Knowing your treatment options, finding support, and working with your doctor can all help you cope with colorectal cancer.

Know your options

The choice of treatment will depend on the stage of your cancer and your general health. Your treatment options include medications, surgery, and radiation.

Medications

Medication options for colorectal cancer include chemotherapy and biological therapy.

Chemotherapy
Chemotherapy uses medications to kill cancer cells. The role of chemotherapy for colorectal cancer treatment depends on the stage of the cancer.

For early colorectal cancer, chemotherapy can be used as adjuvant therapy. This type of treatment is given to people who have had surgery to cure their cancer, but are at a high risk for having the cancer come back. Adjuvant therapy is given after surgery to reduce the risk that the cancer will return. For people with rectal cancer, chemotherapy may also be used before surgery to shrink the tumour so it is easier to remove. This is called neo-adjuvant therapy.

For colorectal cancer that has spread (metastatic colorectal cancer), chemotherapy may be used to relieve symptoms caused by the cancer's spread and to prolong life. This is also called palliative therapy.

Researchers have discovered that chemotherapy medications work better when they are used in combinations called regimens. Regimens also define what dosages of each medication are recommended and how often the medications should be given. Common medications that may be found in chemotherapy regimens for colorectal cancer include:

  • 5-fluorouracil (also called 5-FU; generics)
  • capecitabine (Xeloda®)
  • cetuximab (Erbitux®)
  • irinotecan (Camptosar®)
  • leucovorin (Lederle®, generics)
  • oxaliplatin (Eloxatin®)
  • raltitrexed (Tomudex®)

Two common chemotherapy regimens are:

  • FOLFOX (5-FU + leucovorin + oxaliplatin): used for adjuvant therapy and for metastatic colorectal cancer
  • FOLFIRI (5-FU + leucovorin + irinotecan): used for metastatic colorectal cancer

When choosing a chemotherapy regimen, it's important for you and your doctor to consider the evidence (such as clinical studies) supporting its effectiveness and safety. Chemotherapy regimens can have different side effects, and one regimen may be more appropriate than another for your particular circumstances. It's important to be informed about your options, their benefits and risks, and the evidence to support them - speak to your doctor to learn more.

Biological (targeted) therapy
Biological therapies work by changing the way cancer cells behave. They are sometimes called targeted therapies because they target proteins that affect the growth of cancer cells.

In Canada, biological therapies available to treat metastatic colorectal cancer include bevacizumab (Avastin®) and panitumumab (Vectibix®).

Like other cancer treatments, chemotherapy medications and biological therapies may cause side effects. These side effects may be preventable, manageable, or reversible. Speak with your doctor about the risks and benefits of treatment.

Surgery

If the cancer is in an early stage and has not spread, surgery may be used to cure the cancer. If the cancer has spread only to the liver and lungs, it may still be curable with surgery. Surgery is used to remove the cancerous tissue and a small area (called a margin) around it.

After surgery, some people may need adjuvant therapy (to reduce the risk of the cancer coming back) with chemotherapy.

As with other cancer treatments, surgery may cause side effects. Talk to your doctor to learn more about the risks and benefits of your treatment. Knowing what can be expected and that there is help if you do experience side effects will help you feel more in control of your health.

Radiation and laser therapy

Radiation therapy may be used before surgery for rectal cancer to shrink the tumour so it is easier to remove. This is called neo-adjuvant therapy.

Radiation therapy may also be used to relieve pain or bleeding related to the spread of colorectal cancer that cannot be cured. Laser therapy can be used to control bleeding and blockages caused by the cancer's spread.

Like other cancer treatments, radiation or laser therapy may cause side effects. These side effects may be preventable, manageable, or reversible. Speak with your doctor about the risks and benefits of treatment.

Find support

Battling colorectal cancer can be tough. But you don't have to tough it out alone. Support from family, friends, and others with colorectal cancer can help you cope.

Many people with cancer find it helpful to speak with others who have the same condition. Talking to other cancer survivors can also give you hope for your situation. To get support from others with colorectal cancer in a group setting, find a support group in your area.

If you feel more comfortable talking one-on-one to someone, you may also find it helpful to contact your local cancer agency for information on programs and services to help you manage your condition.

You can also contact the Colorectal Cancer Association of Canada (www.colorectal-cancer.ca), which offers information and support for people who are fighting colorectal cancer.

If you are finding coping difficult, don't keep it to yourself. Talk to your doctor or other members of your healthcare team. They can refer you to services available in your area.

Work with your doctor

If you have colorectal cancer, you have a variety of treatment options and decisions to make. Your doctor can help you determine the most appropriate treatment.

Talk to your doctor about your treatment options, including the pros and cons of each option, what side effects to expect and how to manage them, and how they will affect your life.