Our Treatment Approach to Colorectal Cancer

City of Hope brings together the most advanced resources to manage the treatment of patients with early and advanced colorectal cancers. Our team includes gastroenterologists, medical oncologists, radiation oncologists and surgical oncologists working cooperatively to create the most effective treatment plan.

In addition to conventional therapies, our clinical research programs offer patients access to promising new treatments.

Surgery
Surgery to remove cancerous tissue is a primary treatment at all stages of colorectal cancer. City of Hope surgeons are among the most experienced in the U.S. at treating colon cancer, and have excellent success rates using a range of advanced technologies.

Minimally Invasive and Laparoscopic Surgery
Surgery is the primary treatment used for localized tumors. When applicable, our specialists utilize minimally invasive surgery with advanced technologies such as laparoscopy and the new da Vinci S Surgical System with robotic capabilities that allows for greater precision. These surgeries feature small incisions and potentially:
 
  • Less blood loss, pain and visible incisions
  • Shorter hospital stays and recovery time
  • Fewer complications and quicker return to normal activities

One of the following surgical procedures may be used:
 
  • Local excision
    This surgery (sometimes called a polypectomy) is used to remove precancerous polyps and very small colon cancers.
  • Resection
    If a cancer is larger, a partial colectomy (removing the cancer and a margin of healthy tissue around it) may be performed. Lymph nodes near the colon may also be taken out and examined for signs of cancer. Usually, the surgeon will reattach the healthy parts of the colon back together.
  • Resection and colostomy
    In rare cases, the remaining parts of the colon cannot be reattached. Instead, an opening (stoma) is created on the outside of the body for waste to pass through. This procedure, called a colostomy, may be required only for a few months until the lower colon has healed, after which it can be reversed. However, if the entire lower colon needs to be removed, the colostomy may be permanent.
  • Radiofrequency ablation
    This procedure uses a special probe that kills cancer cells with electrical current. The probe may be inserted directly through the skin, or through an incision in the abdomen. Radiofrequency ablation is sometimes used to treat liver metastases from colon and rectal cancers.

Radiation and chemotherapy
Even if the surgeon can remove all signs of cancer that can be seen during an operation, patients may be given additional treatments. These may include chemotherapy or radiation therapy following surgery to kill any residual cancer cells.

Treatment given after surgery is called adjuvant therapy. In some patients with rectal cancer, chemotherapy and radiation therapy may be given before their operation to reduce the size of the tumor. This is called neoadjuvant therapy.

Radiation Therapy
Radiation therapy uses high-energy X-rays or other types of radiation to kill cancer cells. Our Department of Radiation Oncology was the first in the western United States to offer the Helical TomoTherapy Hi-Art System , one of the first radiation therapy systems of its kind to incorporate not only radiation therapy, but also tumor imaging capabilities comparable to a diagnostic computed tomography (CT) scan.

The helical TomoTherapy Hi-Art system integrates two types of technology – spiral CT scanning and intensity modulated radiation therapy, or IMRT – thus producing hundreds of pencil beams of radiation (each varying in intensity) that rotate spirally around a tumor. The high-dose region of radiation can be shaped or sculpted to fit the exact shape of each patient’s tumor, resulting in more effective and potentially curative doses to the cancer. This also reduces damage to normal tissues and results in fewer complications.

Chemotherapy
Chemotherapy drugs destroy cancer cells by interfering with their growth and multiplication. There are several methods by which these cancer-fighting medicines are delivered. In particular, City of Hope has been a pioneer in furthering the use of infusion chemotherapy to treat liver metastases arising from colorectal cancer.

Patients with liver metastases are evaluated for either resection or radiofrequency ablation. During surgery, a continuous infusion pump is placed under the skin to deliver anticancer medicine directly to the liver, in addition to chemotherapy given through a vein. This approach, called regional chemotherapy, has made major advances in controlling the spread of colorectal cancer.

Chemoradiation
Chemoradiation combines chemotherapy with radiation therapy to increase the effects of both. This strategy is often used for rectal cancers.

Heated Intraperitoneal Chemotherapy (HIPEC)
In the HIPEC procedure, the surgeon uses a special machine to pump high doses of heated chemotherapy drugs into the peritoneal cavity (the inner lining of the abdomen) while still in the operating room. The machine circulates the solution through the patient for up to two hours to reliably attack and eliminate any residual cancer cells that may remain after surgery. By bathing the abdomen with heated chemotherapy immediately following surgery, a higher dose of medication can be used than would normally be tolerated by a patient if given intravenously -- the traditional way chemotherapy is administered.

This type of chemotherapy is best at destroying cancer cells that are too small to be seen with the naked eye and prevents these cells from being left behind to form new cancerous tumors in the abdomen. The procedure also improves drug absorption and effect with minimal exposure to the rest of the body. In this way, the normal side effects of chemotherapy can be avoided.