, radiation therapy is sometimes used to treat certain patients or in advanced cancers, may be used alone to help alleviate symptoms.

John Muir Health is one of northern California premier centers for radiation therapy, with a reputation for clinical excellence and cutting-edge technology. Our state-of-the-art equipment includes five linear accelerators and two dedicated CT scanners to ensure the most precise and effective radiation therapy available. The advanced radiation therapy capabilities at John Muir Health include:

• Three-Dimensional Conformal Treatment - This sophisticated form of external beam therapy uses a computerized treatment planning system that optimizes radiation therapy by pinpointing the location of the tumor with the highest level of precision possible. This capability is important in planning the most effective therapies for colorectal cancer. Special features on the linear accelerator called multi-leaf collimators enable the radiation beam to be "shaped" to closely conform to the contours of the tumor. This permits a higher dose of radiation to be administered directly to the colon, while diminishing the radiation dose to surrounding tissue, thereby increasing cancer-killing effectiveness while minimizing toxicity.
• Intensity-Modulated Radiation Therapy (IMRT) is a newly introduced enhancement of the technology used in three-dimensional conformal therapy. Specialized treatment planning software is used to development a precise plan that "modulates" or varies the radiation used in each treatment session. The highest possible doses of radiation can be applied directly to the colon, while lower doses are applied to areas adjacent to organs and critical structures that need to be protected.

Surgical Treatment for Rectal Cancer

We offer the full complement of advanced surgical techniques for rectal cancer, including the latest laparoscopic approaches and techniques focused on preservation of bowel, bladder, and sexual function. An important capability is the availability of novel sphincter-saving surgical techniques. The choice of surgical approach depends on how far the cancer is from the anus, and depth of penetration into the rectal wall. For early-stage rectal cancer, surgery alone may offer a complete cure. Minimally invasive techniques include removal of cancerous tissue through a lighted scope inserted through the anus into the rectum.

We offer an innovative, nerve-sparing surgical technique for rectal cancer known as mesorectal excision, which is designed to carefully remove all cancerous rectal tissue, without severing the nerves involved in sexual or urinary function. For more advanced cancer, patients may be given chemotherapy and radiation prior to surgery. Preoperative treatment -- which is known as neoadjuvant therapy -- has been shown to improve rectal cancer cure rates. Following surgery, some patients may undergo postoperative (or adjuvant) chemotherapy as well to help prevent cancer recurrence. In addition, we offer Enterostomal therapy, which is a surgical formation of an opening into the intestine through the abdominal wall.

Chemotherapy for Rectal Cancer

Chemotherapy - or the use of drugs that kill cancer - is sometimes used in combination with radiation therapy for patients with resectable rectal cancer. This combination therapy is administered before surgery. Following surgery, certain patients may also receive adjuvant chemotherapy (without radiation).

Patients with metastatic rectal cancer who cannot undergo surgery may receive chemotherapy as the primary treatment. The newest chemotherapy agents, including camptosar and oxaliplatin, are available at John Muir Health as is access to investigational agents.

Radiation Therapy for Rectal Cancer

Radiation therapy is most commonly used in combination with chemotherapy to treat rectal cancer.

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