Colorectal cancer is the third most commonly diagnosed cancer in men and women. Patients with these types of cancers often benefit from radiation therapy as part of treatment. Some cancers involving the bowel run within families (hereditary colorectal cancers). It is important to discuss your diagnosis with family members so they can decide with their doctors whether they need to be screened for colorectal cancers. This is especially important if you were diagnosed with a colorectal cancer before age 50 or if there are several other types of cancers that run in your family.
Radiation therapy is often used with surgery and chemotherapy to treat cancers of the colon, rectum and anus. Treatment involves focused radiation to the bowel and pelvis to treat cancer cells in the area. Surrounding healthy tissue can be affected, but normal cells are often better able to heal from radiation injury than are cancer cells.
Frequently, the goal of treatment is “organ-preservation”. With organ-preservation, the part of your body that controls your bowel movements, the anus, is not removed. Radiation therapy is often used in organ-preserving approaches, with the result that you will continue to be able to have bowel movements through your anus. If the anus does have to be removed, you would wear a bag on the outside of your abdomen to collect and store your bowel movements.
- For colon cancer, depending on the location and stage of your cancer, radiation therapy can lower the chance of recurrence.
- For some rectal cancers, radiation therapy is given before surgery, with or without chemotherapy, to make the tumor smaller so it can be removed more easily. In some cases, radiation and chemotherapy are given after surgery instead of before surgery.
- Anal cancer can often be treated with radiation therapy and chemotherapy, as an “organ-preserving” approach that avoids the need for surgery.
Surgery often plays a key role in treatment. For colorectal cancers, it is the main curative treatment. The surgeon will determine how much of the large bowel (the colon) needs to be removed. Because the tumor can spread to lymph nodes nearby, some lymph nodes are often removed at the time of surgery. Depending upon the location of the tumor, surgery may or may not allow normal bowel function afterwards.
For anal cancers, surgery is less frequently used at the time of diagnosis because effective “organ-preserving” approaches with chemotherapy and radiation therapy are available. If bowel function is poor, sometimes surgery is used at first, but often it is reserved as a second chance treatment when “organ-preserving” treatment does not succeed. Because surgery for the anal canal involves removing the area responsible for bowel movements, a surgery called a colostomy to re-route bowel movements to a bag outside of the body is usually necessary as well.
While surgery and radiation focus directly on treating the bowel or pelvic area, medication is often recommended to improve cure rates. A medical oncologist will evaluate you and determine what medications may be most helpful.
Chemotherapy is a kind of medication that can destroy cancer cells by different methods. Often, two or more drugs may be combined for the best results. The dose and schedule for treatment varies. Some chemotherapy may be given once every few weeks, while in other cases it is given daily. It also differs depending upon the type of cancer. For more details about chemotherapy medications, ask your medical oncologist about what treatment options may be best for you.
External beam radiation therapy involves a series of daily treatments that accurately deliver radiation to the area needing treatment. The radiation beam usually comes from a machine called a linear accelerator. Before beginning treatment, you will be scheduled for a session to map out the area to be treated. This will frequently involve having a CT scan. Landmarks placed on your skin (often tiny tattoos) allow the radiation therapists delivering your treatments to position you in the same position each day.
To minimize side effects, the treatments are usually spread out over several weeks, five days a week (Monday through Friday). This allows your doctors to get enough radiation into your body to kill the tumor cells, while giving healthy cells time to recover each day.
Technical terms that may be mentioned for colorectal and anal cancer treatments include three dimensional conformal radiation therapy (3-D CRT), intensity modulated radiation therapy (IMRT) and image guided radiation therapy (IGRT). Your radiation oncologist can provide more information about these different techniques.
Before beginning treatment, you will be scheduled for a planning session to map out the area of treatment. This procedure is called a simulation. Simulation involves having X-rays and/or a CT scan. Tiny tattoo-like marks made on your skin help the radiation therapist precisely position you for daily treatment.
Typically, radiation therapy is done with high energy X-rays, or photons. If needed, electrons may be used to treat the area where the lump was removed with a less penetrating, more focused beam.
Recent clinical trials suggest that whole breast radiation may be shortened by treating the tumor with higher daily doses over less time.
Additional research suggests women aged 70 or older with hormone receptor positive early-stage breast cancer benefit from radiation in terms of lowering their risk of getting breast cancer again in the treated breast but has not been shown to affect long-term survival. Discuss with your radiation oncologist whether treatment with radiation is necessary.
- Side effects that occur are not the same for all patients. Ask your doctor what you might expect from your specific treatment program.
- It is likely you will receive chemotherapy in addition to radiation therapy. The side effects from the chemotherapy will depend on the type being prescribed and how often you are to receive the treatments. Ask your medical oncologist about what chemotherapy side effects you may experience. Side effects often can be controlled with medications or changes in your diet. Tell your doctor or nurse if you experience any side effects, so they can work to help you feel better.
It is important to care for yourself as well as possible during radiation therapy because the normal parts of your body that are near the tumor are also receiving some radiation, although not as much as the cancer. These normal parts of your body need time and support to heal. A balanced diet, mild amount of physical activity and taking time to rest are all important parts of your cancer treatment. Follow your doctor's orders and, if you are unsure of anything, ask your nurse or doctor any question you may have about treatment. Be sure to tell your radiation oncologist about any vitamins or dietary supplements that you are currently taking to make sure they are safe to take during radiation therapy.
During and even after radiation therapy is over, you will need to take special care of your skin. Stay out of the sun, avoid hot or cold packs, and do not use lotions or ointments without checking with your doctor or nurse first. You should also be sure to clean the skin over the areas receiving radiation therapy with warm water and mild soap.
Completing treatment and recovery can be challenging. Seek out help from support groups and friends ahead of time. If you have a support network in place before and during treatment, it will be easier to get through side effects since people you can count on will be around to help you. If you need additional support, let your doctor and nurse know.
*Content provided by the American Society for Radiation Oncology, www.rtanswers.org, and the American Cancer Society.