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*

STAGE	SURGERY	CHEMOTHERAPY / BIOLOGICS / IMMUNOTHERAPY	RADIATION	INTERVENTIONAL RADIOLOGY
Stage 0	Yes	No	No	No
Stage 1	Yes	No	No	No
Stage 2	Yes	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 3	Yes	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 4	Yes, 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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