Colorectal cancer is the third most commonly diagnosed cancer worldwide and the fourth leading cause of worldwide cancer-related death. Risk factors for colorectal cancer include a low-fiber/high-fat diet, increasing age, male gender and genetic mutations. This cancer is often very insidious in development, with no apparent symptoms other than fatigue, anemia, and altered bowel function; none of these are exclusive symptoms in the elderly population struck so often. Treatment of this disease has improved radically in recent decades.
Surgical Treatment
Surgical resection of the affected colon segment is the primary curative therapy. It may include the associated lymphatics that often aid the tumor in spreading, and the liver is frequently examined during surgery as it is a primary organ of metastasis. Newer research supports the use of laparoscopic technology whenever possible as opposed to the classic "open" approach. This is due to benefits like decreased pain, improved lung function and more rapid return of bowel function after the operation. Surgery can also be done for palliative purposes in cases of metastatic cancer when the tumor is causing obstruction, bleeding or other symptoms if treatment would increase the patient's quality of life.
Medical Treatment
Often medical adjuvant therapy is initiated after surgery, especially in cases of colorectal cancer that is spreading to and beyond the lymph nodes (Stage III). Chemotherapeutic agents employed include 5-FU, leucovorin, and oxaliplatin, which constitute the current standard of care. Treatment includes different combinations and lengths of treatment using these chemotherapies; the clinician dealing with the individual patient can best assess which exact regimen will be most beneficial. Chemotherapy can also be used as primary treatment for metastatic disease to increase survival time, but it is not curative. It also has significant side effects that can impact compliance and quality of life for patients who are already suffering.
Radiation Therapy
Radiation therapy is also employed, but its role is not clearly defined in treatment of colorectal cancer. Currently, it is often combined with chemotherapy drugs and used on selected patients with cancers at increased risk of local recurrence.
Palliative Therapy
This form of therapy, also known as "terminal," is used on patients with unresectable cancer who have poor survival prognosis. The goal is to not allow treating the disease to take the place of treating the suffering that comes with the illness. Treatment is aimed at conditions such as nausea and vomiting (resulting from the cancer or the chemotherapy and often difficult to treat), relentless pain (from organ and bone spread), obstruction of the bowels and the malnutrition syndrome known as cachexia-anorexia. Regular medical and psychological evaluation is pursued and, while challenging, offers the dying the dignity they deserve and as much comfort as can be obtained with such a terrible illness.
References
- "Abeloff's Clinical Oncology, 4th Edition;" M. Abeloff; 2008
- "Gastroenterology Clinics;" Surgical Therapy for Colorectal Adenocarcinoma; N. Wilkinson and C. Scott-Conner; 2008
- "Surgical Clinics of North America;" Palliating Patients . . . ; G. Dunn; 2006
