Treatment Options

Colon Cancer Surgery

Minimally Invasive Colectomy:

• Laparoscopic Surgery - Small incisions, faster recovery
• Robotic Surgery - Enhanced precision and visualization
• Traditional Open Surgery - When needed for complex cases

Types of Colon Resection:

• Right hemicolectomy (right colon tumors)
• Left hemicolectomy (left colon tumors)
• Sigmoid colectomy (sigmoid colon tumors)
• Subtotal colectomy (multiple tumors or Lynch syndrome)

Lymph Node Removal:

• Adequate lymph node harvest (minimum 12 nodes)
• Determines accurate staging
• Guides adjuvant therapy decisions

Rectal Cancer Surgery

Sphincter-Preserving Surgery:

• Low anterior resection (LAR)
• Ultra-low anterior resection
• Coloanal anastomosis
• Goal: Preserve bowel function and avoid permanent colostomy

Advanced Techniques:

• Transanal Minimally Invasive Surgery (TAMIS) - For early rectal tumors
• Transanal Total Mesorectal Excision (TaTME) - For low rectal cancers
• Robotic-Assisted Surgery - Improved access to narrow pelvis

When Permanent Colostomy May Be Needed:

• Very low rectal tumors involving the sphincter
• Emergency surgery for obstruction or perforation
• Poor sphincter function before surgery
• Patient preference

Surgery for Metastatic Disease

Liver Metastases:

• Hepatic resection (removal of liver tumors)
• Ablation therapy (RFA, microwave)
• Combination approaches
• Portal vein embolization to grow remaining liver

Lung Metastases:

• Pulmonary metastasectomy
• Wedge resection
• Lobectomy when needed

Peritoneal Metastases:

• Cytoreductive surgery (CRS)
• Hyperthermic intraperitoneal chemotherapy (HIPEC)

Chemotherapy

Adjuvant Chemotherapy (After Surgery)

For Stage III and high-risk Stage II colon cancer:

• FOLFOX (5-FU, leucovorin, oxaliplatin)
• CAPOX (capecitabine, oxaliplatin)
• Duration: 3-6 months

Neoadjuvant Chemotherapy (Before Surgery)

For selected cases:

• Shrink tumors before surgery
• Treat micrometastatic disease early
• Assess tumor response to therapy

Chemotherapy for Metastatic Disease

 First-line options:

• FOLFOX or FOLFIRI
• CAPOX
• Combined with targeted therapy

Targeted Therapy

Anti-VEGF Therapy (Blocks Blood Vessel Growth)

• Bevacizumab (Avastin)
• Ramucirumab (Cyramza)
• Ziv-aflibercept (Zaltrap)

Anti-EGFR Therapy (For RAS Wild-Type Tumors)

• Cetuximab (Erbitux)
• Panitumumab (Vectibix)

Multi-Kinase Inhibitors

• Regorafenib (Stivarga)
• Trifluridine/tipiracil (Lonsurf)

BRAF Inhibitors (For BRAF-Mutant Tumors)

• Encorafenib with cetuximab

Immunotherapy

For MSI-H/dMMR Tumors (10-15% of colorectal cancers): These tumors respond exceptionally well to immunotherapy:

• Pembrolizumab (Keytruda) - First-line for metastatic disease
• Nivolumab (Opdivo) - Alone or with ipilimumab
• Dostarlimab (Jemperli) - For dMMR tumors

Remarkable Results

 Immunotherapy provides long-lasting control for MSI-H colorectal cancers, including complete responses in some advanced cases.

Precision Medicine

Molecular Profiling Guides Treatment:

• RAS/BRAF mutation status determines targeted therapy options
• MSI/MMR status predicts immunotherapy benefit
• HER2 amplification identifies additional treatment options
• Comprehensive genomic profiling matches patients to clinical trials

Radiation Therapy

Neoadjuvant Radiation for Rectal Cancer

Short-Course Radiation:

• 5 fractions over 1 week
• Surgery within 1 week
• For selected T3 tumors

Long-Course Chemoradiation

• 25-28 fractions over 5-6 weeks
• Combined with chemotherapy (5-FU or capecitabine)
• Surgery 6-12 weeks after completion
• Allows tumor shrinkage and downstaging

Benefits:

• Reduces local recurrence risk
• May allow sphincter preservation
• Can downstage tumors
• Improves surgical outcomes

Brachytherapy

• High-dose radiation delivered directly to tumor
• Short treatment course (4 days vs. 5 weeks)
• Organ-preserving approach for selected patients

Palliative Radiation

• Relieves pain from bone metastases
• Controls bleeding from primary tumor
• Reduces obstruction