This page was reviewed under our medical and editorial policy by
Maurie Markman, MD, President, Medicine & Science.
This page was updated on June 9, 2022.
Treatment for colorectal cancer may include surgery, chemotherapy, immunotherapy and a number of other options. Which would be appropriate for you depends on several factors, including the stage and extent of your disease. The process of treating colorectal cancer often involves the input and expertise of a multidisciplinary care team—a group of doctors who specialize in various fields of medicine related to treating cancer of the colon or rectum. These doctors work together to establish a treatment plan suited to you. As colorectal cancer may be treated using a combination of approaches, different doctors may guide you through these treatments according to their specialty.
The types of doctors involved in your care will depend on your treatment plan, but may include:
In addition to these doctors, you may encounter or meet with other medical professionals, including nurses, pharmacists, psychologists, oncology dietitians and social workers as part of your care team.
Your cancer care team may consider a variety of factors before developing a treatment plan. Your input and preferences are critical in this decision, and you should ask questions about all of your options. Questions to consider include treatment goals and the potential side effects and benefits of each option.
Factors that play a role in determining your treatment plan may include your:
Below, find common treatment options for colorectal cancer.
Surgery is the most common colorectal cancer treatment. Surgery for colorectal cancer may involve removing tumors, removing the affected section of the colon, reattaching healthy ends of the intestines and removing nearby lymph nodes. In rare cases, the entire colon may need to be removed. Patients may receive chemotherapy and/or radiation therapy before and/or after surgery for colorectal cancer. These adjuvant therapies are intended to target cancer cells that may remain after surgery and may help shrink tumors before they are surgically removed.
All surgeries have potential complications. Pain and tenderness at the surgical site are common side effects. Some surgeries for colorectal cancer may cause temporary constipation or diarrhea.
Drugs known as checkpoint inhibitors may be used to treat advanced colorectal cancer that have specific genomic features. The U.S. Food and Drug Administration (FDA) has approved certain checkpoint inhibitors to treat patients with inoperable metastatic tumors with microsatellite instability-high (MSI-H) or mismatch repair deficiency (dMMR) genetic features, regardless of where the tumor is located. MSI-H is often found in colorectal tumors, especially in patients with Lynch syndrome, a genetic condition that elevates the risk of colorectal cancer.
Checkpoint inhibitors work by blocking specific checkpoint receptors, which are immune cells that distinguish good cells from bad ones. Immunotherapy is not recommended for all patients, and responses to the treatment vary. Immunotherapy may also be used in combination with other treatments, such as surgery or chemotherapy.
Potential side effects of immunotherapy include:
Chemotherapy drugs are designed to destroy cancer cells or impede their ability to grow and reproduce. Chemotherapy may not be necessary for patients with stage 1 or stage 2 colorectal cancer, but it is a common treatment option for patients with stage 3 or stage 4 disease. Chemotherapy for colorectal cancer may be given intravenously or in pill form.
Neoadjuvant chemotherapy is given prior to colorectal cancer surgery. An oncologist may recommend a combination of chemotherapy and radiation therapy to help reduce the size of a tumor before surgery. This treatment is more common for rectal cancer.
Adjuvant chemotherapy is given after surgery. This treatment may help destroy colorectal cancer cells that remain after cancer removal surgeries and may help lower the risk of recurrent cancer. Adjuvant chemotherapy may help prevent colorectal cancer from spreading to other parts of the body.
The potential side effects of chemotherapy include:
Most chemotherapy drugs used to treat colorectal cancer are unlikely to cause significant hair loss, unlike many other types of chemotherapy.
Radiation therapy may be an option for colorectal cancer treatment for a number of reasons, including:
The potential side effects of radiation therapy include:
Monoclonal antibody therapy is a type of targeted therapy used to treat colorectal cancer. Monoclonal antibodies are bio-engineered proteins that may help leverage the body’s natural immune response to recognize, attack and destroy colorectal cancer cells. Monoclonal antibodies may be used alone or in combination with other treatments, such as chemotherapy.
The potential side effects of targeted therapy may vary depending on the type of drug used. Some targeted therapy drugs may present complications such as rashes, headache, fatigue, fever and diarrhea. Others may cause high blood pressure, bleeding, a high risk of infections, mouth sores and poor appetite. More serious complications may also occur.
It’s important to ask your care team about the potential side effects and complications of targeted therapy before undergoing treatment.
City of Hope may offer clinical trials to qualifying colorectal cancer patients as part of our commitment to offering new and innovative treatment options. Clinical trials are a critical testing ground for determining the effectiveness and safety of new and developing cancer drugs and other treatments. Qualifying colorectal patients may be eligible to participate in a clinical trial at any stage of their disease and/or treatment. Talk to your doctor about whether a clinical trial is an option for you and ask about the risks and requirements involved.
Treatment plans for colorectal cancer depend largely on the cancer’s stage. Surgery is a common treatment option used for earlier-stage colorectal cancers (stage 0, 1, 2 and 3). Additionally, your doctor may choose to combine surgery with a systemic treatment such as chemotherapy to help prevent the cancer from spreading.
Sometimes, cancer returns after scans show no sign of disease. This is called recurrent cancer. Cancer may come back in the same place it started or in another part of the body.
If cancer recurs, you’ll undergo testing again to figure out the cancer’s location and whether it has spread. Then, a treatment plan can be made accordingly.
After you’ve been diagnosed with colorectal cancer, the process of deciding on a treatment plan can be confusing and scary. It’s important to communicate openly with your care team about your preferences and concerns.
When your doctor presents you with a treatment plan, you may want to do some research on the options presented. That way, you can come back with questions and make sure that you understand all of your options.
Some questions you may want to consider asking include: