What are the treatment options?
     If you have cancer of the colon or rectum, your doctor will probably talk to you about
various treatment options. Surgery to remove the tumor is usually the main
treatment for colon and rectal cancer. Chemotherapy (treatment with drugs that kill
cancer cells) is often used when there is a risk that the colon or rectal cancer will
come back. Radiotherapy (treatment with x-rays that kill cancer cells) may be used
either before or after surgery for rectal cancer. Sometimes both radiotherapy and
chemotherapy are used.

What is cancer staging?
     Doctors use a system that puts colon or rectal cancer into 1 of 4 stages. These
stages are referred to as stage I, stage II, stage III and stage IV. The stage
depends on how deep the cancer is in the wall of the colon or rectum and how much
the cancer has spread to the lymph nodes (small structures in the body that produce
and store cells that fight infection) or other organs.

     Stage I cancer is the earliest stage. Stage IV is the most advanced stage. The
higher the cancer stage, the more the cancer has spread and the lower your chance
for cure. Doctors also use staging to decide whether to use additional treatments,
such as radiotherapy or chemotherapy, to prevent the cancer from coming back after
surgery,


What does stage I cancer mean?
     Stage I colon or rectal cancer means that the tumor is only in the inner layer of your
colon or rectum and has not spread further through the wall of your colon or rectum.
Stage I cancer has a good chance of being cured. For this stage of colon or rectal
cancer, the cure rate with surgery alone is high. Chemotherapy and radiotherapy
are usually not needed.


What does stage II cancer mean?
     Stage II cancer of the colon or rectum means the tumor has grown deeper into the
wall than with stage I cancer. Stage II cancer goes through the inner layer of the
colon or rectum but usually does not go completely through the wall. There are some
stage II colon cancers that have a high risk of recurrence (coming back). The tumor
that was removed at surgery will be examined in a lab to help your doctor tell
whether your tumor has a high risk of recurrence. If you have a stage II cancer with
a high risk of recurrence, your doctor may recommend that you have chemotherapy.
Radiotherapy may be used if you have rectal cancer.


What does stage III cancer mean?
     Stage III cancer of the colon or rectum means the cancer has spread to the lymph
nodes. When colon or rectal cancer has spread to your lymph nodes, the risk that
the cancer will come back is high. Recent research studies of patients with stage III
cancer have shown that when chemotherapy or radiotherapy, or both, are used in
addition to surgery, survival rates are better and the cancer is less likely to come
back.


What does stage IV cancer mean?
     Stage IV cancer of the colon or rectum means that the cancer has spread to another
part of the body, such as the liver or bone. This spread is called metastasis. A
metastatic cancer cannot typically be cured. Chemotherapy is offered to people with
this stage of colon or rectal cancer to control their symptoms.  However, some stage
IV patients with isolated metastases to the liver can be treated with removal of the
colon and liver disease with surgery and have a good survival rate (chance of cure)
with chemotherapy.

What kind of chemotherapy is used to treat colon and rectal cancer?
     Chemotherapy can kill cancer cells that may have been left behind after the tumor
was removed by surgery. Immunotherapy is also used to treat colon or rectal
cancer. With immunotherapy, a person takes drugs that help the immune system
fight cancer. Research has shown that the combination of chemotherapy and
immunotherapy helps prevent the spread of colon or rectal cancer.

     One treatment course uses fluorouracil (sometimes called 5-FU) as the drug that kills
the cancer cells and levamisole as the drug that boosts the immune system. Another
approach uses leucovorin (a specific vitamin preparation), which is added to
fluorouracil. A drug called irinotecan or a drug called oxaliplatin can be used in
combination with fluorouracil and leucovorin to treat colon or rectal cancer. A drug
called capecitabine can also be used to treat stage IV cancer of the colon or rectum.  
Your oncologist will discuss with you which chemotherapy would be best for your
stage of cancer.


When is radiotherapy used?
     Radiotherapy (also called radiation) may be used to treat rectal cancer. With rectal
cancer, there is a risk that the cancer may come back in the pelvic area.
Radiotherapy reduces this risk. If you have a stage II or III rectal cancer, the risk of
the cancer coming back is great enough to justify the use of radiotherapy in addition
to surgery. Chemotherapy using fluorouracil added to radiotherapy has been shown
to improve the outcome in rectal cancer, similar to the effect of chemotherapy in
colon cancer.

     At many medical centers, radiotherapy is given before surgery for rectal cancer to
shrink the tumor and prevent return of the cancer in that area. At other hospitals,
radiotherapy is given after surgery only if there is an increased risk of the cancer
returning or spreading. There is still some debate about whether it is best to give
radiotherapy to people with rectal cancer before or after surgery.


What about side effects?
     Cancer treatment affects every person differently. Some people have few side
effects or none at all. However, the side effects of cancer treatment make many
people feel very sick.

     Your doctor will tell you what kinds of side effects you might expect with your cancer
treatment. He or she will also tell you which side effects are unusual and mean you
need to call the doctor’s office.


What about clinical research programs?
     While the use of chemotherapy and radiotherapy after surgery for colon and rectal
cancers is now standard practice, doctors still want to learn more. You may be given
the opportunity to participate in a clinical research program to help doctors learn
which drug regimen is the best or what the best timing or length of treatment is.
Radiotherapy and chemotherapy are being studied in an effort to keep improving
results. Your doctor can help you decide if you want to participate in a clinical study.