How to Manage Colorectal Cancer

How do you manage colorectal cancer?

manage colorectal cancerTreatment strategies to manage colorectal cancer depend largely on the stage of the cancer, according to Dr. James Posey.  Early stage colorectal cancer has spread much less than later stages of the disease and may only need one surgery.  Once the cancer has passed through the muscular or outer wall of the colon chemotherapy is often used to reduce the risk of recurrence.

In cases that are more advanced and spread to the lymph nodes or other organs, treatment strategies focus on getting the disease under control and keeping it from spreading further.  These cases and their treatment may take six months or more depending on the response to therapy.

James Posey, MD: How do we manage colorectal cancer? Well as you may imagine, it has a lot to do with what stage of the cancer we are dealing with. In many cases, we use staging terminologies such as stage 1, stage 2 and 3 and 4. Well, we will use another way of characterizing that would be early stage colorectal cancer where the cancer has not gone through the muscular wall and does not involve lymph nodes and it is an early stage cancer.

Often times an operation is the only intervention that is needed. There are patients for whom the tumor has unfortunately gone through the muscular wall of the colon and we think about whether or not to offer adjuvant therapy and we have tests now that can help us with precision of risk of recurrence. These genetic tests can tell us a little bit about that individual tumor in terms of whether adjuvant therapy or treatment that we would give, chemotherapy that we would give to reduce risk of recurrence may be of some benefit.

Moving along, occasionally, the cancer will not only go through the wall of the colon and through the outer lining, but involve lymph nodes. In that setting, we know that giving chemotherapy can reduce the risk of recurrence and we typically would give that for defined period of time. We give chemotherapy in this setting for about six months.

In some cases, the cancer is yet further advanced, its beyond the muscular wall of the colon, its beyond the outer wall either involving the lymph nodes or not involving the lymph nodes, but we find that the cancer is already in other organs such as the liver being a common site or the abdominal cavity or in some cases to lung. In that setting, when we think about treatment, the goal is to get the cancer under control. We want to see it decrease in size, we want to make sure that it does not grow and spread.

So, the duration of therapy in this setting is often times not rigidly defined at six months. We certainly hope and believe that we can get the disease process under control within six months. Often times, we get clues for that much earlier. So, roughly after about six to eight weeks, we begin to think is this cancer that is now advanced or metastatic under control and there are a number of chemotherapy combinations that allow us to hopefully control the cancer and then we can think about from an individual perspective based on where the tumor is located, can we consider other interventions including an operation to eradicate the disease process.

Unfortunately, this is not the case for most patients with advanced disease, but yet there are opportunities in select patients that respond favorably to the chemotherapy where this can be considered. So, we make these distinctions between advanced disease or metastatic disease based on response to therapy. In the earlier stages of the disease process, we think about giving a defined number of treatments to reduce the risk of recurrence.

Dr. James Posey
Dr. James A Posey, III, MD earned his medical degree from Howard University College of Medicine in Washington, DC. He completed his internal medicine residency at Georgetown University Medical Center in Washington, DC. Dr. Posey completed two fellowships -Hemotology/Oncology and Development Therapeutics - at Lombardi Cancer Center, Georgetown University Medical Center in Washington, DC.
Dr. James Posey

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