Colorectal cancers form in the digestive tract. The digestive tract begins at the mouth, where food enters, and ends where digested food exits our body through the anus. The large intestine is the last 6 feet of this passageway. The large intestine is mostly colon, and the last small section is the rectum. 

Colon and rectal cancers often have many of the same symptoms, but treatments can look very different. That’s why our specialists meet weekly to choose the best therapy for each person.

What are colorectal polyps?

Colorectal cancers begin as tiny fleshy growths from the cells lining the intestines, called polyps. As you age, it’s common to develop polyps in the colon or rectum. These start out benign, or noncancerous, and typically grow very slowly.

Certain types of polyps can turn into cancer. Polyps that are more likely to be cancerous include:

• Villous adenomas
• Serrated polyps
• Polyps larger than 1 centimeter
• Polyps that show signs of abnormal cells
• Three or more found at a time

Colorectal cancer screening

The way we avoid colorectal cancer is to find polyps early on with routine colorectal cancer screening. If everyone followed the colorectal cancer screening guidelines, this disease would be nearly eradicated.

Removing a polyp stops it from progressing to cancer. Any time you catch a cancer early you can simplify the treatment and improve your chances of long-term survival. Ask a Carilion doctor what kind of colorectal cancer screening makes sense for you.

During a colonoscopy, your doctor will take a sample of the polyps or tumors they find. Specialists called pathologists analyze this sample to identify your polyp or cancer type. Each person’s cancer is unique, and the cells give us clues to what cancer treatments are most likely to cure your cancer.

The following types of colon and rectal cancer are the most common:

• Adenocarcinomas: These cancers start in mucus cells that lubricate the inside of your colon and rectum. 
• Carcinoid tumors: These start in hormone-making cells in your intestine. Most carcinoid tumors grow slowly, but some can multiply and spread quickly.
• Lymphomas: These are cancers of immune system cells that can start in your colon, rectum, or other organs.

Rarer types of colorectal cancers include sarcomas that start in the blood vessels, muscles, or connective tissues. Another very rare type of colorectal cancer is gastrointestinal stromal tumors that start from nerve cells.

Depending on how advanced your cancer is, colorectal cancer can have many different treatment options. At Carilion, our experts work with you to decide the best course of treatment.

The exact order of treatment varies person to person. In some cases, doctors will do rounds of cancer medicine and radiation before surgery. Other times the surgery is first.

Cancer surgery

Surgery is one of the main ways we treat colorectal cancer.

Surgical options include:

• Polypectomy: This is surgery to remove polyps.
• Colectomy: This is surgery to remove your cancer and part, most, or all of your colon.
• Complete mesocolic excision: This is surgery to remove the tissue and lymph nodes surrounding your colon.
• Colostomy and ileostomy: These are surgeries to help your body get rid of waste through an opening in your stomach wall. They can be temporary or permanent.
• Rectal surgery: This is surgery to remove cancer from your rectum.

Cancer medicines

Cancer medicines are another main way we treat colorectal cancer. A medical oncologist oversees treatment with cancer medicines. 

As opposed to surgery, a cancer drug travels through the body seeking to kill or control the growth of colorectal cancer cells. For colorectal cancer, we can give most of these drugs through an IV in your vein or a pill. 

Options for cancer medicines include:

• Non-targeted therapy: Medicines like chemotherapy kill fast-growing cells all over the body.
• Targeted therapy: Some cancer cells have an “Achilles’ heel.” Targeted medicines use this weakness to kill the cancer cells and leave healthy cells relatively untouched.
• Immunotherapy: Medicines that boost your immune system to fight cancer cells. In rectal cancer especially, immune therapy can be the most potent weapon we use.

Radiation therapy

We use high-energy rays to target and kill cancer cells. We aim the radiation at the cancer cells to stop their growth and shrink the tumor. Sophisticated machinery, scanners, and molding devices ensure the cancer is the target, not the surrounding healthy cells.

Our radiation oncology team works with the other cancer specialists to devise a plan for every person fighting this cancer. Cancers arising in the rectum will typically receive radiation as part of the treatment plan. Cancers of the colon do not.

Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy

On occasion colorectal cancer can escape the intestine and finds its way to the abdominal cavity, which holds all of our inner organs. When cancer gets into this space, there's a very specialized treatment available at Carilion called cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC) that can be lifesaving. 

This 2-step procedure combines a complex surgery to remove as much of the cancer as is possible and then heated chemotherapy is applied inside the abdomen. This treatment is difficult to perform, and also to receive, but can be effective when other options aren’t working.

Clinical trials

Clinical trials are another way to fight cancer. We usually compare a new medicine or protocol to the current best therapy in a trial. Your care team may ask you to consider a trial when they’re studying a new and exciting way to treat your cancer.

These studies are voluntary; you'll talk to your care team before enrolling. A trial can be a first treatment option or an option if your treatment stops working.