Treatment

Doctors will need to consider many aspects of both the patient and the cancer in order to decide on the best treatment.

Planning of treatment involves a multidisciplinary team of medical professionals. This usually implies a meeting of different specialists, called multidisciplinary opinion or tumour board review. In this meeting the planning of treatment will be discussed according to the relevant information mentioned before.

The treatment will usually combine therapies that:

• Act on the cancer locally, such as surgery or radiotherapy
• Act on the cancer cells systemically (all over the body) such as chemotherapy and biologic targeted therapy

All treatments have their benefits, their risks and their contraindications. It is recommended that you ask your doctors about the expected benefits and risks of every treatment in order to be informed about the consequences of the treatment. For some patients, several possibilities are available and the choice should be discussed according to the balance between benefits and risks.

Treatment options for patient with colorectal cancer have advanced greatly in recent years and it is very important to be well informed as there are probably several  options available to treat your cancer.

In the past all patients were treated in the same way – ‘one size fits all’ – and all patients with colorectal cancer received the same treatment. However new medicines that are available today are more personalised to the individual.

The planning and type of treatment you will receive depends on several criteria:

• Your medical history and age
• The clinical staging (Stage I – IV) and Tumour Nodules Metastasis (TNM) classification, including the degree of penetration of the tumour through the wall of the colon and the presence, or absence, of lymph nodal involvement (see section on diagnosis)
• The molecular profile of your tumour (for example presence or absence of mutations) (see section on diagnosis)
• The high or low risk of cancer relapse (risk assessment)

Planning of treatment involves the input of a multidisciplinary team (MDT) of medical professionals. This usually implies a meeting of different specialists (oncologist, surgeon, pathologist, radiotherapist…).

These professionals will discuss your situation and it is called a multidisciplinary opinion or tumour board review.

After an MDT meeting, your treating clinician will propose a specific and personalised treatment plan for you and discuss it with you in detail.

The treatment will usually combine therapies that:

• Act on the cancer locally – such as surgery or radiotherapy
• Act on the cancer cells systemically (all over the body) such as chemotherapy and biologic targeted therapy

Your clinician will explain that very early-stage malignancies can be treated with a clearly curative intention.

However in the case of cancers that have metastasised (spread beyond the original cancer site) treatment such as chemotherapy or targeted therapies cannot cure the cancer. Therapy may be helpful in shrinking the cancer, improving or completely eliminating distressing symptoms caused by the cancer for a period of time and helping you live longer. The use of chemotherapy in these situations is called palliative chemotherapy.

All treatments have their benefits, their risks and their contraindications. It is recommended that you ask your doctors about the expected benefits and risks of every treatment in order to be informed about the consequences of the treatment.

For some patients several possibilities are available and the choice should be discussed according to the balance between benefits and risks.

Unfortunately not all treatment options/medicines are available in every country.

Before a treatment starts, talk with your doctor about the goal of any suggested (new) treatments. Talk about your chance of getting better.

Talk to your clinician about your interest in participating in a clinical trial and ask if she or he knows about one that may be a good match for you.

The extent of the treatment will depend on the stage of the cancer, on the characteristics of the tumour and on the risks for the patient.

In this section we will briefly describe the main treatment options for colon and rectal cancer.

Please note that your treating clinician will advise you on the best approach to take. Treatments for colorectal cancer may include any one of the following or in some cases in different combinations.

• Surgery
• Chemotherapy
• Biological (targeted) therapy (including biosimilars)
• Radiation therapy
• Clinical trials
• Treatment stop

There is often more than one treatment available but remember that the extent of the treatment will depend on the stage of the cancer, on the characteristics of the tumour and on the risks for you as a patient.