How We Treat Colon and Rectal Cancers

Treatment for Colon Cancer

The sequence of care if you have colon cancer is:

  1. Diagnosis
  2. Consultation
  3. Staging studies
  4. Surgery
  5. If needed, chemotherapy (if the cancer has spread to the lymph nodes)
  6. Follow-up

Most often, physicians discover colon cancer during a colonoscopy, an outpatient procedure that uses a flexible fiberoptic tube to visually examine the lining of the large intestine. Sometimes a barium enema or a CT scan can also help diagnose colorectal cancer, but usually doctors detect cancer with a colonoscopy.

Our gastroenterologists perform some 15,000 screening, surveillance and diagnostic colonoscopies each year. They check for tumors (cancerous tissue) and for polyps — typically small growths in the intestine that, if not removed, can develop into cancer. Gastroenterologists remove small polyps and take a biopsy, or tissue sample, of any suspicious cells.

Our pathologists examine the polyps and tissue biopsy to determine if the cells are cancerous. If the biopsy confirms cancer, staging is the next step to determine if the tumor is localized (confined to one area) or if the cancer has spread (metastasized) to the lymph nodes or other organs. More radiologic imaging studies may be necessary (such as a CT Scan) along with blood work to gather this information.

The curative therapy for colon cancer is surgery to remove the tumor, the blood supply and the lymph nodes in the area. If your cancer is discovered early, you will most likely be cured with surgery.

Renowned Surgical Expertise

Surgery for colon cancer can either be an open (extended) procedure, or laparoscopic, which uses small keyhole incisions. BIDMC surgeons are acclaimed for their technical proficiency and experience in laparoscopic colectomy, a minimally invasive operation to remove part of the large intestine to treat cancer. Laparoscopic colectomy is one of the more technically challenging procedures in the field of surgery because the colon is not a fixed target, and so the operation is rather like picking up spaghetti with chopsticks. Still, most people are candidates for laparoscopic colectomy — with excellent outcomes at BIDMC — due to our surgical expertise and the volume of procedures we perform.

Studies show that laparoscopic colectomy, because it uses smaller incisions compared to an open procedure, may decrease your risk in developing a hernia or bowel obstruction following surgery. Smaller incisions also mean better pain control and faster recovery.

Advances in Medical Oncology

If the colon cancer has spread to your lymph nodes, then you will most likely need chemotherapy following surgery. You will see a medical oncologist — a doctor who treats cancer with chemotherapy and other drugs. Our medical oncology team is highly specialized and offers access to state-of-the-art clinical trials, and coordinated systemic (chemotherapy) cancer treatment. Not unlike the quarterback on a football team, your medical oncologist will help coordinate the care you need and talk with you and your family about treatment decisions.

Medical oncology uses chemotherapy and other systemic medicines, such as biological therapy, to treat colorectal cancer. Chemotherapy travels through the bloodstream to kill cancer cells. BIDMC has a specialized outpatient medical oncology unit for outpatient oncology evaluation and treatment, and a specialized inpatient medical oncology floor for inpatient oncology care.

You may benefit from standard chemotherapy protocols (drugs and treatment guidelines) that improve the outcome of your particular cancer and symptoms. Or you may qualify for one of our extensive clinical trials - research studies that are designed to find better treatments for cancer patients based on the most updated information from around the country.

As a founding member of the Dana Farber/Harvard Cancer Center (DF/HCC), Beth Israel Deaconess is part of the largest cancer research consortium in the country, with access to a broad array of the most current clinical trials. The BIDMC Cancer Clinical Trials Office coordinates trials in connection with DF/HCC and the Eastern Cooperative Oncology Group (ECOG), among others.

Personalized Follow-Up

If your cancer is in the earliest stage, you have an excellent chance of being cured with surgery. Chemotherapy is necessary only if the cancer has spread to your lymph nodes. Following treatment, we will create an individualized surveillance, or follow-up care plan, just for you. Surveillance studies and physician evaluation will continue at regular intervals for normally up to five years. If your colon cancer does not reoccur in five years, then you are cured. 

Treatment for Rectal Cancer

In our multidisciplinary Rectal Cancer Clinic, a team of physicians — surgeons, oncologists, gastroenterologists, radiologists, pathologists, and nurses among others — collaborate to diagnose and treat tumors and growths of the rectum and anus, including advanced rectal cancer. Rectal cancer is an area where BIDMC's hallmark multidisciplinary approach can significantly improve patient outcomes and maintain quality of life.

Our novel clinic expedites care by completing testing and diagnostic assessment within two weeks of you or your doctor calling for an appointment. This work-up takes place prior to your first visit, so we can generate a comprehensive and individualized treatment plan for you at your first appointment. This plan reflects treatment consensus from all members of our clinic team.

Our clinic's integrated approach to evaluation and treatment helps enhance diagnostic accuracy, promotes stage-based treatment, gives you the broadest range of treatment alternatives, including less invasive options when possible, and customizes the care you receive.

Treatment features minimally invasive and sphincter-sparing surgery, state-of-the-art chemotherapy and radiation therapy, and novel treatment options offered through special research studies called clinical trials. We are especially skilled and highly experienced at performing minimally invasive surgery with sphincter-sparing technique for rectal cancer. In sphincter-sparing surgery, surgeons remove the cancerous part of the rectum but keep the anus sphincter in tact — the circular muscle that controls defecation. Sphincter-sparing surgery preserves normal bowel function.

Most people do not need a colostomy. BIDMC surgeons are noted for our expertise at resecting (removing) the cancerous section of the rectum, and reconnecting the healthy portions, without creating an opening through the abdomen into the rectum for body waste to exit (a colostomy).

Anal cancer is treated primarily by chemotherapy and radiation therapy.

For both rectal and anal cancer, the clinic creates a personalized surveillance (follow-up) program for you. Surveillance studies and physician evaluation will continue at regular intervals for many years.