In Europe survival from colorectal (bowel) cancer has increased over the past decade largely due to improved treatments and standards of care, however colorectal cancer is the most common type of cancer occurring, with deaths from it only exceeded by those from lung cancer. Treatment for colorectal cancer will depend on the stage to which the cancer has progressed at the time of diagnosis. Therefore each individual patient should have an individualised treatment pathway.
The Function of the Colon/Bowel
The colon is also known as the bowel or the large intestine.
As the last part of the digestive system, the colon’s main purpose is to extract water and salt from solid waste (faeces or stools) prior to the waste being eliminated from the body. The colon tends not to absorb food and nutrients, however it does absorb water, potassium and some fat soluble vitamins.
The colon consists of 4 sections: the ascending colon, the transverse colon, the descending colon and the sigmoid colon.
Surgery is the primary treatment for removing a cancer from the colon. Unlike some other cancers where there are many treatment choices, surgery remains the most common treatment option for treating colorectal cancer. In many cases this approach to remove colorectal cancer is highly successful and can be completely curative if the cancer is caught at an early enough stage.
Many innovations have been made in the way colorectal cancer is treated with of the most effective and patient friendly innovations being the Enhanced Recovery Program.
The enhanced recovery program is about improving patient outcomes and speeding up a patient's recovery after surgery. It results in benefits to both patients and staff. The program focuses on making sure that patients are active participants in their own recovery process. It also aims to ensure that patients always receive evidence based care at the right time.
Outcomes of the enhanced recovery program are:
- Better outcomes and reduced length of stay
- Increased numbers of patients being treated (if there is demand) or reduced level of resources necessary
- Better staffing environment
Much surgical advancement in the treatment of colorectal cancer has also been achieved in particular the reduction in patients required to have a permanent colostomy. (A colostomy is a surgical procedure in which a stoma is formed by drawing the healthy end of the large intestine or colon through an incision in the anterior abdominal wall and suturing it into place).
However, in some cases, the colon cannot be rejoined straight away, and a temporary colostomy is required. For most people, the stoma is temporary and can be reversed after a few months. It is needed only until the colon or rectum heals from surgery. After healing takes place, the surgeon reconnects the parts of the bowel and closes the stoma.
Radiotherapy is the treatment of cancer by deep X-rays. It is more commonly used to treat cancers of the rectum; this may be given before surgery to reduce the size of the tumour. This is called neo-adjuvant treatment. Radiotherapy can be used after the operation to make sure all the cancer cells are destroyed. This is called adjuvant treatment.
Your radiotherapy treatment will usually be planned by an oncologist - a doctor specialising in treating cancer. In planning the radiotherapy, your doctor takes into account the size of the cancer, its sensitivity to radiation and the sensitivity of the surrounding tissues. He or she will also take into account your general health and fitness level.
In some cases surgery alone will not be enough to prevent the cancer from returning and in many cases further treatment may be required in the form of chemotherapy. Your chemotherapy regime will be prescribed by your oncologist. Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. Chemotherapy drugs can stop cancer cells dividing and reproducing themselves; carried in the blood they can reach cancer cells anywhere in the body.
Chemotherapy is normally given in a series of treatment sessions.. Each session is followed by a rest period. The session of chemotherapy and the rest period is known as a treatment cycle. A series of cycles makes up a course of treatment. The aim of having a rest period is to allow normal cells and tissue to recover from the treatment.
Monoclonal Antibodies MAB (Biological Agents)
Monoclonal antibodies are a laboratory produced type of biological therapy and are a different type of treatment to chemotherapy. MAB can locate tumour cells and either destroy them or deliver tumour-killing substances to them without harming normal cells. They may also recruit the body's immune system to attack the target cells. They do this by recognising certain proteins that are found on the surface of some types of cancer cells (known as receptors) and 'locking' themselves onto them.
Personalised Medicine is: “providing the right treatment, to the right patient at the right time by using modern biology’s new methods and tools.”
Targeted/Personalised Treatments for Colorectal Cancer Patients
Biotechnology is providing doctors with more tools which are helping to move from the treatment of diseases to prevention and cure. A whole new range of tools are being developed to support the human body to utilise its own capacities to fight infectious or cancerous diseases as well as injuries. Greater understanding of disease and the causes of disease is helping to produce better therapies that can more effectively address medical needs. New insights into the biology of disease and more precise understanding of why some people react differently lie at the heart of biotechnology. The promise of more targeted/personalised treatments to individual groups of patients as well as providing treatments for diseases that so far have eluded treatment are providing us with new opportunities to meet challenging but common diseases like heart disease, cancer and Alzheimer’s as well as rare diseases.
KRAS is a new biomarker being used to select the best treatment for individual colorectal cancer (CRC) patients. The KRAS gene in a CRC tumor may be 'wild-type' or 'mutant' and this KRAS 'status' will help determine which treatment the patient is given. The test is very simple and uses tissue from the tumour which has already been removed. It should take about a week for you to receive the results.