How Colorectal Cancer Treatments Differ Based on the Stage of Disease.

Colorectal cancer remains among the top four most common cancer diagnoses in the United States, yet deaths caused by colon and rectal cancers have slowly declined since 1968. While this can largely be attributed to increases in colonoscopies and other screening tools, advances in colorectal cancer treatment allow us to offer more effective options than ever before–while also preserving patients’ quality of life. 

Colon and rectal cancers are often referred to as “colorectal cancers,” yet treatment for the two can be very different, especially depending on the stage of the cancer. If you or a loved one have colorectal cancer, it's important to understand the differences between early- and late-stage treatment options.
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What is the difference between colon and rectal cancer?

Colon cancer and rectal cancer are grouped together frequently, but they are two distinct types of cancer that differ based on the precise location where the tumor begins. Colon cancer occurs in the colon, also known as the large intestine. The rectum is the last portion of the colon, closest to the anus. Therefore, rectal cancer begins in the tissues of the rectum. Rectal cancer can spread to the rest of the colon and vice versa, as well as elsewhere in the body. As a result, prompt diagnosis and treatment is important for both colon and rectal cancer.
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Understanding colorectal cancer staging.

Once you’ve been diagnosed with colon cancer via endoscopy and a biopsy, the next step is to understand the stage. A cancer’s stage describes how advanced it is. Staging impacts the goal of treatment and potential treatment options. Colon cancer stages vary based on the following questions:  
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• How deep through the wall has the colon cancer grown?

• Has the cancer traveled to nearby lymph nodes?

• Has it traveled to farther away other organs (metastasized)?

Colon cancer stages range from one to four, with one being the earliest stage.
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• Stage I: The tumor has grown in the colon wall but not beyond the muscle layer. It has not traveled to nearby lymph nodes or organs.

• Stage II: The tumor has grown deeper into the muscle layer but not beyond the colon.

• Stage III: Cancer has traveled to nearby lymph nodes but not to other organs.

• Stage IV: Cancer has spread to nearby lymph nodes and other organs. This is called metastatic colon cancer.

Rectal cancer can be trickier to diagnose and often involves an additional diagnostic step. In most cases, your doctor will use an MRI to determine its stage. Similar to colon cancer, the higher the cancer stage, the further the cancer has spread.
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Treatment for early-stage colorectal cancer.

In most cases, early-stage colon cancer can be treated with surgery. The bowels, or colon, resemble one long pipe. The goal of colon cancer surgery is to remove the part of the pipe with the tumor and surrounding tissue to minimize the risk of any microscopic cancer being left behind. Then, the pipe is reconnected. For the vast majority of patients with stage I colon cancer, surgery can be curative and no other treatment is necessary, although follow-up will be an important part of preventing recurrence. 

Stage II may also be considered early-stage and treatable with surgery. For some patients with stage II colon cancer, your doctor may also recommend chemotherapy after surgery. This will vary patient-by-patient depending on the pathology of your tumor and the likelihood of recurrence.

Many patients with early-stage rectal cancer may also be candidates for surgery, depending on the size of the tumor. In every case, our multidisciplinary team of experts will help our patients weigh the advantages and potential risks of each treatment option to help them determine the right next steps for them.   
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Minimally invasive surgery.

While surgical options will vary based on the thickness of the tumor and how far it has spread, in many cases, our gastroenterology surgeons use laparoscopic and robotic surgery. These minimally invasive surgical options offer numerous benefits for patients, including smaller incisions, shorter hospital stays, less pain, and faster recoveries.
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Treatment for locally advanced colorectal cancer.

Stage three colon cancer treatment also likely involves surgery to remove the tumor. Patients with stage III colon cancer can expect to undergo three to six months of chemotherapy following surgery to bring survival benefit from 50 percent up to almost 75 percent. Your doctor will help you weigh the risks and side effects against your personal benefit to determine the best approach for you. Considering long-term side effects is especially important, as many diagnoses are occurring in younger patients.

Rectal cancer requires a different approach. Tumors in the rectum that have grown into the wall and/or to lymph nodes typically undergo chemotherapy, radiation, or a combination of both upfront. Then, we’ll reevaluate the tumor to see if it has shrunk enough to make you a surgical candidate or eliminated the need for surgery altogether. Called total neoadjuvant treatment, therapy before and after surgery may allow your surgeon to preserve the rectum and reduce the need for a colostomy.   
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Treatment for metastatic colorectal cancer.

For patients with colorectal cancer that has spread beyond the colon into other organs, treatment options will vary for each individual. In some cases, such as where cancer has only spread to the liver, surgery may be an option. In other instances where surgery is not possible, the standard of care is systemic therapy, which may involve chemotherapy drugs or targeted therapies. For patients with Lynch syndrome, immunotherapy may also be a treatment option. Thanks to advances in molecular testing, we can test a  tumor’s DNA to gather information that helps us guide the best upfront treatment regimen. Certain genetic mutations may be more responsive to specific targeted therapies and molecular testing allows us to identify these cases. 

In addition, our partnership with the Georgetown Lombardi Comprehensive Cancer Center, a National Cancer Institute-designated comprehensive cancer center, ensures our patients have access to clinical trials that may not be widely available. 
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Whatever the colorectal cancer stage, seek treatment from an experienced, multidisciplinary team.

Even if you’ve been diagnosed with colorectal cancer elsewhere, it’s never too late to get a second opinion, especially when it comes to rectal cancer treatment options. At MedStar Health, experts in gastroenterology, medical oncology, radiation oncology, surgery, and other specialties meet weekly to review each colorectal cancer case and collectively discuss the best treatment plan for each individual. All treatment options consider the least invasive and most effective options to target the cancer and minimize the risk of recurrence.

In addition, MedStar Health is the first in Maryland to receive national accreditation for rectal cancer, ensuring the highest level of care for our patients. In fact, MedStar Franklin Square Medical Center is the only hospital in Maryland to earn the three-year rectal cancer accreditation by the National Accreditation Program for Rectal Cancer (NAPRC) of the American College of Surgeons. The unique distinction has been shown to result in fewer colostomies and a better quality of life compared to non-accredited hospitals. 

While treatment is the most straightforward for early-stage colorectal cancers, we have treatment options available for every stage of disease. Contact us today to schedule a second opinion consultation and understand all of your options.