Personalized Treatment Options

Colon Cancer Surgery

Minimally Invasive Colectomy:

• Laparoscopic Surgery - Small incisions, faster recovery

• Robotic Surgery - Enhanced precision and visualization

• Traditional Open Surgery - When needed for complex cases

Types of Colon Resection:

• Right hemicolectomy (right colon tumors)

• Left hemicolectomy (left colon tumors)

• Sigmoid colectomy (sigmoid colon tumors)

• Subtotal colectomy (multiple tumors or Lynch syndrome)

Lymph Node Removal:

• Adequate lymph node harvest (minimum 12 nodes)

• Determines accurate staging

• Guides adjuvant therapy decisions

Rectal Cancer Surgery

Sphincter-Preserving Surgery:

• Low anterior resection (LAR)

• Ultra-low anterior resection

• Coloanal anastomosis

• Goal: Preserve bowel function and avoid permanent colostomy

Advanced Techniques:

• Transanal Minimally Invasive Surgery (TAMIS) - For early rectal tumors

• Transanal Total Mesorectal Excision (TaTME) - For low rectal cancers

• Robotic-Assisted Surgery - Improved access to narrow pelvis

When Permanent Colostomy May Be Needed:

• Very low rectal tumors involving the sphincter

• Emergency surgery for obstruction or perforation

• Poor sphincter function before surgery

• Patient preference

Surgery for Metastatic Disease

Liver Metastases:

• Hepatic resection (removal of liver tumors)

• Ablation therapy (RFA, microwave)

• Combination approaches

• Portal vein embolization to grow remaining liver

Lung Metastases:

• Pulmonary metastasectomy

• Wedge resection

• Lobectomy when needed

Peritoneal Metastases:

• Cytoreductive surgery (CRS)

• Hyperthermic intraperitoneal chemotherapy (HIPEC)

Chemotherapy

Adjuvant Chemotherapy (After Surgery)

For Stage III and high-risk Stage II colon cancer:

• FOLFOX (5-FU, leucovorin, oxaliplatin)

• CAPOX (capecitabine, oxaliplatin)

• Duration: 3-6 months

Neoadjuvant Chemotherapy (Before Surgery)

For selected cases:

• Shrink tumors before surgery

• Treat micrometastatic disease early

• Assess tumor response to therapy

Chemotherapy for Metastatic Disease

First-line options:

• FOLFOX or FOLFIRI

• CAPOX

• Combined with targeted therapy

Targeted Therapy

Anti-VEGF Therapy (Blocks Blood Vessel Growth)

• Bevacizumab (Avastin)

• Ramucirumab (Cyramza)

• Ziv-aflibercept (Zaltrap)

Anti-EGFR Therapy (For RAS Wild-Type Tumors)

• Cetuximab (Erbitux)

• Panitumumab (Vectibix)

Multi-Kinase Inhibitors

• Regorafenib (Stivarga)

• Trifluridine/tipiracil (Lonsurf)

BRAF Inhibitors (For BRAF-Mutant Tumors)

• Encorafenib with cetuximab

Immunotherapy

For MSI-H/dMMR Tumors (10-15% of colorectal cancers):

These tumors respond exceptionally well to immunotherapy:

• Pembrolizumab (Keytruda) - First-line for metastatic disease

• Nivolumab (Opdivo) - Alone or with ipilimumab

• Dostarlimab (Jemperli) - For dMMR tumors

Remarkable Results

Immunotherapy provides long-lasting control for MSI-H colorectal cancers, including complete responses in some advanced cases.

Precision Medicine

Molecular Profiling Guides Treatment:

• RAS/BRAF mutation status determines targeted therapy options

• MSI/MMR status predicts immunotherapy benefit

• HER2 amplification identifies additional treatment options

• Comprehensive genomic profiling matches patients to clinical trials

Radiation Therapy

Neoadjuvant Radiation for Rectal Cancer

Short-Course Radiation:

• 5 fractions over 1 week

• Surgery within 1 week

• For selected T3 tumors

Long-Course Chemoradiation:

• 25-28 fractions over 5-6 weeks

• Combined with chemotherapy (5-FU or capecitabine)

• Surgery 6-12 weeks after completion

• Allows tumor shrinkage and downstaging

Benefits:

• Reduces local recurrence risk

• May allow sphincter preservation

• Can downstage tumors

• Improves surgical outcomes

Brachytherapy

• High-dose radiation delivered directly to tumor

• Short treatment course (4 days vs. 5 weeks)

• Organ-preserving approach for selected patients

Palliative Radiation

• Relieves pain from bone metastases

• Controls bleeding from primary tumor

• Reduces obstruction