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Treatment of colorectal cancer depends on the location and stage of disease at the time of diagnosis and the person's overall condition and co-existing medical conditions. Options include surgery, chemotherapy, targeted (biological) therapy, radiation or a combination of these treatments.

Chemotherapy and Targeted (Biological) Therapy

Chemotherapy is the administration of drugs to destroy cancer cells. Depending on the drug used, it may be administered intravenously, through injection, or in pill form. Depending on the chemotherapy regimen, treatment may be given in an outpatient clinic or doctor's office, in the hospital hospital, or at home. Rarely, a hospital stay may be needed. The side effects of chemotherapy depend mainly on the specific drugs and the dose and are related to the fact that these drugs tend to affect any cells that divide rapidly (including those in the bone marrow and blood cells, the hair, the digestive tract, and the skin), not just cancer cells.

Chemotherapy that is administered following surgical resection of the tumor is called adjuvant chemotherapy. The goal is to prevent local recurrence or distant metastases and to prolong survival. Neoadjuvant chemotherapyis the use of chemotherapy * prior to* radiation or surgery to reduce the size of the tumor which needs to be irradiated or removed.

Significant progress has been made in chemotherapy options for the treatment of colorectal cancer in the past 10 years. From the late 1950s until very recently, the only drug approved for the treatment of colorectal cancer was fluorouracil. Later, a drug called leucovorin was added to make fluorouracil work more effectively and raised the response rate from 10-15% with fluorouracil alone to 25% when used in combination with leucovorin. The availability of new chemotherapeutic agents has doubled the median overall survival for metastatic colorectal cancer from 10 to 20 months, however, the optimal sequence for administration of these agents is not yet clear and the choice of initial therapy may depend on the person's overall condition and coexisting medical issues.

Chemotherapy for colorectal cancer may include:

• Fluorouracil (also called 5-FU)
• Capecitabine (Xeloda; Roche Laboratories, Inc.) - an oral drug that is converted to fluorouracil in the body. It is usually given twice daily for 2 week cycles, followed by a 1 week break before resuming another 2 week cycle.
• Irinotecan (Campostar, CPT-11; Pfizer, Inc.)
• Oxaliplatin (Eloxatin; Sanofi-Aventis, Inc.)

Newer combination chemotherapy regimens have markedly improved response rates and shown prolonged median survival over fluorouracil/leucovorin and have become the standard approach for metastatic colorectal cancer. In fact, the sequential administration of combined regimens has been shown to improve overall survival significantly.

In recent years, researchers have identified sites in tumor tissue that may serve as specific targets for treatment by interrupting the normal cellular pathways necessary for tumor growth, survival, and metastasis, in addition to reducing the toxic effects associated with chemotherapies. This has led to the development of newer treatments called targeted or biological therapies for a variety of cancers, including colorectal cancer.

Targeted (biological) therapies for colorectal cancer include: