Treatment for Colorectal Cancer

Colorectal cancer (CRC) treatment depends on the stage of the cancer and where it is located in the body. There are several ways to treat CRC, and cancer doctors (oncologists) may use a combination of options. The goal of colon cancer treatment is to remove the cancer, stop its spread, and prevent it from coming back.^1,2

Treatment for stage 0 colorectal cancer

In stage 0 CRC, the cancer is located in only the innermost layer of the colon or rectum. It has not spread to other areas. Treatment for stage 0 colorectal cancer is usually removal of the cancer, which may include:^1,2

• Polypectomy – If the cancer is found during a colonoscopy, it can sometimes be removed during the procedure. This is called a polypectomy.
• Local excision – In some cases, surgery to remove the cancerous tissue and some surrounding healthy tissue is performed. This is called a local excision.

In most cases, people with stage 0 CRC do not need other treatments because the cancer has not spread.^1,2

Treatment for stage 1 colorectal cancer

In stage 1, the cancer has grown deeper into the layers of the colon or rectum but has not spread outside the colon. This means that no cancer has been found in the lymph nodes or other organs. Treatment options include:^1,2

• Surgery – The main treatment is surgery to remove the section of the colon or rectum with cancer, along with some surrounding healthy tissue. This is called a partial colectomy.

Most people with stage 1 CRC will need only this surgery.²

Treatment for stage 2 colorectal cancer

Stage 2 CRC means the cancer has grown through the wall of the colon or rectum but has not spread to the lymph nodes. Treatment may include:^1,2

• Surgery – Surgery is still the first-line treatment. The surgeon will remove the cancerous part of the colon or rectum by the methods mentioned above.
• Chemotherapy – In some cases, chemotherapy may be recommended before or after surgery. Chemotherapy can be helpful, especially if the cancer has a higher risk of coming back after treatment. Colorectal cancer that comes back after treatment is called recurrent CRC.

Chemotherapy regimens combine multiple drugs that work together in a specific way. The following regimens are commonly used to treat CRC:^1-3

• FOLFOX – fluorouracil, leucovorin, and oxaliplatin
• CAPEOX – capecitabine and oxaliplatin
• FOLFIRI – irinotecan, fluorouracil, and leucovorin

Treatment for stage 3 colorectal cancer

In stage 3, the cancer has spread to nearby lymph nodes but not to distant parts of the body. Treatment typically includes:^1,2

• Surgery – The first step is surgery to remove the cancer and nearby lymph nodes.
• Chemotherapy – Chemotherapy after surgery is a standard treatment for stage 3 CRC. It can help kill remaining cancer cells.
• Radiation therapy – Doctors may recommend radiation therapy before or after surgery. This treatment can help shrink the tumor or reduce the chances of it coming back.

Treatment for stage 4 (metastatic) colorectal cancer

Stage 4 CRC – also known as metastatic CRC – means the cancer has spread to distant organs. Metastatic CRC commonly spreads to the lymph nodes and liver. It can also spread to other organs like the lungs and ovaries.^1-4

One possible cause of metastatic CRC is a change to a gene called a genetic mutation. One common genetic mutation related to CRC is the BRAF V600E mutation. This is a very aggressive, fast-growing genetic mutation that accounts for 8 to 12 percent of metastatic CRC mutations.⁵

Metastatic CRC is very difficult to treat. People at this stage will commonly undergo a combination of treatments that may include:^1-4,6

• Surgery – Surgery is used in combination with other treatment methods like chemotherapy and targeted therapy. If the cancer has spread to only 1 or 2 organs, surgeons can sometimes remove these areas where the cancer has spread (metastases).
• Chemotherapy – Chemotherapy is the main treatment for stage 4 CRC. It can help shrink tumors, slow the spread of the cancer, and relieve symptoms. Chemotherapy may be used in addition to other treatment options, like targeted therapy drugs.
• Targeted therapy – Some people with stage 4 CRC may benefit from drugs that target specific mutations in cancer cells. There are many targeted therapy drugs that your oncologist may recommend for you. Examples of targeted therapy drugs used for CRC are:Avastin® (bevacizumab)
  Braftovi® (encorafenib) in combination with cetuximab for the treatment of those with the BRAF V600E mutation
  Cyramza® (ramucirumab)
  Eylea® (aflibercept)
  Immunotherapy – Immunotherapy uses your own body’s immune system to fight the cancer. If the cancer has certain genetic features, immunotherapy drugs may be appropriate. These genetic features include microsatellite instability (MSI) and mismatch repair deficiency (MMR). Examples of immunotherapy drugs for CRC include:
  Jemperli (dostarlimab-gxly)
  Keytruda® (pembrolizumab)
  Opdivo® (nivolumab)
• Radiation therapy – For advanced cancers, radiation therapy can help shrink tumors that are located in places outside the colon, such as the lung. Radiation can also help prevent or reduce cancer symptoms like pain.

Work with your cancer care team

Colorectal cancer treatment can vary widely, depending on the stage and location of the cancer. Surgery is often the first step. But chemotherapy, targeted therapy, radiation, and other therapies may be needed to help control the disease. Work closely with your doctor and medical team to choose the best treatment plan for you.^1-3