Your top questions about colon cancer treatment, answered

Have you received a colon cancer diagnosis? There’s a lot think about as you meet with your care team. Here are important facts to find out.

Patient talking to the doctor about colon cancer

A colon cancer diagnosis is a lot to take in. You may be worried. You’re probably wondering what’s next. But first, no matter what stage colon cancer you have, keep this in mind: There are a variety of effective new treatment options that can help.

And there’s even more hopeful news: Breakthrough treatments are being introduced all the time, says medical oncologist David Cosgrove, M.D. That means he can offer his patients hope. “I tell them, ‘Yes, you can get through this treatment and yes, it will be successful,’” he says. “And yes, you will be back to ‘normal’ relatively quickly.”

So ask questions. The more you know, the easier it will be to make important decisions about your treatment plan. “There’s not a one-size-fits-all way to deal with this,” says Dr. Cosgrove.

Are you starting to consider your treatment options? Here are five key questions to ask your care team right now.

1. What stage is my colon cancer?

This is important to know. Each stage has a number from 0 (very early cancer) to 4 (cancer that’s more advanced). The lower the stage, the less likely that your colon cancer has spread to other parts of your body, according to the American Cancer Society (ACS).

Your cancer stage helps your doctor decide what kind of treatment you need, says Dr. Cosgrove. First, they may need more tests or images. A CT scan or an MRI, for example, can show exactly where the cancer is. “You want to be as certain as you can about the extent of the disease when you start out on a treatment path.”

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2. What are my treatment options?

That depends on your cancer stage and your overall health. Your cancer care team may recommend one type of treatment or a combination of a few. Here are some possibilities:

Surgery: Surgery is the most common treatment for colon cancer at any stage, according to the National Cancer Institute (NCI). For 35% to 40% of people with colon cancer, it’s the only treatment they’ll need, says Dr. Cosgrove.

There are several types of surgery:

Local excision: This procedure is done to remove early-stage cancers. The surgeon puts a tube with a cutting tool at the end through your rectum and into your colon. Recovery times are quicker because your surgeon doesn’t have to cut through your abdominal wall, according to the ACS.
Colectomy: Your surgeon makes a cut through your belly and then removes part of your colon and some nearby lymph nodes. (Those are small bean-shaped structures that help your body fight infection.) The surgeon then reconnects the healthy parts of your colon.
Colostomy: If your surgeon can’t reconnect your colon, you may need an ostomy. That’s a hole in your belly from your bowel. It lets you release stool into a bag. Usually, it’s temporary. It gives your colon and rectum time to heal. “The majority of patients going through colon cancer surgery don’t require a long-term ostomy anymore,” Dr. Cosgrove says.

Chemotherapy: A combination of surgery and chemotherapy is a common treatment for colon cancer, according to the American Society of Clinical Oncology (ASCO). Chemotherapy uses drugs to kill cancer cells. You can take chemotherapy pills at home. Or you can go to the hospital or clinic, where you’ll receive medicine through an intravenous (IV) tube placed in a vein.

You might have chemotherapy before surgery to shrink a large tumor. But most often, it’s done after surgery, says Dr. Cosgrove. That may be recommended if your cancer is larger or has spread to your lymph nodes.

Radiation: Radiation therapy uses powerful x-ray beams to kill cancer cells or to shrink a large tumor. It’s not a common treatment for colon cancer, but it may be used in certain cases. For example, radiation can help shrink a tumor before surgery to make it easier to remove, says the ACS.

Immunotherapy: Your doctor will give you special drugs that help your immune system kill cancer cells. It’s usually used for later stages of colon cancer.

Targeted drug therapy: These drugs attack your cancer cells. Targeted therapy can be used by itself or with other treatments, such as chemotherapy, surgery, or radiation.

Ablation or embolization: Your doctor may use this process if your colon cancer has spread to other areas of your body, like your liver or lungs. It uses heat or energy to kill cancer cells. These might also be good options if your tumors come back after surgery or if your cancer can’t be cured with surgery.

3. How long will my treatment last and how long will it take to recover?

It’s different for everybody and for each type of treatment.

Surgery: Expect to spend a few days in the hospital and a couple of weeks recovering, Dr. Cosgrove says. During the first few weeks after surgery, you’ll have some post-surgical pain and may not be able to work. But most people feel back to normal within a few weeks.
Chemotherapy: Chemotherapy treatment may last about three to six months. (Maybe longer if you have advanced colon cancer.) Many people can work part time during chemotherapy, but some have stronger side effects that make working difficult. Dr. Cosgrove says most people recover within a few weeks to a few months after chemotherapy.
Radiation: Treatment can last for several weeks. Most people feel fairly normal early on, but you may feel fatigue later in your treatment.
Colostomy: If you had a temporary colostomy after colon cancer surgery, it usually takes about six to eight weeks to heal.

4. What side effects can I expect?

Many colon cancer treatments have side effects. The good news? “Each of the treatments have continually improved over time,” says Dr. Cosgrove. Plus, he points out, there are anti-nausea pills to help with chemotherapy side effects. But you still might have some issues.

Pain after surgery is common, but usually can be controlled with medication. Other surgical side effects include diarrhea or constipation.

With chemotherapy, the side effects depend on the type of chemotherapy drugs and how long you take them. In addition to nausea, you may also experience hair loss and fatigue.

Many radiation side effects go away after treatment is over. “Fatigue is the big issue,” says Dr. Cosgrove. Others include skin irritation and diarrhea.

5. Should I get a second opinion?

Lots of people do. Maybe you’re puzzled about which treatment to choose. Or you may worry that you haven’t explored all your options, says the ACS. The best reason of all: You want to put your mind at ease.

“Most oncologists encourage patients to have that second opinion,” says Dr. Cosgrove. “In the very early stages of colon cancer, there’s usually a standard surgery plan. But in later stages, there may be clinical trials or different ways to combine chemotherapies that might work better.”

And don’t worry about hurting your doctor’s feelings, says Dr. Cosgrove. “Your treatment team is used to this.” Feel free to keep asking questions as you get a treatment plan in place. Your care team will be there to support you in the weeks and months ahead.

Additional sources:
Colon cancer stages: American Cancer Society
Surgery statistic: National Cancer Institute
Local excision facts: American Cancer Society
Chemo and surgery statistic: American Society of Clinical Oncology
Radiation: American Cancer Society