Colon Cancer

Treatment

At Mayo Clinic, a dedicated team of colorectal specialists works collaboratively to design comprehensive, innovative and individualized treatment regimens for each patient. Depending on the location and stage of cancer, therapeutic options may include surgery, chemotherapy and minimally invasive ablative procedures.

Polypectomy

Mayo Clinic endoscopists remove most precancerous polyps during colonoscopy. Large polyps and those that can't be safely reached are removed surgically using minimally invasive techniques. Once a polyp is eliminated, it can't recur, but you have a moderate chance of developing new polyps in other areas of your colon in the future. For that reason, follow-up care is extremely important.

Surgery

Surgery is the main treatment for most colon cancers. At Mayo Clinic, surgeons perform the great majority of colon cancer surgeries using minimally invasive (laparoscopic) techniques. Mayo physicians have been at the forefront of the study and use of laparoscopic surgery for colon cancer and perform hundreds of these procedures every year.

Unlike traditional open surgery, which uses a long abdominal incision, laparoscopic surgery is performed through several small incisions that require just a stitch or two to close. The long-term outcomes for laparoscopic and open surgery are similar, but laparoscopic surgery offers important benefits to patients, including less post-operative pain, a shorter hospital stay — usually three days as opposed to a week or more — and a faster overall recovery.

How much of the colon is removed depends on the location of cancer and how far it has penetrated into the wall of the bowel. Mayo Clinic colorectal surgeons remove only the portion of the colon that contains the tumor as well as nearby lymph nodes. They then reconstruct the bowel by connecting the healthy segments of your intestine. Within a few months, you should regain normal bowel function, although you may have more frequent bowel movements than you had before surgery. Advanced nerve-sparing techniques help preserve urinary and sexual function, even in patients who undergo extensive resections.

Mayo Clinic is one of the few institutions where surgeons from different specialties remove tumors from more than one organ during the same operation. For instance, when colon cancer spreads to the liver, a colorectal surgeon and an expert in hepatobiliary (liver) surgery may work together to remove the cancer. By undergoing a single operation, you experience less trauma, recover more quickly and have a better long-term prognosis.

Chemotherapy

Depending on the stage of cancer, Mayo Clinic physicians may recommend chemotherapy after surgery. By eliminating microscopic cancer cells that may have escaped into neighboring tissues, chemotherapy reduces the chance that cancer will recur. For cancer that has spread through the colon wall and invaded the liver — the most common site of colon cancer metastasis — doctors at Mayo Clinic may give chemotherapy before other treatments. This approach helps shrink liver tumors so that they can be removed surgically or treated with ablative therapies.

At Mayo Clinic, tumor biomarker analysis helps determine which treatments will be effective for patients receiving targeted cancer therapy. Targeted medications work differently from traditional chemotherapy and are usually used along with chemotherapy to treat advanced disease. A number of studies, including some conducted at Mayo, have shown that people whose tumors carry a mutation on a particular gene known as the KRAS gene do not respond to certain targeted cancer drugs. By testing for the KRAS mutation, Mayo physicians avoid treatment regimens that won't benefit this group of patients.

Ablative therapies

More than half of colon cancer patients with advanced disease develop liver tumors. When surgery isn't an option, Mayo physicians often use minimally invasive ablative therapies to destroy cancer cells in the liver.

• Radiofrequency ablation: In this nonsurgical procedure, Mayo Clinic interventional radiologists, guided by ultrasound or CT scans, insert a needle probe through your skin and into the liver tumor. Low-frequency radio energy delivered through the needle generates enough heat to destroy abnormal cells, while sparing surrounding healthy tissue. The treatment is safe and effective for small tumors — those less than 4 centimeters — and has a very low complication rate. In some cases, radiofrequency ablation may be combined with surgery. After treatment, you're followed closely with frequent imaging tests to ensure that any recurring tumors receive prompt care.
• Cryotherapy: Mayo Clinic is one of a handful of institutions in the United States offering cryotherapy, which uses liquid nitrogen or carbon dioxide to freeze cancer cells. Like radiofrequency ablation, the procedure involves inserting a needle probe through your skin into the tumor. Sub-zero gas circulating inside the closed needle tip freezes and destroys targeted cancerous tissue, which is then naturally absorbed by your body.

Lifestyle counseling

Mayo Clinic physicians use all possible measures to reduce the chance that cancer will return after treatment. That includes advising patients about lifestyle changes that can help prevent colon polyps, such as:

• Limiting or eliminating red meat
• Quitting smoking
• Getting regular exercise
• Drinking alcohol in moderation, if at all
• Supplementing your diet with calcium and vitamin D