There’s a ton of info that you could learn about your cancer — but not all of this information is relevant when it comes to figuring out which treatments are right for you. So let’s just focus on things that affect your treatment plan.
Read MoreAfter you are diagnosed with colorectal cancer (CRC), your doctor will want to discuss how to treat it. There are two big treatment categories: systemic and local. Systemic treatments are ingested or infused into your body and affect your whole system — like chemotherapy or other drug treatments. Local treatments address a specific organ or tumor, like surgery, radiation, or ablation.
Depending on the type of CRC you have, the treatments you get may vary. In the United States, oncologists make treatment decisions based on their experience and knowledge, as well as The National Comprehensive Cancer Network® (NCCN) guidelines. If you want to know more, the NCCN patient guidelines for colon cancer and rectal cancer can be found here: https://www.nccn.org/guidelines/patients.
For people with early-stage (non-metastatic) colon cancer (stages I, II & III), treatment frequently includes resection (removing the tumor surgically). For early-stage tumors with more advanced disease, this is followed by a minimum of 3 months of chemotherapy (if the tumor has characteristics that indicate that chemotherapy is necessary to get to a cure). Non-metastatic rectal cancer treatment frequently includes radiation too. Stage IV (metastatic) treatment plans may be less straightforward. To learn more, visit the stage IV patient section at the end of this guide.
The very first type of systemic treatment regimen you undergo is called a “first-line treatment.” There may be very promising first-line clinical trials available for newly diagnosed patients who haven’t yet started chemotherapy. So it’s always good to find out if you qualify for these clinical trials early on — as they can be an excellent way to access new treatments or tests.
Your primary tumor is where your cancer originated. For colorectal cancer, primary tumors are found in the colon (colon cancer) or rectum (rectal cancer). This is important to know because treatment plans differ significantly depending on location. For example, rectal tumors often require radiation before surgery, whereas colon tumors do not. Where your tumor is located inside the colon or rectum matters too. For example, rectal cancer in the lower rectum (near the sphincter) is treated differently than cancer closer to the colon. For colon cancer, know if your tumor is in the right side (the end closer to the small intestine, containing the cecum, ascending colon, and most of the transverse colon) or the left side (the end closer to the rectum, containing the descending colon and sigmoid colon).
Determining if your tumor has spread — and if so, how much it has spread — is known as staging. The lower the number, the less the cancer has spread. Although each person’s cancer experience is unique, cancers in the same stages often have a similar outlook, and are treated in similar ways.
Cancer can be found solely in the primary site (stage I and II), spread to nearby lymph nodes (stage III) or spread to organs farther away (stage IV). Tumors that have spread to distant organs are called metastases, or mets. Different stages have differing treatment plans. For example, the best treatment for an early-stage cancer might be surgery, while later stages may require chemotherapy and other drug therapies. For colorectal cancer, it can be difficult to determine whether you’re stage II or stage III using scans alone, so often staging will be determined or confirmed after surgery. In the case of stage II and III colon cancer, surgery will likely be first, while in rectal cancer, there will likely be treatment before surgery. Not to worry though, as treatment before surgery (called neoadjuvant treatment) is usually the same for stage II and III rectal cancer — which together are called ‘locally advanced’. Stage IV treatments will likely focus on the metastases first. More on Stage IV treatment can be found at the end of this guide.
There are two major types of colorectal cancer: MSS and MSI-H.
According to the NCCN guidelines, all newly diagnosed CRC patients should get their tumors tested for MSS/MSI-H status. Finding out which kind of tumor you have can have a big impact on what treatment options are available to you, including clinical trials. If your tumor is MSI-H, then it is recommended that you get tested for an inherited cancer condition called Lynch Syndrome.
