Treatment

• A multidisciplinary approach is recommended.

• Treatment depends primarily on the location of the tumor and the TNM stage.

• Surgery of primary tumor

  • Indicated in any resectable primary tumor with no metastasis or resectable distant metastases

  • Complete resection with clear margins (R0 resection) is associated with the best prognosis.

  • See “Surgery for colon cancer” and “Surgery for rectal cancer” for details.

• Regional lymph node dissection: performed routinely alongside resection of the primary tumor

• Resection of metastases

  • Indicated in patients with resectable metastases (e.g., liver and/or lung metastasis)

  • May significantly improve the survival of patients with limited metastatic disease.

Consider in patients with nonresectable distant metastases to prevent or treat complications of colorectal cancer.

• Intestinal bypass (e.g., ileocolonic anastomosis, colostomy) or enteral stenting for obstructing/occlusive CRC

• Tumor resection to manage immediately life-threatening complications, such as complete bowel obstruction, persistent GI bleeding, or perforation.

• FOLFOX: folinic acid (leucovorin) PLUS 5-fluorouracil (5-FU) PLUS oxaliplatin

• FOLFIRI: folinic acid (leucovorin) PLUS 5-fluorouracil (5-FU) PLUS irinotecan

• CAPOX: capecitabine PLUS oxaliplatin

• Anti-VEGF antibodies (e.g., bevacizumab)

• EGFR antibodies (e.g., cetuximab)

• Rectal cancer: standard treatment modality in most stages of rectal cancer

• Colon cancer

  • Not a standard modality because of adverse effects on the small intestine leading to enteritis and strictures

  • May be used in palliative care to treat bone and brain metastases