Colorectal Cancer Treatment

Treatment at MD Anderson’s Colorectal Center combines the latest technology and research with a multidisciplinary team approach tailored to your unique needs.  

Our surgeons use minimally invasive techniques that reduce recovery time and maximize your quality of life. 

Your colorectal cancer treatment at MD Anderson may include one or more of the following therapies:

Surgery  

Surgery is the most common treatment for colorectal cancer, especially if it has not spread. As for many cancers, surgery for colorectal cancer is most successful when done by a surgeon with a great deal of experience in the procedure. At MD Anderson, colorectal cancer surgery is performed by surgeons who are specialized in colorectal cancer surgery and are national and international leaders in the field.

The type of surgery depends on the stage and location of the tumor and they include:

Polypectomy: A colonoscope, which is a long tube with a camera on the end, is inserted into the rectum and guided to the polyp. Tiny tools or a wire loop removes the polyp. A polypectomy is ideal for stage 0 and localized colon cancer cases.

Endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD): If a polyp is too large to be removed by traditional polypectomy, an EMR or ESD may be performed. Your doctor will use small instruments inserted through a colonoscope to perform detailed surgery from inside the colon. The polyp and some surrounding tissue will be removed. With this type of advanced endoscopic procedure, major surgery can sometimes be avoided.

Colectomy: In a colectomy, the section of the colon affected by cancer, along with some healthy surrounding tissue and all of the associated lymph nodes, is removed. The lymph nodes will be examined under a microscope to determine if cancer has spread to them. The surgeon then reconnects the remaining sections of the colon back together. This surgery also is called a hemicolectomy or partial colectomy. It can generally be performed with a minimally invasive approach (see below).

Proctectomy: When the cancer is located in the rectum, your surgeon will remove a part of the rectum, along with surrounding tissue containing lymph nodes.  Usually, the colon can be brought down and connected to the remaining rectum or directly to the anus. This is called sphincter preserving surgery and it allows you to retain full control of your bowel movements. Surgeons at MD Anderson are specialized in sphincter preserving surgery.

Pelvic exenteration:  Sometimes rectal cancers can grow into surrounding structures within the pelvis. If that has occurred, it is very important that surgery completely removes the tumor and any other structure that is involved by the tumor altogether. A pelvic exenteration is a highly specialized operation that involves removing any structure affected by cancer, such as the rectum, part of the colon, reproductive organs, or the bladder. Once these structures are removed, your surgical team then performs reconstructive surgery. This may involve creating new pathways for waste to leave your body. Pelvic exenteration is a life-changing procedure that requires expert medical care.

Minimally invasive robotic or laparoscopic surgery:  With minimally invasive surgery, small cuts are made in the abdomen to introduce a tiny camera and surgical instruments into the abdomen.  The surgeon then uses high-definition video imaging, including 3D, to perform the surgery. MD Anderson surgeons are among the most experienced in the world in minimally invasive robotic colorectal cancer surgery.

With minimally invasive surgery, patients can experience faster recovery with less pain. Your doctor will decide whether it is best to perform minimally invasive robotic or laparoscopic or traditional open surgery.

As for many cancers, surgery for colorectal cancer is most successful when done by a surgeon with a great deal f experience in the procedure. At MD Anderson, colorectal cancer surgery is performed by surgeons who are specialized in colorectal cancer surgery and are national and international leaders in the field.

Neoadjuvant and adjuvant therapy

Colorectal cancer may be treated with surgery alone, surgery and chemotherapy, or with surgery, chemotherapy, and radiation. Chemotherapy or radiation may be given:

• Before surgery: This is called neoadjuvant therapy
• After surgery: This is called adjuvant therapy

The purpose of neoadjuvant therapy is usually to shrink the tumor and make both the surgery and recovery process easier on the patient. Adjuvant therapy is used to kill off any cancer cells that might have been missed during surgery, as well as to prevent cancer from recurring.

Chemotherapy

Chemotherapy uses powerful drugs to kill or control cancer cell growth. It is a systemic treatment, meaning that it travels throughout your body to kill cancer cells. MD Anderson offers the most up-to-date and effective chemotherapy options for colorectal cancer.

Chemotherapy drugs are given by mouth (pills) or intravenously (injected into a vein).

Chemotherapy may be used to help:

• Shrink cancer before surgery
• Keep you cancer-free after surgery
• Prolong life when surgery is not an option

Radiation therapy

Radiation therapy uses focused, high-energy photon beams to destroy cancer cells. MD Anderson provides the most advanced radiation treatments, including:

• 3D-conformal radiation therapy: Several radiation beams are given in the exact shape of the tumor
• Intensity-modulated radiotherapy (IMRT): Treatment is tailored to the specific shape of the tumor to reduce damage to normal tissue.
• Proton therapy: A type of radiation therapy that uses protons to target cancer and reduce damage to normal tissue.
• Brachytherapy: Tiny radioactive seeds are placed in the body close to the tumor
• Intraoperative radiation therapy (IORT): IORT is used to treat an exposed tumor during cancer surgery. Surrounding healthy organs and tissues are protected by lead shields or moved out of the radiation field.

Immunotherapy

Immunotherapy uses the body's natural defenses to fight cancer. White blood cells (T cells) that make up the immune system can be stimulated by specially designed drugs that allow them to recognize and kill cancer cells.

In its infancy, immunotherapy used drugs designed to boost the body’s immune system to fight cancer cells. More recently, research has advanced, discovering several proteins on the surface of T cells that act as a brake, or checkpoint, preventing them from attacking cancer cells.

At MD Anderson, our team of specialists are leading studies to harness the immune system to fight colorectal cancer.

Clinical trials

Clinical trials are a key component of MD Anderson's mission to end cancer. Patients may volunteer to participate in these research studies, which help doctors improve cancer prevention, diagnosis, and treatment. 

Some clinical trials allow patients to receive experimental medications or treatments, though not all patients are eligible.

If you're interested, ask your doctor if you might be a candidate for a colorectal clinical trial.