Chemotherapy For Colorectal Cancer
Chemotherapy is treatment with anti-cancer drugs that may be injected into a vein or taken by mouth. These drugs travel through the bloodstream and reach most parts of the body. Chemo is often used to treat colorectal cancer.
Chemo may be used at different times during treatment for colorectal cancer:
- Adjuvant chemo is given after surgery. The goal is to kill cancer cells that might have been left behind at surgery because they were too small to see, as well as cancer cells that might have escaped from the main colon or rectal cancer to settle in other parts of the body but are too small to see on imaging tests. This helps lower the chance that the cancer will come back.
- Neoadjuvant chemo is given before surgery to try to shrink the cancer and make it easier to remove. This is often done for rectal cancer.
- For advanced cancers that have spread to other organs like the liver, chemo can be used to help shrink tumors and ease problems they’re causing. While it’s not likely to cure the cancer, this often helps people feel better and live longer.
Treatment Of Recurrent Metastatic Colon Cancer
When colon cancer has returned following initial treatment with surgery, radiation therapy, and/or chemotherapy or has stopped responding to treatment, it is said to be recurrent or relapsed.
Patients with recurrent colon cancer can be broadly divided into two groups:
- Those with isolated recurrence of cancer that can be surgically removed or treated with a directed therapy with the goal of cure.
- Those with more widespread cancer.
Most patients with recurrent colon cancer have previously been treated and the recurrent cancer has typically become resistant to whatever treatment regimen was initially used. Testing for specific genomic abnormalities of an individual cancer is essential to determine optimal treatment for recurrent disease. Many patients survive for years after developing recurrent cancer as a result of precision cancer medicines being developed to target the specific genomic abnormalities. In addition, participation in a clinical trial if available should be considered.
Many individuals will not have a specific mutation identified that can be targeted. Treatment of these individuals consists of chemotherapy medications not previously used or participation in a clinical trial.
Determining The Extent Of The Cancer
If you’ve been diagnosed with colon cancer, your doctor may recommend tests to determine the extent of your cancer. Staging helps determine what treatments are most appropriate for you.
Staging tests may include imaging procedures such as abdominal, pelvic and chest CT scans. In many cases, the stage of your cancer may not be fully determined until after colon cancer surgery.
The stages of colon cancer are indicated by Roman numerals that range from 0 to IV, with the lowest stages indicating cancer that is limited to the lining of the inside of the colon. By stage IV, the cancer is considered advanced and has spread to other areas of the body.
During a colonoscopy, the doctor inserts a colonoscope into your rectum to check for abnormalities in your entire colon.
Colon cancer stages
At its earliest stage , colon cancer is limited to the inner lining of your colon. As colon cancer progresses, it can grow through your colon and extend to nearby structures. The most advanced stage of colon cancer indicates cancer has spread to other areas of the body, such as the liver or lungs.
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Folfox As An Adjuvant Treatment
Adjuvant therapy is a cancer treatment administered after the primary treatment to help prevent relapse. For example, the primary treatment for colon cancer is often surgery. Chemotherapy is often used as adjuvant therapy after surgery to destroy remaining cancer cells.
FOLFOX or XELOX for 6 months is a standard adjuvant treatment for people with stage 3 colon cancer in good health.
has found that FOLFOX may offer benefits for people with stage 3 colon cancer when they receive at least eight cycles of treatment. Each cycle of FOLFOX lasts 2 weeks.
Biofeedback Cancer Rehabilitation Therapy For Rectal Cancer
Before and after treatment, patients can benefit from physical therapy that focuses on the muscle near the rectum knows as the levator muscles .
It is important for rectal cancer patients to find a physical therapist who is trained to treat the pelvic floor and has experience providing pelvic floor therapy to cancer patients.
Biofeedback Cancer Rehabilitation therapy for rectal cancer consists of training the external and internal muscles of the pelvic floor that may be affected by surgery or radiation. Surgery may remove or weaken key muscles used in digestion and bowel movements. Radiation may shorten muscle fibers in the pelvic floor. These effects of radiation can last up to five to ten years after treatment.
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Resistance To Antiangiogenic Therapy
Resistance to anti-VEGF has been observed in various cancer types, including CRC, which may be explained by compensatory activation of other signaling pathways and alternative excretion of angiogenesis-related proteins.
The fact that PIGF is upregulated and overexpressed in CRC cases that are resistant to antiangiogenic therapies suggests that PIGF is a crucial factor in overcoming anti-VEGF resistance, which might explain why aflibercept performed better than bevacizumab in xenograft models.
The angiopoietin/TIE signaling RTK pathway contributes to vascular formation and stabilization by mediating downstream the RAS/RAF and PI3K/AKT pathways, which may be negatively regulated by angiopoietin-2. Abnormally increased levels of angiopoietin-2 have been noticed in a wide range of cancers, including CRC, and are associated with resistance to bevacizumab. Targeting both VEGF and angiopoietin-2 in preclinical studies helped control proliferation and progression in cancers that were resistant to VEGF-targeted therapies.,, The VEGF-A and angiopoietin-2 cotargeting agent vanucizumab, which inhibited growth in a CRC xenograft model, has passed through a phase I study with acceptable safety and encouraging anticancer effects.
How Is Chemotherapy Given
You can get chemotherapy in different ways to treat colorectal cancer.
- Systemic chemotherapy: Drugs are put right into your blood through a vein or you take them by mouth. The drugs enter your bloodstream and reach almost all areas of your body.
- Regional chemotherapy: Drugs are put right into an artery that leads to the part of the body with the cancer. This focuses the chemo on the cancer cells in that area. It reduces side effects by limiting the amount of drug reaching the rest of your body. Hepatic artery infusion, or chemo given directly into the hepatic artery, is an example of regional chemotherapy sometimes used for cancer that has spread to the liver.
Chemo drugs for colon or rectal cancer that are given into a vein , can be given either as an injection over a few minutes or as an infusion over a longer period of time. This can be done in a doctors office, infusion center, or in a hospital setting.
Often, a slightly larger and sturdier IV is required in the vein system to administer chemo. These are known as central venous catheters , central venous access devices , or central lines. They are used to put medicines, blood products, nutrients, or fluids right into your blood. They can also be used to take blood for testing.There are many different kinds of CVCs. The most common types are the port and the PICC line.
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Side Effects Of Surgery
Bowel cancer operations carry many of the same risks as other major operations, including:
- developing blood clots usually in the legs
- heart or breathing problems
The operations all carry a number of risks specific to the procedure.
One risk is that the joined-up section of bowel may not heal properly and leak inside your abdomen. This is usually only a risk in the first few days after the operation.
Another risk is for people having rectal cancer surgery. The nerves that control urination and sexual function are very close to the rectum, and sometimes surgery to remove a rectal cancer can damage these nerves.
After rectal cancer surgery, most people need to go to the toilet to open their bowels more often than before, although this usually settles down within a few months of the operation.
Occasionally, some people particularly men have other distressing symptoms, such as pain in the pelvic area and constipation alternating with frequent bowel motions.
Support and advice should be offered on how to cope with these symptoms until the bowel adapts to the loss of part of the back passage.
Chemotherapy Drugs Used In The Treatment Of Colon Cancer
For treating colon cancer, the 5-fluorouracil drug has been used as a first-choice treatment option for many years now. It is usually administered intravenously with leucovorin, making it more effective.
Capecitabine in pill form is also changed to 5-fluorouracil when it gets to the tumor. This drug is also used in adjuvant and neoadjuvant therapy in combination with radiation to treat people with rectal cancers.
Other chemotherapy drugs used for treating colon cancer include oxaliplatin and irinotecan . Usually, these drugs are given with Xeloda or 5-FU after surgery or in cases of advanced cancer.
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How Colorectal Cancer Is Treated
In cancer care, different types of doctors often work together to create a patients overall treatment plan that usually includes or combines different types of treatments. This is called a multidisciplinary team. For colorectal cancer, this generally includes a surgeon, medical oncologist, radiation oncologist, and a gastroenterologist. A gastroenterologist is a doctor who specializes in the function and disorders of the gastrointestinal tract. Cancer care teams include a variety of other health care professionals, such as physician assistants, nurse practitioners, oncology nurses, social workers, pharmacists, counselors, dietitians, and others.
Treatment options and recommendations depend on several factors, including the type and stage of cancer, possible side effects, and the patients preferences and overall health. Take time to learn about all of your treatment options and be sure to ask questions about things that are unclear. Talk with your doctor about the goals of each treatment and what you can expect while receiving the treatment. These types of talks are called shared decision-making. Shared decision-making is when you and your doctors work together to choose treatments that fit the goals of your care. Shared decision-making is particularly important for colorectal cancer because there are different treatment options. Learn more about making treatment decisions.
Colon Cancer Mutations Targeted By Precision Cancer Medicines
Genetic Mutations: Not all colon cancer cells are alike. They may differ from one another based on what genes have mutations. Molecular testing should be performed to test for genetic mutations or the proteins they produce on ALL patients. By testing an individualâs colon cancer for specific unique genomic- biomarkers doctors can offer a personalized treatment approach utilizing precision medicines. Colon cancer mutations are being identified and new medicines developed to target these mutations on an ongoing basis.
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Stage Ii And Stage Iii Rectal Cancer Treatment
Stage II rectal cancer is cancer that has grown through the wall of the rectum and possibly into nearby tissues. However, there is no lymph node involvement.
Stage III rectal cancer is cancer that has spread to nearby lymph nodes.
Most stage II and III rectal cancers are treated with a combination of chemotherapy, radiation therapy and surgery. The specific order and timing of these treatments will vary among patients.
Adjuvant Therapy For Colon Cancer: Impact Of Stopping Treatment Early
For patients with stage III colon cancer, early discontinuation of adjuvant chemotherapy leads to worse outcomesbut early discontinuation of oxaliplatin did not. These findings, which came from an analysis of the large ACCENT and IDEA clinical trials databases, were presented at the 2022 ASCO Gastrointestinal Cancers Symposium.1
Early discontinuation of FOLFOX or CAPOX was defined as receipt of 75% or less of the planned cycles, and this was associated with a significant and clinically relevant decrease in disease-free and overall survival. Although early discontinuation of oxaliplatin alone was not detrimental, patients who received less than 50% of the planned number of cycles of oxaliplatin did have poorer outcomes, said Claire Gallois, MD, of the Hopital Européen Georges Pompidou, Paris.
In patients being treated with the 6-month adjuvant regimen, it seems important to maintain the planned number of treatment cycles, she said.
The importance of oxaliplatin in the treatment of early-stage colon cancer is well established, but many patients cannot tolerate a full course. Relative dose intensity of oxaliplatin less than 60% has been associated with poorer outcomes.2,3
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Side Effects Of Chemotherapy For Colorectal Cancer
Chemotherapy drugs may cause side effects , but they arent as severe as they used to be, and certain medications and strategies are available to help manage them.
The most common side effects of chemotherapy drugs include:
- Changes to your skin
- Finding that you bruise or bleed easier
- Greater chance of infections
- Nausea, vomiting and mouth sores
Some side effects from chemotherapy are specific to the type of medication used:
Allergic reactions or sensitivity: Let your care team know if you develop reactions such as a skin rash, dizziness or trouble breathing. These reactions are often associated with oxaliplatin.
Diarrhea: Although several chemotherapy drugs may cause diarrhea, it can be particularly challenging with irinotecan. Thats why your team will likely recommend a drug or other steps that may help control it. Diarrhea may lead to dangerous dehydration if left unchecked.
Hand-foot syndrome: Signs are blistering, swelling and redness that may develop on the hands and feet with certain types of chemotherapy. For colorectal cancer patients, the condition is specifically associated with capecitabine or 5-FU given as an infusion. Talk with your care team as soon as you notice any such symptoms so that they can help treat this reaction.
Expert cancer care
When Is Chemotherapy Used In Colon Cancer
Chemotherapy can be used at different times during the treatment of colon cancer. Chemotherapy can be used in the following ways:
Chemotherapy is given before surgery and sometimes with radiation. This is done to shrink the tumor to make it easier to remove during surgery
Adjuvant chemotherapy is given to the patient after surgery. The goal of this kind of treatment is kill the cancer cells that have been left behind after surgery. This helps lower the risk of the cancer coming back.
Chemo for advanced cancer
Chemotherapy can be used when the cancer has spread to the other organs as it can be used to ease out symptoms and it can be used to shrink tumors. It is called as palliative chemotherapy Even though it cannot fully cure the patient it can help them live longer and feel better.
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How To Prepare For A Colorectal Resection
The doctor may ask you to stop taking some medicines up to one week before colon resection surgery. Usually these are drugs that can lead to excess bleeding, like aspirin or blood thinners.
You should also prepare by drinking eight 8-ounce glasses of fluid every day. You may require a special diet for several days before surgery. The colon must be cleaned out before the surgery. Your doctor may ask you to take an enema or laxatives. You may have to drink a large container of solution. This preparation may start several days before the procedure. Its not a fun process, but also not painful.
Its important to arrange for a ride to and from the hospital. Youll also probably need help at home for the first few days after the procedure.
Chemotherapy And Targeted Therapies For Bowel Cancer
ChemotherapyChemotherapy treatment involves the administration of drugs that either kill cancer cells or prevent them from dividing. When given by mouth, or by injection or infusion into muscle or the bloodstream, it is termed systemic chemotherapy. When placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas. This is known as regional chemotherapy.
There are a number of medicines used in New Zealand for the treatment of bowel cancer. A number of chemotherapy drugs are publicaly funded in New Zealand by government funding agency PHARMAC. These are available to patients at no charge. These funded medicines are often used in combination with immunotherapy drugs in the treatment of metastatic bowel cancer.
Immunotherapy drugsAlso known as targeted therapies, are designed to selectively target cancer cells and the mechanisms that encourage their growth. They are currently not publicly funded in New Zealand however are available through co-share payment plans with pharmaceutical companies.
These plans assist with the purchase of the drugs but the patient is still responsible for the cost of administration in a clinic or hospital. Your oncologist may mention these to you, if appropriate for your treatment plan and you may enquire about them as part of your treatment discussion.
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Strategies To Improve Treatment
The major research focus in advanced colon cancer is the identification of additional cancer driving mutations as targets for precision cancer medicines and the development of immunotherapy treatment strategies.
Precision cancer medicine uses targeted drugs and immunotherapies engineered to directly attack colon cancer cells with specific abnormalities, leaving normal cells largely unharmed. Development of precision medicines are for the treatment of colon cancer is ongoing and these novel medicines are first utilized patients with recurrent cancers and once proven effective they become available through clinical trials for treatment of earlier stage disease. All patients need to make sure their cancer undergoes genomic profiling. This can also be accomplished with a tissue sample and in blood using a “liquid biopsy” if tissue is not available.
Overcoming Resistance To Immunotherapy
Given the unsatisfactory results for immune checkpoint blockade therapy observed in patients with MMR proficient or microsatellite stable CRC, who constitute the major proportion of patients with CRC, it is unfortunate that the underlying mechanism has not been clearly determined. Investigators have tried to overcome the resistance of pMMR or MSS CRC to immune checkpoint inhibitors on the basis of several hypotheses related to reduced tumor-specific antigen expression, antigen presentation defects, altered immunosuppressive pathways , and alternative activation of other immune checkpoint signaling pathways, immune regulatory cells, and cytokines. Strategies to improve pMMR or MSS CRC immune checkpoint inhibitor responses are being developed, such as combined therapy with various approaches including radiotherapy, bispecific antibody therapy, other immune checkpoint modulators, and other targeted agents.
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