When Jennifer Marrone of San Diego, CA, was diagnosed with stage IV colon cancer at age 30, she didn't just want to know what her treatment options were. "I wanted to know how they were going to affect my life," says Marrone, who's now 35. She was pleased when her oncologist at UC San Diego Health gave her several suggestions for medications and lifestyle changes, like adopting a diet free of animal protein. He also had copies of research studies to back up each potential therapy and treatment.
"I knew from reading research online and talking to others with colon cancer that treatment had improved a lot in the past decade," Marrone says. She chose to be treated with surgery, several types of chemotherapy, and non-chemo medications called targeted therapies. She's had no signs of disease for three years. "When I talk to people with colon cancer, I urge them to ask their medical team, What are all of my options?And how will [each] impact me? Remember, you're a patient, not a protocol," she says.
Colon cancer treatments that weren't available 10 years ago -- or even three or four -- are now an option for many patients. "Today, we have more treatments that can save lives and, in cases where cancer can't be cured, can significantly extend life expectancy and improve overall quality of life," says David Dietz, MD, vice chair of colorectal surgery at the Cleveland Clinic in Ohio. Here's what you need to know about proven treatments as well as newer therapies.
Surgery: The Gold Standard
Surgery is often the first step in treatment. It's how doctors remove the tumor and part of the colon. They may also remove lymph nodes at the same time. "Surgery is a crucial part of treatment for most patients with stage I, II, and III colon cancer, and many with stage IV," Dietz says.
If you have stage 0 or stage 1 cancer, your doctor may be able to remove tumors with a colonoscope -- a long, narrow tube that's inserted into the colon through the rectum.
The doctor may recommend chemotherapy prior to surgery. It could help shrink tumors so they're easier to remove.
Compared to previous decades, doctors now know more about how to make a surgery successful. Operating techniques have improved, too.
"It used to be that surgeons made a long incision and used their hands," says Roberto Bergamaschi, MD, chief of the division of colon and rectal surgery at Stony Brook University Medical Center in New York. Now, more and more doctors use laparoscopic surgery, making several small incisions in the abdomen rather than one large cut. Some colon cancer surgeries may be done with a robot. In those cases, a doctor sits at a control panel and operates robotic arms to perform the procedure. With both methods, "there is usually less pain afterward and a lower risk of post-operation infection and abdominal hernia," Bergamaschi says.
Keep in mind that the doctor who operates on you is as important as the technique he uses. "You want to see a surgeon who regularly does colon cancer surgery -- not a general surgeon. Be sure to ask your surgeon if they work with a multi-disciplinary team that includes oncologists and radiation oncologists who will meet together to discuss your case and your treatment options," Dietz says.
Deciding What's Next
While your doctor may have given you some idea how advanced your cancer is before surgery, "The real staging is done after the operation," says Lawrence Leichman, MD, director of the GI Cancer Program at NYU Langone's Perlmutter Cancer Center in New York. "Once you're staged, that's when the rubber meets the road and colon cancer experts, like oncologists, help you make a treatment plan."
To determine how advanced your cancer is, doctors do a CT scan of your chest, abdomen, and pelvis. They look to see if disease has spread to other areas, like your liver, lungs, and lymph nodes. Based on this and the size of your tumor, they'll diagnose you with stage I, II, III, or IV cancer. Then, your medical team may suggest one or a combination of the following:
No treatment. If you have very small tumors that are removed during surgery, doctors may decide to take a "watch and wait" approach. They'll monitor you for new signs of cancer.
Chemotherapy ("Chemo"). Your doctor will use drugs to fight cancer. You might take some medications by mouth; you'll get others through your veins. The goal is to kill cancer cells that might have hung on after surgery.
There are "standard" chemotherapy treatments, like 5-fluorouracil (5-FU). Doctors are also doing clinical trials to see if new drugs, like those that are already approved for other types of cancers, may work better.
Radiation. This technique uses high-energy rays (like X-rays) to kill cancer cells and shrink tumors. It may be used before surgery or after surgery if doctors think cancer cells have been left behind. Radiation lowers the odds your cancer will return. It's sometimes given with chemotherapy, which makes radiation more effective. But when they're used together, you could have more side effects than if you used just one.
Targeted therapies. These are drugs that home in on the changes in genes and proteins that cause cancer. They tend to have different - and often fewer - side effects than chemotherapy.Bevacizumab (Avastin), cetuximab (Erbitux), and panitumumab (Vectibix) are a few examples.
"In most cases, targeted therapies are a second line, a.k.a. 'next step,' treatment for people who need more treatment than traditional chemotherapy," Dietz says. "Research shows that these drugs are often able to lengthen the lives of patients with advanced colon cancer," though they don't work for everyone. Some cancers with certain gene mutations don't respond to targeted therapies.
This treatment can be used with chemotherapy or alone if chemo doesn't work.
Ablation and embolization. These destroy tumors without removing them. They're used in combination with other therapies, like surgery and chemotherapy. Your doctor may suggest one of these techniques if your colon cancer has spread to your liver.
Immunotherapy. This treatment relies on vaccines that use your body's immune system to fight cancer more effectively. Some of these may prevent colon cancer from coming back. In some clinical trials, immunotherapy has helped patients with advanced cancer stay in remission for a long time. Ask your doctor if you may be eligible for a clinical trial.
Complementary therapies. Acupuncture and massage may help ease some of the side effects of colon cancer and chemo. Researchers are also exploring whether different diets may help reduce symptoms. Keep in mind that there are no known alternative "cures" for colon cancer. Always tell your medical team about the complementary therapies you're using or considering.
Understand Your Options
It's not easy to choose a treatment plan. But the more you understand about your choices, the better you'll feel. Your medical team should be willing to explain each option to you -- not only what it involves, but also what it will mean for your chances of recovery and your quality of life.
To make sure you feel confident about your treatment plan, "Consider getting a second opinion from another colon cancer specialist or team," Dietz says. Your doctor should welcome this idea and even offer suggestions on specialists to consider. If he doesn't, "or you don't feel you're getting the information you need -- and feel secure in your next steps -- find another doctor."