Treatments for colorectal cancer

The treatment of colorectal cancer is always individual. Treatment is influenced by the location of the tumor (colon or rectal cancer), its size and characteristics, the stage of spread, and the patient’s general health.

The goal of treatment varies depending on how advanced the cancer is. If the cancer is curable, this goal is actively pursued by combining different forms of treatment. In such cases, surgery is often combined with chemotherapy, and in rectal cancer, also with radiotherapy. Other treatments combined with surgery aimed at removing the cancer are generally referred to as adjuvant therapy.

If the advanced cancer cannot be cured, the goal of treatment is to reduce the symptoms caused by the cancer, improve the quality of life, and prolong life. Information on treatments for advanced colorectal cancer can be found on the page

Summary of Colorectal Cancer Treatments

  • The treatment of colorectal cancer is planned individually based on the location, size, and stage of the tumor, as well as the patient’s general health. If the cancer is curable, treatment often involves surgery, alongside chemotherapy if necessary, and radiotherapy for rectal cancer.

  • Surgery is the most common form of treatment, during which the section of the bowel containing the tumor and the surrounding tissue are removed. In some cases, a temporary or permanent stoma (colostomy/ileostomy) is created during the surgery.

  • Chemotherapy and antibody therapies can destroy cancer cells, slow down the progression of the disease, and prevent recurrence, but they can cause side effects. After treatments, the patient is monitored with follow-ups, such as blood tests and colonoscopies, to detect any potential recurrence.

Surgical Treatment

Surgery is the most common treatment for colon and rectal cancer. The goal of surgical treatment is to remove the section of the bowel containing the tumor, along with surrounding healthy tissue and lymph nodes. Removing healthy tissue aims to ensure that even individual cancer cells are eradicated. Surgical treatment is used either alone or combined with radiotherapy and chemotherapy.

Surgical treatment may include creating a permanent or temporary stoma

From the patient’s perspective, a key aspect of surgical treatment is whether a stoma must be created, or if it is possible to remove the cancer and sew the healthy ends of the bowel back together (anastomosis), allowing the normal passage of stool to be maintained. In colon cancer, the ends of the bowel can usually be reconnected. However, in emergency surgery, a surgeon may sometimes have to create a stoma that is closed later.

In rectal cancer, a so-called protective (defunctioning) stoma may be created during surgery, which is removed once the bowel anastomosis has healed. Cancers located close to the anus require the removal of the entire rectum, in which case the end of the remaining colon is brought through the abdominal wall, and stool is directed into a collection bag as a permanent stoma.

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Medical Treatment

Chemotherapy

Chemotherapy drugs (also known as cytostatics) are medications designed to destroy cancer cells. Dozens of different drugs are in use, which either kill cancer cells or prevent them from multiplying. Chemotherapy for colorectal cancer usually consists of several medications administered simultaneously. This type of treatment is called combination therapy. Combination therapy is used because different drugs damage or kill cancer cells in different ways. Thanks to the combined effect of the medications, more cancer cells can be destroyed than with individual drugs.

Chemotherapy is given as a preventive (adjuvant) treatment to prevent the recurrence of colon or rectal cancer. Chemotherapy is also used to treat advanced colorectal cancer to shrink the tumor, reduce symptoms, and slow down the progression of the disease.

Chemotherapy also affects healthy tissues

The effect of chemotherapy is not limited only to cancer cells; it also damages cell division in the body’s healthy tissues. These effects of chemotherapy directed at areas other than the cancer tumor are called adverse or side effects. The most common side effects of chemotherapy include sore oral mucosa (mouth sores), diarrhea, a drop in white blood cell count, fatigue, and nausea.

Chemotherapy can cause neuropathy

Some chemotherapy drugs can also cause neuropathy, which means damage to the peripheral nervous system. The most common symptoms of neuropathy include numbness and tingling pain in the fingers and feet, sensitivity to heat or cold, and fine motor problems (difficulty using fingers to grip or hold items).

Learn more about neuropathy in our online guide.

CHEMOTHERAPY-INDUCED PERIPHERAL NEUROPATHY

Yksi suolistosyövän solunsalpaajahoidossa käytettävistä lääkeaineista on kapesitabiini, josta Hyks Syöpäkeskus on tehnyt yllä olevan videon.

Antibody Therapies

Antibodies are drugs that target a specific molecule. The binding of an antibody to its target blocks the function of that target molecule, thereby stopping cancer cell division and tumor growth. An antibody attached to the surface of a cancer cell can also serve as a signal to the body’s own immune system that the cell is abnormal and must be destroyed. The targets chosen for antibodies are molecules known to be highly abundant in cancer tissue but found only in small amounts in other tissues of the body. The goal of this precise targeting is for antibody drugs to have fewer adverse effects on healthy tissues compared to traditional chemotherapy.

Post-treatment Follow-up

A recurrence of colon and rectal cancer can appear as metastases in organs such as the liver, lungs, abdominal cavity, or ovaries, or locally near the site of the original primary tumor. Metastases in the bones or brain are less common.

Currently, there is no single national recommendation or practice for post-treatment follow-up; instead, each hospital district has its own guidelines. Follow-up includes measuring the CEA tumor marker from the blood and conducting endoscopic examinations of the bowel (colonoscopies).

An increase in CEA levels is the most common finding indicating a recurrence of the disease. In such cases, or if the patient experiences symptoms suggestive of a recurrence, more extensive CT scans are performed. CEA levels do not always rise when cancer recurs, which is why CT scans may also be used in follow-up for aggressive forms of the disease within 2 to 3 years after surgery.

Follow-up appointments can be discontinued after five years if the tumor has not recurred. However, it is advisable to undergo repeat colonoscopies every 5 to 10 years for the rest of one’s life, as colorectal cancer patients have a higher risk of developing a new colorectal cancer in a different location compared to the general population on average.

More Information

In spring 2019, Finland’s first national treatment guideline for colorectal cancer was published. Its purpose is to improve the survival prognosis and quality of life for colorectal cancer patients, as well as to ensure equal treatment and high-quality care regardless of where the patient lives. Although the treatment guideline is aimed at physicians, the freely accessible document also serves patients and their loved ones by providing an overview of a colorectal cancer patient’s care pathway. The treatment guideline was updated on March 1, 2022, and June 18, 2024. Key updated topics include the potential use of total neoadjuvant therapy (TNT) in selected rectal cancer patients, DPYD gene testing before starting fluoropyrimidine treatment, pembrolizumab as a first-line treatment for advanced MSI (microsatellite unstable) disease, changing the histopathological classification to match the 2019 WHO classification, and clarifications regarding the histopathological classification of polyp carcinomas.

 

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Radiotherapy

Radiotherapy is high-energy ionizing radiation produced by a dedicated radiotherapy machine. The goal of radiotherapy is to destroy cancer cells and shrink the tumor. Radiation specifically affects cells that are in the process of dividing, which are more abundant in cancer tissue than in normal tissue.

Radiotherapy is a local treatment that only affects the cancer cells in the treated area. The radiation treatment is painless and does not make the patient radioactive. Radiotherapy may have some side effects, which depend on the target of the treatment (i.e., the organs and tissues receiving radiation), the number of radiation sessions, and the total radiation dose received by the patient. Side effects include irritation of the skin and mucous membranes, as well as potential diarrhea.

Radiotherapy is used in the treatment of rectal cancer

Radiotherapy is generally used only for the treatment of rectal cancer. The two most common forms of radiotherapy for rectal cancer are short-course radiotherapy and long-course chemoradiotherapy. Short-course radiotherapy, given over five consecutive days, is administered for localized cancers that have clearly grown through the bowel wall. In most cases, surgery to remove the tumor takes place within a week after the radiation treatment ends.

If the cancer tumor is large or has grown into adjacent organs, such as the prostate or vagina, and is difficult to remove, a so-called long-course chemoradiotherapy is given. This involves administering radiotherapy over a period of 5 to 6 weeks combined with chemotherapy. The combination of radiation and chemotherapy often succeeds in shrinking the tumor enough so that it can be completely removed through surgery, or its symptoms can be reduced.

Radiotherapy can also be used to treat metastases of colon and rectal cancer in selected cases. For example, radiotherapy can be used to treat a symptomatic bone metastasis or brain metastasis. In certain cases, precisely targeted stereotactic radiotherapy can be used to treat, for instance, a liver or lung metastasis that is not suitable for surgical treatment.