Treatment Options for Colorectal Cancer: Treatments Overview

    What are the treatment options for colorectal cancer?

    Treatment for colorectal cancer depends on several factors including the location of the tumor, a patient’s overall health, and the stage of diagnosis. There are many types of cancer treatment including surgery, chemotherapy, radiation therapy, targeted therapy, immunotherapy, clinical trials, and more. Considering all the available treatments can seem very overwhelming, and most patients have many questions.

    Numerous resources for information about cancer treatment exist, but your best resource is your doctor, who knows the specific details about your diagnosis. Discussing your questions and concerns with your doctor is important, so you have the best possible understanding of your cancer diagnosis. You and your doctor should work together to determine the most effective treatment plan for you. 

    Colon Cancer Treatment by Stage

    • Stage 0
      • Surgery is often the only treatment that is needed.
    • Stage I
      • Surgery is often the only treatment that is needed. 
    • Stage II
      • Surgery 
      • Chemotherapy is sometimes recommended if the cancer: 
        • Is high grade (very abnormal cells)
        • Has tested positive for the MSI or MMR biomarker
        • Has grown into nearby tissue or blood or lymphatic vessels
        • Has blocked (obstructed) the colon
        • Has caused a perforation (hole) in the wall of the colon
    • Stage III
      • Surgery 
      • Chemotherapy
      • Radiation therapy is sometimes recommended to shrink a tumor before surgery.
    • Stage IV (metastatic)
      • Surgery is usually only done if the tumor is blocking the bowel.
      • Chemotherapy
      • Radiation therapy is sometimes used to ease symptoms such as pain, bleeding, or intestinal obstructions.
      • Targeted therapy
      • Immunotherapy
      • Liver directed therapy

    Rectal Cancer Treatment by Stage

    • Stage I
      • Surgery is often the only treatment that is needed. 
    • Stage II
      • Surgery
      • Chemotherapy only if the cancer is an advanced stage II
      • Radiation therapy only if the cancer is an advanced stage II
    • Stage III
      • Surgery
      • Chemotherapy
      • Radiation
    • Stage IV (metastatic)
      • Surgery
      • Chemotherapy
      • Radiation
      • Targeted therapy
      • Immunotherapy
      • Liver directed therapy

    Treatment Table*

    STAGESURGERYCHEMOTHERAPY / BIOLOGICS / IMMUNOTHERAPYRADIATIONINTERVENTIONAL RADIOLOGY
    Stage 0YesNo No No
    Stage 1YesNoNoNo
    Stage 2Yes

    IIA, IIB, or IIC with no high risk factors:

    Observation OR 

    Clinical trial OR

    5-FU/LV or capecitabine

    IIA, IIB, or IIC with high-risk features: 

    Observation OR

    Clinical trial OR

    5-FU/LV or capecitabine

    FOLFOX or CapeOx

    		Yes, for rectal cancer. May be given with 5-FU or Xeloda (Capecitabine)    No
    Stage 3Yes

    FOLFOX (5-FU, leucovorin, and oxaliplatin) OR

    CapeOx (capecitabine and oxaliplatin)

    Some patients may get 5-FU with leucovorin or capecitabine alone based on their age and health needs

    		Yes, for rectal cancer. May be given with 5-FU or Xeloda (Capecitabine)    No
    Stage 4Yes, if the tumor is obstructive or blocking the bowel or if there are limited metastases

    FOLFOX: leucovorin, 5-FU, and oxaliplatin (Eloxatin) 

    FOLFIRI: leucovorin, 5-FU, and irinotecan (Camptosar) 

    CAPEOX or CAPOX: capecitabine (Xeloda) and oxaliplatin 

    FOLFOXIRI: leucovorin, 5-FU, oxaliplatin, and irinotecan 

    One of the above combinations plus either a drug that targets VEGF, (bevacizumab [Avastin], ziv-aflibercept [Zaltrap], or ramucirumab [Cyramza]), or a drug that targets EGFR (cetuximab [Erbitux] or panitumumab [Vectibix]) 

    5-FU and leucovorin, with or without a targeted drug 

    Capecitabine, with or without a targeted drug 

    Irinotecan, with or without a targeted drug 

    Cetuximab alone 

    Panitumumab alone 

    Regorafenib (Stivarga) alone 

    Trifluridine and tipiracil (Lonsurf) alone or in combination with Bevacizumab (Avastin) 

    Fruquintinib (FRUZAQLA)

    		Yes, for rectal cancer and in certain other cases    Possibly. Options could be Radio Frequency Ablation (RFA), Stereotactic Body Radiation Therapy (SBRT), or chemoembolization (liver-directed therapy)           

    *Treatments listed are the most common options for colorectal cancer patients.

    Metastatic Colorectal Cancer Treatment Options

    Supplemental therapies for patients with metastatic colorectal cancer (mCRC) depend on several factors, including tumor stage, the presence of high-risk pathologic features, MSI status, patient age, and performance status. This download, updated with support from Taiho Oncology, can help you understand treatment options for a metastatic colorectal cancer diagnosis.

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