Our Treatment Approach

Colon and Rectal Cancer

World-Renowned Surgeons
Critical Role of Radiology and Radiation Therapy
The Use of Chemotherapy
Avoiding Recurrence and Relieving Symptoms
Clinical Trials and Genetic Screening

World-Renowned Surgeons
Surgery is the backbone of therapy for colon and rectal cancer. It usually results in a cure if all the cancer, surrounding tissue and involved large intestine (colon or rectum) can be removed as one large piece.

Colon and rectal surgeons at the Siteman Cancer Center, who treat an average of 350 new cancer patients a year, are internationally recognized for their expertise. They have pioneered “sphincter-sparing” surgical techniques that allow most patients with rectal cancer to be treated successfully without a colostomy, a procedure that creates an opening in the abdomen for the drainage of stool.

Our surgeons also are leaders in developing minimally invasive laparoscopic surgery techniques to treat colon and rectal cancer. First, they make a tiny incision in the abdomen. Through this hole they insert a thin, lighted tube and long, slender instruments, which they use to perform standard operations without making a large incision.

Even recurrent or metastatic cancer (cancer that has spread) can be treated surgically. Special techniques for liver or pelvic surgery are used to achieve the best cure rates possible for these problems.

Critical Role of Radiology and Radiation Therapy
New radiological techniques, such as positron emission tomography (PET), have made it possible for surgeons to plan aggressive surgical treatments and carry them out in selected patients with excellent success. PET identifies patients who have localized, curable disease and can undergo surgery to remove tumors and a small margin of normal surrounding tissue. Radiation and chemotherapy before surgery often are necessary for these patients. PET also identifies patients who are candidates for liver or pelvic surgery for recurrent or metastatic disease.

The sophisticated procedures used by Siteman surgeons are enhanced by the state-of-the-art techniques used by our radiation oncologists. For instance, they deliver radiation therapy to the rectum and pelvis to shrink rectal tumors and allow sphincter-sparing surgery as well as reduce recurrence and improve long-term survival. Patients with small rectal cancers that would require a permanent colostomy if surgically removed can sometimes be treated by radiation alone. Our physicians have treated one of the largest patient groups in the world using endocavitary radiation, in which radiation is delivered directly to the tumor through a large scope inserted into the rectum.

In addition, our radiation oncologists use external-beam radiation therapy to give higher doses of radiation to a tumor while sparing normal surrounding tissue. Using state-of-the-art equipment, they deliver high doses of radiation to tumors in a precise manner, using CT images of the pelvis and rectum for guidance. This allows them to minimize the amount of radiation received by normal tissues and reduce side effects.

The Use of Chemotherapy
At Siteman, chemotherapy also plays an important role in the treatment of colon and rectal cancers. Data going back nearly 15 years shows that chemotherapy after surgery improves the survival rate of patients with colon and rectal cancer by about 30 percent. For patients with cancer that has spread, there is evidence that chemotherapy can improve survival rate and quality of life.

Over the past five years, several new drugs have increased the number of chemotherapy agents available to treat patients with colon and rectal cancers. Our physicians are conducting a number of studies to discover what combinations of these new treatments have the most impact.

Avoiding Recurrence and Relieving Symptoms
Recurrent colon or rectal cancer can be very difficult to treat. Siteman physicians have achieved outstanding success in avoiding recurrence. Fewer than 5 percent of our patients treated using multiple forms of therapy – including surgery, radiation and chemotherapy – have local recurrence of their rectal cancer.

When local control of the cancer is not possible, patients can achieve best relief from pain, obstruction (food blockage) and symptoms related to wide tumor growth in a multidisciplinary setting that includes Siteman experts in medical oncology, radiation oncology, colon and rectal surgery, gastroenterology, anesthesiology and psychology. Minimally invasive or laparascopic techniques and PET scanning are used to select the easiest method for the patient to overcome the acute problem and start receiving treatment.

Clinical Trials and Genetic Screening
Siteman is actively involved in national and international clinical trials testing exciting new treatments for colon and rectal cancer. In addition, we are conducting ground-breaking research to understand how patients’ genes affect their response to different drugs. This work is helping physicians choose more effective therapies for individual patients.

While investigating the genetics of colon and rectal cancer, all members of our colon and rectal cancer team work closely with medical geneticists and basic science researchers. Patients who may have an inherited form of colon and rectal cancer – such as familial adenomatous polyposis (FAP) or hereditary nonpolyposis colon and rectal cancer (HNPCC) – have access to the latest techniques for diagnosis and treatment. Families can undergo genetic counseling and genetic testing for these diseases and also receive cancer screening tests.