Important Facts That You Should Know About Colorectal Cancer Treatment
VIDEO: Cancer Research UK features video on Prostate Cancer Treatment. Watch video below
Stages of Colon Cancer
The stage describes the extent of the cancer in the body and is one of the most important factors in determining prognosis and treatment options. The higher stages of cancer require advanced treatment options.
Stage 0 = Earliest stage of cancer
Stage IV = Most advanced stage of cancer
Surgery
Surgery is the most common treatment for colorectal cancer. There are three main types of surgery:
Colonoscopy
A small malignant polyp may be removed from your colon or upper rectum with a colonoscope. Some small tumors in the lower rectum can be removed through your anus without a colonoscope.
Laparoscopy
Early colon cancer may be removed with the aid of a thin, lighted tube — a laparoscope. Three or four tiny cuts are made into your abdomen. The surgeon sees inside your abdomen with the laparoscope. The tumor and part of the healthy colon are removed. Nearby lymph nodes also may be removed. The surgeon checks the rest of your intestine and your liver to see if the cancer has spread.
Learn more about laparoscopy by watching the videos below with Dr. James Fleshman, or with a former patient, Alissa Murphy.
Open surgery
The surgeon makes a large cut into your abdomen to remove the tumor and part of the healthy colon or rectum. Some nearby lymph nodes are also removed. The surgeon checks the rest of your intestine and your liver to see if the cancer has spread.
Chemotherapy
Chemotherapy refers to treatment using chemicals to kill cells that divide rapidly, such as harmful cancer cells. Typically, your doctor will give these drugs in cycles, administering a treatment for a period of time followed by a rest to allow your body time to recover.
Approved chemotherapy drugs for colon cancer:
Fluorouracil (5-FU)
Camptosar (Irinotecan/CPT-11)
Xeloda (Capecitabine)
Eloxatin (Oxaliplatin)
Stivarga (Regorafenib)
Approved chemotherapy combinations:
FOLFOX (5-FU, leucovorin and oxaliplatin)
FOLFIRI (5-FU, leucovorin and irinotecan)
CapeOx (Capecitabine and oxaliplatin)
5-FU and leucovorin
Biologics
Biologics include a wide range of substances from animal products and other living sources (as opposed to chemically manufactured medications) to prevent, diagnose or treat disease.
Approved biologics to treat colon cancer:
Avastin (Bevacizumab)
Erbitux (Cetuximab)
Vectibix (Panitumumab)
Zaltrap (Ziv-aflibercept)
Fluorouracil (5-FU)
FDA Approved: 1950s
This chemotherapy drug is used to treat cancers of the breast, stomach, and pancreas, and certain types of colorectal and head and neck cancers. It is given through an IV or infusion. The amount and schedule can vary from several hours to several weeks. 5-FU is also known asAdrucil, EfudexorFluoroplex.
5-FU is often given with leucovorin (also called folinic acid), which increases efficacy. Due to a national shortage of leucovorin, a similar drug called levo-leucovorin may be used instead.
Common side effects:
Diarrhea
Loss of appetite, nausea and/or vomiting
Mouth sores
Watery eyes, sensitivity to light
Taste changes, metallic taste in mouth during infusion
Suppressed immune system
Camptosar (Irinotecan/CPT-11)
FDA Approved: 1996
Irinotecan is a chemotherapy drug that can be administered through an injection or port, which puts the drugs directly into a large vein in the chest.
Irinotecan blocks an enzyme in cells called topoisomerase I. Cells need this enzyme to divide and grow. When the enzyme is blocked by irinotecan, the cell’s DNA gets tangled up and the cell can’t divide. Since cancer cells divide faster than normal cells, they are more likely than normal cells to be affected by irinotecan.
Common Side Effects:
Diarrhea
Fatigue
Loss of appetite, nausea and/or vomiting
Skin rashes
Suppressed immune system
Mouth sores and ulcers
Xeloda (Capecitabine)
FDA Approved: 2001
Xeloda is a chemotherapy drug typically administered in pill form and taken every day for two weeks. This may be repeated as directed by a doctor. Xeloda works by slowing or stopping cancer cell growth and by decreasing tumor size.Xeloda is similar in action to 5-FU and can be used in place of 5-FU and leucovorin.
Common Side Effects:
Diarrhea
Loss of appetite, nausea and/or vomiting
Weakness, feeling light-headed, hot or dry skin
Pain, tenderness, redness, swelling, blistering or peeling skin on your hands or feet (hand -foot syndrome)
Fever
Eloxatin (Oxaliplatin)
FDA Approved: 2002
Oxaliplatin is a chemotherapy drug typically used in combination with 5-FU and leucovorin to treat colon cancer. It is administered by IV and stops cancer cell growth and slows the spread of cancer cells in the body.
Common Side Effects:
Diarrhea
Loss of appetite, nausea and/or vomiting
Mouth sores
Numbness, burning and tingling in the hands or feet from nerve damage (peripheral neuropathy, sensitivity to cold)
Stivarga (Regorafenib)
FDA Approved: 2012
Regorafenib is a chemotherapy drug typically taken in pill form and works to block the production of certain proteins necessary for cancer growth. It is designed to treat patients with metastatic colon cancer whose cancer has continued to advance after approved standard therapies.
Common Side Effects:
Diarrhea
Loss of appetite, nausea and/or vomiting
Mouth sores
Redness and pain the palms of the hands and soles of the feet (hand-foot syndrome)
Rashes
Bleeding
FOLFOX (5-FU, leucovorin and oxaliplatin)
FDA Approved: 2004
FOLFOX is a chemotherapy regimen of several different drugs and leucovorin. It is typically given through injection or IV into a port in your chest.
FOL = Leucovorin Calcium (Folinic Acid)
F = Fluorouracil
OX = Oxaliplatin
Common Side Effects:
Risk of Infection
Diarrhea
Mouth Sores
Fatigue
Redness and pain the palms of the hands and soles of the feet (hand-foot syndrome)
Numbness, burning and tingling in the hands or feet from nerve damage (peripheral neuropathy), cold sensitivity
FOLFIRI (5-FU, leucovorin and irinotecan)
FOLFOX is a chemotherapy regimen of several different drugs and leucovorin. It is typically given through injection or IV into a port in your chest.
FOL = Leucovorin Calcium (Folinic Acid)
F = Fluorouracil
IRI = Irinotecan
Common Side Effects:
Diarrhea
Loss of appetite, nausea and/or vomiting
Mouth sores
Anemia
Redness and pain the palms of the hands and soles of the feet (hand-foot syndrome)
Numbness, burning and tingling in the hands or feet from nerve damage (peripheral neuropathy)
Hair thinning or loss
CapeOx (Capecitabine and oxaliplatin)
CapeOx is a chemotherapy regimen of several different drugs and leucovorin. It is typically given through injection or IV into a port in your chest.
Cape = Capecitabine
Ox = Oxaliplatin
Common Side Effects:
Diarrhea
Loss of appetite, nausea and/or vomiting
Mouth sores
Anemia
Redness and pain the palms of the hands and soles of the feet (hand-foot syndrome)
Numbness, burning and tingling in the hands or feet from nerve damage (peripheral neuropathy), cold sensitivity
Avastin (Bevacizumab)
FDA Approved: 2004
Avastin is a tumor-starving (or anti-angiogenic) biologic therapy. Cancers need blood in order to grow. To get enough blood, tumors tell the body to grow new blood vessels. Angiogenesis inhibitors block this process.Avastin blocks a protein called vascular endothelial growth factor, or VEGF. Normal cells produce VEGF, but some cancer cells overproduce VEGF. Blocking VEGF may prevent the growth of new blood vessels that feed tumors.
Avastin is administered through an injection every two weeks in combination with other chemotherapies.
Common Side Effects:
Diarrhea
Loss of appetite, nausea and/or vomiting
Fatigue
Dry skin/skin inflammation
Back pain
Headache
Taste change
Fertility issues
High blood pressure
Erbitux (Cetuximab)
FDA Approved: 2004
Erbitux slows cancer growth by targeting a protein found on the surface of some cells called the epidermal growth factor receptor (EGFR). EGFR plays a role in cell growth and is present in about 75% of colon cancers.
Common Side Effects:
Diarrhea
Loss of appetite, nausea and/or vomiting
Fatigue
Dry skin, acne and/or rashes
Mouth sores
Itching
Vectibix (Panitumumab)
FDA Approved: 2006
Vectibix slows cancer growth by targeting a protein found on the surface of some cells called the epidermal growth factor receptor (EGFR). EGFR plays a role in cell growth and is present in about 75% of colon cancers.
Common Side Effects:
Diarrhea
Loss of appetite, nausea and/or vomiting
Fatigue
Dry skin, acne and/or rashes
Zaltrap (Ziv-aflibercept)
FDA Approved: 2012
Zaltrap is a biologic given with chemotherapy (FOLFIRI) for metastatic patients previously treated with oxaliplatin. Zaltrap is a tumor-starving (or anti-angiogenic) biologic therapy. Cancers need blood in order to grow. To get enough blood, tumors tell the body to grow new blood vessels. Angiogenesis inhibitors block this process. Zaltrap blocks a protein called vascular endothelial growth factor, or VEGF. Normal cells produce VEGF, but some cancer cells overproduce VEGF. Blocking VEGF may prevent the growth of new blood vessels that feed tumors.
Zaltrap is administered through an IV.
Common Side Effects:
Diarrhea
Loss of appetite, nausea and/or vomiting
Mouth sores
Fatigue
Redness and pain the palms of the hands and soles of the feet (hand-foot syndrome)
