Treatment of Stage III Colorectal Cancer

This content has been reviewed and approved by

Howard Burris, MD
Director, Drug Development
Sarah Cannon Cancer Center
Tennessee Oncology

Treatment for stage III begins with resection or laparoscopic surgery to remove the cancer.

• Resection - Your doctor will remove the cancer and a small amount of the healthy tissue surrounding the cancer. The doctor will usually sew the healthy parts of the colon together so that your bowel can continue to function normally. This procedure is known as anastomosis. In anastomosis, the doctor often removes lymph nodes near the colon and examines them under a microscope to find out if they have any cancer cells.
• Laparoscopic surgery (also known as keyhole surgery) - In some cases, Stage III colorectal cancer can be treated with laparoscopic surgery. In laparoscopic surgery, the surgeon uses a laparoscope, or tiny telescope connected to a video camera. The laparoscope is put into a narrow tubelike instrument called a cannula, which has been inserted into the abdomen. The laparoscope shows a magnified view of the colon on a monitor. The surgeon inserts several other cannulas to work inside and take out part of the colon. The cuts needed to insert the cannulas are usually small and heal quickly.

If you have rectal cancer, you might be treated with radiation therapy and chemotherapy before surgery. This reduces the chance that the cancer will come back and can make the surgery more effective.

If you have Stage III colon or rectal cancer, you will probably receive adjuvant therapy, or treatment after surgery. The typical recommendation is 6 months of chemotherapy, typically with one or more of the following drugs, either alone or in combination:

• Camptosar^® (irinotecan) - Irinotecan can be used in combination with other chemotherapy drugs, especially fluorouracil (5-FU) and leucovorin, as the first treatment for metastatic colorectal cancer (cancer that has spread to other parts of the body). This combination is known as FOLFIRI for folinic acid, 5-FU, and irinotecan.
  
  
  Some people have an inherited genetic variation that makes it hard for them to tolerate irinotecan. Luckily, a test is available to find out if you have this genetic variation. If you do, your doctor will prescribe a different chemotherapy drug or drugs for you.
  
• Eloxatin^® (oxaliplatin) - This drug can be very effective when it is combined with 5-FU and leucovorin. Sometimes oxaliplatin is combined with both 5-FU and folinic acid. This combination is known as FOLFOX (for folinic acid, 5-FU, and oxaliplatin). FOLFOX seems to be the most effective treatment for colorectal cancer that has returned (recurred) after it was originally treated.
  
• Fluorouracil (5-FU) - This is the drug used most often to treat colorectal cancer. 5-FU is often given with another drug, leucovorin, to make it more effective. Patients usually receive injections of 5-FU over a few days or weeks and then take a few weeks off from chemotherapy. These cycles are repeated over 6 months to a year.
  
• Xeloda^® (capecitabine) - Capecitabine is usually taken by mouth. It actually turns into 5-FU when it gets to the tumor. This drug can be used instead of 5-FU, and it acts as if the 5-FU were being given continuously.
  

You might be treated with radiation therapy if the cancer has spread to tissues next to the colon and rectum. Radiation can help reduce certain symptoms, such as pain.

• External beam radiation therapy (EBRT) - This is the most common type of radiation treatment for people with colorectal cancer. A machine called a linear accelerator directs the radiation at the tumor from outside your body. The treatments last just a few minutes and are given 5 days a week for several weeks