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How We Treat Colon Cancer

  • The Colon and Rectal Cancer Center at Dana-Farber/Brigham and Women's Cancer Center (DF/BWCC) brings together experts who specialize in treating colon cancer. We see about 1,000 cases of colon cancer a year, and offer patients the most advanced treatments, including innovative surgical procedures, personalized gene-based treatments, and clinical trials for different stages of the disease. Many of these therapies were developed by our own researchers.

    Personalized treatment plans

    Our specialists work closely together to ensure that your care plan offers the best possible outcomes, and that all your needs are met. We view every patient as an individual, with unique needs and expectations, so we take the time to involve you and your family in each step of the treatment process. Your needs and desires guide us in creating a treatment plan that takes into account your lifestyle and personal situation.

    As you go through treatment and recovery, you have access to a wide range of resources – from nutritional services to integrative therapies – to support you and your family.

    Multidisciplinary approach

    An integrated team of medical specialists, nurses specializing in colon cancer, and other support staff collaborate in the management of your care. We work as a large multidisciplinary group to direct your care. Because of our close integration with other specialists, our team offers you their collective expertise when formulating and executing an optimal care plan.

    Your team (including gastroenterologists, medical oncologists, radiation oncologists, surgical oncologists, pathologists, radiologists, nurses, social workers, and nutritionists) works together throughout your entire treatment and recovery, ensuring that your care is highly coordinated.

    Clinical trials and genetic screening

    As a new patient, your tumor will be tested for molecular alterations, the results of which will help form the basis of your treatment. Our specialists are actively involved in research, and they apply the latest knowledge to your care. Our clinical trials are a significant part of our treatment approach, and many of our patients choose to participate.

    Consultations and second opinions

    It is important to be seen quickly if you've been diagnosed with colon cancer so you can start treatment and possibly enter a clinical trial. We provide evaluation and diagnostic services for people who:

    • Have suspected tumors or abnormal test results and want to be evaluated.
    • Have received a diagnosis of cancer and want to be treated at Dana-Farber/Brigham and Women's Cancer Center.
    • Would like a second opinion, including referring doctors throughout the country.

    We regularly consult with patients at all stages of colon cancer. We perform specialized diagnostics and surgery on patients from around the country, who then return to their local hospitals for further treatment.

    Some reasons to consider a second opinion include:

    • To confirm your diagnosis and stage of disease.
    • To determine the optimal therapy.
    • To learn more about your cancer from a specialist who has treated other patients like you.
    • To learn if you're eligible for a clinical trial or targeted gene therapy.

    Our team often coordinates with providers at other hospitals to:

    • Conduct specialized scans.
    • Recommend a treatment plan.
    • Perform surgery.
    • Continue in an advisory role.
    • Conduct genetic profiling.
    • Evaluate if a patient may be eligible for a clinical trial.

    Phone: 877-442-DFCI or 877-442-3324
    Online: Complete the Appointment Request Form
    If you cannot travel to Boston in person, you can take advantage of our Online Second Opinion service

    Treatment for colon cancer

    There are several types of treatments, from standard therapies to those being tested in clinical trials.

    Standard treatments include:

    Surgery

    Surgery (removing the cancerous growth in an operation) is usually the key component of treatment for most patients with colon cancer. It is the most common treatment for people with all stages of colon cancer. Our colorectal surgical team is one of the most experienced in the country.

    • Advances in understanding colon cancer, such as making sure enough lymph nodes are removed during the operation, have made surgery more likely to be successful.
    • Our gastrointestinal surgeons specialize in colorectal cancer.
    • Our surgical nurses specialize in gastrointestinal and colorectal procedures.
    • Our ostomy nurse team works with patients who need a temporary or permanent ileostomy or colostomy.

    A surgeon may remove the cancerous growths through:

    • Local excision: If the cancer is found at a very early stage, the surgeon may remove it without cutting through the abdominal wall. The surgeon may put a tube through the rectum into the colon to cut the cancer out. This is called a local excision. If the cancer is in a polyp, the operation is called a polypectomy.
    • Resection of the colon with anastomosis: Part of the colon containing the cancer and nearby healthy tissue is removed, and then the cut ends of the colon are joined.

      colon resection illustration

    • Resection of the colon with colostomy: If the doctor is not able to sew the two ends of the colon back together, an opening is made on the outside of the body for waste to pass through. This is called a colostomy.

    Dedicated colorectal surgeons use a variety of innovative techniques, including minimally-invasive and robotic surgeries using laparoscopic techniques.

    Even if the doctor removes all the cancer possible during an operation, you may be given chemotherapy or radiation therapy to eliminate any remaining cancer cells. This treatment aims to lower the risk that the cancer will come back. It is called adjuvant therapy. Your surgeon and medical oncologist will discuss with you whether adjuvant therapy is advisable.

    If your cancer has spread, you may have surgical treatment options. There are times when a metastasis can be removed, and we have a team of surgical oncologists that specialize in the removal of metastases from the liver. Being able to identify which patients are candidates for surgery is essential in order to optimize outcomes. Dana-Farber/Brigham and Women's Cancer Center's team approach includes thorough discussions about which patients with metastatic disease should have surgical removal of metastases.

    In addition to surgery for metastases, there are certain procedures for metastases performed by our interventional radiologists at Brigham and Women's Hospital. Procedures include:

    • Radiofrequency ablation: Radiofrequency ablation is the use of a special probe with tiny electrodes that eliminate cancer cells. Sometimes the probe is inserted directly through the skin and only local anesthesia is needed. In other cases, the probe is inserted through an incision in the abdomen.
    • Cryosurgery: Cryosurgery is a treatment that uses an instrument to freeze and destroy abnormal tissue. This type of treatment is also called cryotherapy.

    Chemotherapy

    When indicated, our medical oncologists use chemotherapy, a cancer treatment that uses drugs to stop the growth of cancer cells, by either eliminating the cells or stopping them from dividing. You may be given chemotherapy or radiation therapy to eliminate any remaining cancer cells. This treatment aims to lower the risk that the cancer will come back. It is called adjuvant therapy. Your surgeon and medical oncologist will discuss with you whether adjuvant therapy is advisable.

    Our 25 medical oncologists are national leaders in improving the use of chemotherapy for colorectal cancer through clinical trials and laboratory research. They are highly experienced in optimizing chemotherapy and reducing side effects, and use their extensive expertise to determine the most appropriate care plan for you.

    While undergoing chemotherapy at Dana-Farber/Brigham and Women's Cancer Center, you will have a medical oncologist and nurse practitioners involved in your care. Our medical oncologists have experience with the latest therapies and have the expertise to tailor these therapies to you for the greatest likelihood of a good outcome.

    • Throughout your treatment, our team of medical oncologists, nurse practitioners, nurses, dietitians, social workers, and other staff will work to minimize the side effects of chemotherapy and maximize your quality of life.
    • Our team will address other symptoms you may be experiencing, such as weight loss and emotional distress.

    Targeted therapy

    Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells without harming normal cells.

    Some targeted therapies used in colon cancer focus on certain changes that occur around tumors, specifically the blood supply to tumors. These therapies are called angiogenesis inhibitors, and they stop the growth of new blood vessels that tumors need to grow and spread.

    Another kind of targeted therapy for colon cancer attacks a protein on the cell – called the epidermal growth factor receptor (EGFR) - that drives cells to divide and spread.

    More and more, targeted therapies focus on specific molecular changes in a patient's individual tumor. Dana-Farber/Brigham and Women's Cancer Center is a leader in precision cancer medicine (also called personalized medicine). You are offered testing of your tumor for genetic mutations. This may help guide your care using standard treatment and also direct you to the right clinical trial to find better therapies for attacking your tumor.

    View a slide show about research driving targeted gastrointestinal therapies looking at the genome (DNA).

    Clinical trials

    Our specialists are actively involved in research and apply the latest knowledge to your care. Our many targeted therapies through clinical trials are a significant part of our treatment approach and provide you with the most innovative treatment options, which may not be available elsewhere.

    We typically have multiple clinical trials open at a time for patients with colon cancer.

    What are clinical trials?

    Clinical trials study the safety and efficacy of new treatments or new combinations of treatments. Most of today's standard treatments for cancer are based on earlier clinical trials.

    Some clinical trials include only patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not improved. There are also clinical trials that test new ways to stop cancer from recurring or reduce the side effects of treatment. Patients can enter clinical trials before, during, or after cancer treatment, depending on the design of the trial.

    When you have an initial visit – and throughout the course of your care at Dana-Farber/Brigham and Women's Cancer Center – we will discuss with you whether enrolling in a clinical trial would be good to consider for your specific type of cancer.

    Radiation therapy

    Our radiation oncologists are national leaders in the use and study of radiation therapy. Radiation therapy uses high-energy x-rays to eliminate cancer cells or keep them from growing. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer.

    While radiation therapy is not as commonly used in colon cancer as in other cancer types, there are times when radiation therapy is recommended:

    • After surgery and chemotherapy to further decrease the chance of the cancer returning.
    • To reduce the tumor prior to surgical resection.
    • To help control cancers that cannot be removed surgically.
    • To help symptoms from specific metastases, to reduce pain in that area.

    You will receive a carefully considered, customized plan to use radiation therapy when and where it is likely to be most effective.

    A summary of treatment by stage

    Stage 0
    • Local excision surgery.
    • Resection and anastomosis (connecting colon together). This is done when the tumor is too large to remove by local excision.
    Stage I
    • Resection and anastomosis.
    Stage II
    • Resection and anastomosis.
    • You should meet with a medical oncologist to discuss adjuvant chemotherapy. Many patients with stage II colon cancer don't benefit from adjuvant therapy but you may. This important discussion will help you and your team to make the right decision.
    Stage III
    • Resection and anastomosis followed by chemotherapy.
    • Clinical trials of new chemotherapy regimens after surgery.
    Stage IV
    • Chemotherapy to shrink tumor and improve/control symptoms from the cancer.
    • Targeted therapy with a monoclonal antibody or an angiogenesis inhibitor.
    • Clinical trials of chemotherapy and/or targeted therapy.
    • If you are having symptoms from the cancer in the colon, resection with or without anastomosis or colostomy.
    • For certain patients, surgery to remove parts of other organs, such as the liver, lungs, and ovaries, where the cancer may have recurred or spread. Radiofrequency ablation or cryosurgery may be used if surgery is not an option.

    Supportive resources

    To address all your physical and emotional needs, we encourage you and your family to explore our comprehensive range of support services and integrative therapies.

    Survivorship care

    If you have early-stage colon cancer or metastatic colon cancer in which all the disease has been removed, you will be followed by our medical oncologists and nurse practitioners for several years after your therapy. At the end of treatment, your team will discuss with you what testing should be done, and when, including certain blood tests, imaging, and colonoscopies.

    In addition, our Adult Survivorship Program helps you find expertise, education, and support to manage issues related to surviving cancer. The Survivorship Program works with specialists focused on challenges that you may face. Specialists include those in cardiology, endocrinology, bone health, sexual health, reproductive health, nephrology (kidneys), and exercise physiology.

    Experts at the Colon and Rectal Cancer Center are leaders in studying diet and lifestyle factors in colon cancer survivors. We were the first to report that patients who exercise have lower risk of cancer recurrence. We have completed many studies on the potential benefit of diet and vitamin D in colon cancer survivors. We offer research studies that colon cancer survivors may be eligible to participate in.

    Recurrent colon cancer

    While many new treatments for colon cancer are effective, this kind of cancer can return, despite doing all recommended therapies. Our physician-scientists are studying ways to reduce the risk of recurrence.

    The cancer may come back in the colon or in other parts of the body, such as the liver, lungs, or both. Sometimes surgery can be performed in the area where the cancer came back. However, more often, recurrent colon cancer is treated with chemotherapy and targeted therapy, including clinical trials.

    Your hospital care

    Post-surgical and other inpatient care is provided by your care team at either Brigham Hospital or Dana-Farber's Inpatient Hospital located within Brigham and Women's Hospital.

    All outpatient therapy is provided at the Yawkey Center for Cancer Care at Dana-Farber Cancer Institute, one of the most advanced outpatient cancer centers in the country.

    Radiation Oncology has two separate units, one at Brigham and Women's Hospital and the other at Dana-Farber. These are staffed by 25 radiation oncologists who work at both units.

    For Referring Physicians

    Because you, the referring physician, are an integral part of your patient’s care team, we are committed to collaborating to best care for your patient.

    If you are a physician and have a patient with diagnosed or suspected colon cancer, we look forward to working with you and encourage you to contact us before starting your patient on a treatment regimen. How to refer a patient.

    Colon Cancer Support Services and Follow-up Care

    We understand that cancer treatment can be challenging both physically and emotionally to your whole family. To address all of your and your family's needs, we provide a comprehensive range of support services and integrative therapies.

    We offer individual and family counseling, nutritional counseling, exercise planning, rehabilitation and physical therapy, pain and symptom management, acupuncture, massage, Reiki, and support groups. Our patients, and their families, have access to all of these services, throughout treatment and recovery.

    Nutrition plays a big role during treatment and in post-treatment plans. You work with a registered dietitian to come up with an optimal diet during all stages of your cancer journey, including tips on how food can help with the side effects of treatment. (Watch a slideshow on healthy eating for gastrointestinal cancer patients.)

    If you have had a colostomy, you can work with ostomy nurses, as well as social workers, who can teach you about diet and how to care for your colostomy.

    Managing symptoms and side effects

    We understand that both the symptoms of cancer and cancer treatment are very challenging. We can help you find ways to feel better, managing your symptoms with nutritional guidance, pain management, counseling, integrative therapies, and more.

    Explore additional information, resources, and support for living well beyond cancer.