Colon and Rectal Cancer Treatment Guidelines for Patients – Version IV, February 2005

Introduction

With this report, patients have information on the way colon and rectal cancer is treated at the nation’s leading cancer centers. Originally developed for cancer specialists by the National Comprehensive Cancer Network (NCCN), these treatment guidelines have now been written for the general public by the American Cancer Society (ACS). To obtain another copy of these guidelines, call the ACS at 1-800-ACS-2345, or the NCCN at 1-888-909-NCCN, or visit these organizations’ Web sites at www.cancer.org (ACS) and www.nccn.org (NCCN).

These patient guidelines will help you better understand your cancer treatment options. We urge you to discuss them with your doctor and ask the following questions:

• Where is my cancer located?
• How far has my cancer spread? What is the stage of my cancer? How does this stage influence my outlook for cure and survival and my treatment options?
• What treatment options do I have?
• What are the risks or side effects associated with each of my treatment options and how are they likely to affect my quality of life?
• What should I do to be ready for treatment, reduce side effects of treatment, and hasten my recovery?
• What support services are available to me and my family?

In addition to these questions, be sure to write down some of your own. For instance, you might want more information about how long it will take you to recover from surgery so you can plan your work schedule. Or you may want to ask about clinical trials.

Making Decisions about Colon and Rectal Cancer Treatment

Colon cancer and rectal cancer have many features in common. They are often referred to together as “colorectal cancer,” and in some sections of this document, they are discussed together. In other sections, however, colon and rectal cancers are discussed separately to reflect ways in which treatments differ.

Colorectal cancer is the third most common cancer (excluding skin cancer) of both men and women in the United States. The ACS estimates that about 106,000 new cases of colon cancer and 41,000 new cases of rectal cancer are diagnosed each year. About 57,100 people die of colorectal cancer each year.

Most colorectal cancers are adenocarcinomas (cancers of the glandular cells that line the inside of the colon and rectum). The information here refers to colorectal adenocarcinomas only. Other tumors that can involve the colon or rectum, such as carcinoid tumors, stromal tumors, and lymphomas, are much less common. The treatment and prognosis for these rarer types of colorectal tumors differ from that of adenocarcinomas and are not covered on this website.

Although colorectal cancer is a serious disease, it can be treated by a team of health care professionals. The team may include a gastroenterologist, surgeon, radiation oncologist, medical oncologist, pathologist, oncology nurse, social worker, radiologist, and enterostomal therapist. This information is intended to help you understand the treatment options available to people with colon and rectal cancers so that you and your doctor can work together to decide which ones best meet your medical and personal needs.

On this web site you’ll find flow charts that doctors call decision trees. The charts represent different stages of colon or rectal cancer, and each one shows how you and your doctor can arrive at the choices you need to make about your treatment. You will also find information on colorectal cancer, an explanation of colorectal cancer stages, what tests are needed to diagnose and stage your cancer, and treatment options with possible side effects for each option. A glossary of medical terms is also included; words in blue italics are defined in the glossary; you can access their definitions in a small pop-up window by clicking on them.

About the Colon and Rectum

Understanding a little about the normal function and anatomy of the colon and rectum can help you understand how colorectal cancers spread and what is removed by the operations we will discuss later in this report.

Organs of the Digestive System

The colon and rectum are parts of the large intestine, or bowel, which is part of the digestive system. The digestive system processes food for energy and rids the body of solid waste matter.

After food is chewed and swallowed, it travels through the esophagus to the stomach. There it is partly broken down and then sent to the small intestine, also called the small bowel. The small intestine continues breaking down the food and absorbs most of the nutrients. The small intestine joins the colon, a muscular tube about 5 feet long. The large intestine continues to absorb water and mineral nutrients from the food and stores waste matter, called feces or stool. The waste matter left after this process passes out of the body through the anus. The first 4 1/2 feet or so of the large intestine is called the colon, and the remainder is the rectum. The colon has 4 sections. The small intestine is connected to the first of these, called the ascending colon because it extends upward on the right side of the abdomen. The part where the ascending colon joins the small intestine is called the cecum. The second section is called the transverse colon because it goes across the body from the right to the left side. There it joins the third section, the descending colon, which continues downward on the left side. The fourth section is known as the sigmoid colon because of its S-shape. The sigmoid colon joins the rectum, which in turn joins the anus.

Each of these sections of the colon and rectum has several layers (see diagram) .Colorectal cancers start in the innermost layer and can grow through some or all of the other layers. Knowing a little about these layers is important because the stage (extent of spread) of a colorectal cancer depends to a great degree on which of these layers it affects. This is discussed further in the section on Colon and Rectal Cancer Stages.

The lymphatic system carries fluid throughout the body. Lymph is a clear fluid that contains waste products and immune system cells. Lymphatic vessels carry this fluid to lymph nodes (small, bean-shaped collections of immune system cells important in fighting infections). Most lymphatic vessels of the colon or rectum lead to nearby (regional) lymph nodes. Cancer cells may enter lymph vessels and travel to lymph nodes, where they can continue to grow. If cancer cells grow in these lymph nodes, they are more likely to have spread to other organs of the body as well.

The walls of the colon and rectum are nourished by blood from arteries. After flowing through these body parts, the blood flows into veins. Veins from the colon and rectum lead to the liver and then back to the heart. This pattern of blood flow is important, because cells may break off from a colorectal cancer, enter veins leaving these organs, and travel to the liver. This is why the liver is the most common site for colorectal cancer to spread metastasize.

The entire report is also available as a PDF file:
NCCN_Colorectal_Guidelines.pdf 674 k

You will need Adobe Acrobat to read this file.  Click here to download a current version.

COLON AND RECTAL CANCER WORK UP (EVALUATION)

The mutual goal of the National Comprehensive Cancer Network® (NCCN®) and the American Cancer Society (ACS) partnership is to provide patients and the general public with state-of-the-art cancer treatment information in understandable language. This information, based on the NCCN’s Clinical Practice Guidelines, is intended to assist you in the dialogue with your physician. These guidelines do not replace the expertise and clinical judgment of your physician. Each patient’s situation must be evaluated individually. It is important to discuss the guidelines and all information regarding treatment options with your physician. To ensure that you have the most up-to-date version of the guidelines, consult the web sites of the ACS (www.cancer.org) or NCCN (www.nccn.org). You may also call the NCCN at 1-888-909-NCCN or the ACS at 1-800-ACS-2345 for the most recent information.

© 2005 by the National Comprehensive Cancer Network (NCCN) and the American Cancer Society (ACS). All rights reserved. The information herein may not be reproduced in any form for commercial purposes or downloaded and stored in any information-retrieval system without the express written permission of the NCCN and the ACS. Single copies of each page may be printed out for personal, noncommercial use only.