Every Colorectal Cancer Patient’s Journey Is Unique

An expert explains why there is never just one approach to treating colorectal cancer.

If you’ve been diagnosed with colorectal cancer and your treatment plan includes surgery, this situation is undoubtedly frightening.

Knowing key facts about surgical treatment for colorectal cancer, including cancer of the appendix, may ease your initial fear and help you on your journey. In fact, most colorectal cancer patients do very well and go on to live mostly normal lives.

Kyle Cologne, MD, a colorectal surgeon with the USC Colorectal Cancer Program, part of Keck Medicine of USC, shares what to know about colorectal cancer and treatment options.

Colorectal cancer care is not one-size-fits-all

Not all cancers behave and/or are treated the same way, as a variety of factors influence what we do.

This is important to keep in mind as you gather information online or from friends, family members or others who have experienced colorectal cancer care. Their advice may differ from your doctor’s. These differences do not mean you’re getting the wrong treatment, or that you are being over- or undertreated or that your family and friends were treated incorrectly.

It simply means that colorectal cancer treatment plans are individualized to each patient’s unique situation and cancer – particularly now, when we have started to include personalized genetics in these decisions. Some patients need chemotherapy; others need radiation. Some need both. Sometimes treatments are administered before surgery; sometimes afterward. There are even different types of chemotherapy to consider, depending on the genetic signals that may make some more effective. Many patients undergo surgery to remove a portion of the intestine, and some may require removal of other organs.

Navigating your own colorectal cancer treatment plan can get quite complicated. The best medical care teams are those who are committed to successfully walking you through the steps of your cancer journey.

Colorectal cancer survival rate

One of the first questions patients ask is what their chances of survival are. In general, colorectal cancer survival rates are very good overall, in many cases exceeding 90% when involving early-stage disease.

The number one way to ensure good survival is to get screened before symptoms of colorectal cancer develop. Screening should happen around age 45, or 10 years before the age when any first-degree relative (mom, dad, brother or sister) was diagnosed with colorectal cancer – whichever is sooner. Encourage your friends and family to get screened as well.

Your doctor can discuss various colorectal cancer screening options, including colonoscopy, stool testing and blood testing. These screening tests increase the chances of detecting colorectal cancer early, before it starts causing symptoms. Doing so improves colorectal cancer survival rates. Anyone with symptoms of rectal bleeding, weight loss or other changes in their bowel function should discuss these changes with their doctor, as they may require further investigation or testing.

Colorectal cancer survival rate depends on the stage of the cancer. This includes how deep into the layers of the intestine the cancer has grown and whether any lymph nodes outside the intestine wall are involved.

Finally, the colorectal cancer survival rate depends on whether the tumor has spread to any other organs, including the liver, lungs or nearby organs such as the bladder or uterus.

While more advanced tumors – stage 3 or stage 4 tumors – have lower survival rates overall, good results can be achieved especially when care plans involve multidisciplinary medical teams that combine the expertise and resources of a broad range of health care specialists.

Colon cancer versus rectal cancer: What is the difference?

Because the rectum sits low in the pelvis, which is a narrow space, rectal cancers are treated a little differently. It is much more common to be prescribed chemotherapy and/or radiation before surgery to try to shrink these tumors first, which increases the chance of successful removal during surgery.

Rectal cancers also require additional testing, such as an MRI or ultrasound, to get a better sense of the estimated stage of the cancer. This will help determine which treatment options are best for you.

It can be difficult to know whether your tumor is located in the colon or in the rectum, so your doctors may want to confirm the exact location. This can be critical in determining the right action plan.

Important considerations when determining options for treatment include:

• The size of the tumor and its location within the intestine
• Any symptoms including blockage, bleeding or a change in baseline bowel habits
• How well your sphincter muscle works
• What your CT and/or MRI imaging tests show
• Any previous surgery and whether radiation therapy is needed

Deciding on the right care plan can be a complex process that requires discussion between the patient, surgeon and often a medical and/or radiation oncologist. At Keck Medicine of USC, these complicated cases are also reviewed by an expert multidisciplinary panel to gain input from a variety of doctors.

What to know about colorectal cancer surgery

In the majority of colorectal cancer cases, surgery can be done using minimally invasive (laparoscopic or robotic) technology, meaning the surgery is done through small incisions. This makes recovery faster and has a variety of other benefits.

Some circumstances, such as scarring from prior surgery or tumor-related factors, may require a bigger incision that makes a minimally invasive approach less likely to be successful. The recovery from this type of surgery does include some pain, but enhanced recovery and multimodal pain-control regimens can enable shorter hospital stays and a faster return to a normal life.

Will I need a colostomy bag?

This is probably the most important question patients want to know when undergoing colorectal cancer surgery: Will I require an ileostomy or colostomy bag to eliminate waste after surgery?

While this is never our first option, a handful of circumstances may require an ostomy bag, such as low tumors, nutritional considerations, development of rare complications and/or a need for more treatment.

While most patients will not require this, particularly for colon cancers, it can be an important part of the treatment process. Many ostomy bags can also be reversible.

To learn about your options and about all other aspects of your colorectal cancer care, talk to your doctor.

Seek guidance from experts

There is no one answer or one way to approach treating colorectal cancer. The decision-making process for colorectal cancer is nuanced, now more than ever. Recommendations are always changing or getting updated based on the latest research.

To figure out the best approach for you, and to achieve the best outcomes, talk to a knowledgeable and expertly trained colorectal surgeon, preferably one who is board certified, works at a multidisciplinary center and collaborates with a whole cancer team. The physicians at Keck Medicine do exactly this and can help you get the best possible treatment in what can be a difficult time in your life.

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