Any type of cancer is difficult, but when “advanced” is a word used with your diagnosis, it’s important to know that you’ll be cared for by a determined medical team with treatments that are more advanced than your disease. You’ll find these innovations at the OSUCCC – James.
What is advanced colorectal cancer?
Once colorectal cancer spreads to other parts of your body, your diagnosis will be considered “advanced.”
You might also hear it referred to as metastatic or stage IV colorectal cancer.
Within stage IV colorectal cancers there are additional defining factors:
- Stage IVA is when your cancer has spread to a single distant organ, such as lungs, ovary, liver or distant lymph node.
- Stage IVB is when your cancer has spread to more than one distant organ or part of the body.
- Stage IVC is the term used when your cancer has spread to the peritoneum or tissue that lines the walls of your abdomen and/or other organs and areas in your body.
Defining your stage simply helps your medical team develop a more targeted approach to your care.
Recurrent colorectal cancer
As a slightly different diagnosis, if you’ve had a previous case of colorectal cancer and it reappears in your colon or rectum and not other parts of the body, it would instead be called recurrent colorectal cancer.
Where in the body does metastatic colorectal cancer usually spread?
While the cancer may have started in your colon or rectum, it can spread to distant parts of your body. Most often this is to the liver, but other common spots include the lungs, bones, brain, ovaries, spinal cord or distant lymph nodes.
Because the OSUCCC – James has a range of specialists treating nearly every kind of cancer, this gives your cancer team an advantage. They have medical partners and research teams exploring advancements in all kinds of cancer.
You can also access a full range of cancer support services depending on your treatment side effects and the challenges that you face. As examples, we offer cancer rehabilitation and pain management services, financial assistance, a specialized pharmacy and a Patient and Family Resource Center. Older patients can ask for a referral to our Cancer and Aging Resiliency Clinic for additional evaluations by a nurse, pharmacist, case manager, nutritionist, physical therapist, audiologist and physician all in one visit.
Treatment options for advanced colorectal cancer
Even after your cancer moves to another organ or part of your body, it’s still considered colorectal cancer because it started in your colon or rectum. Adding the word advanced simply indicates this spread.
For most patients, an advanced diagnosis comes years after previous successful treatment for colorectal cancer. Although all signs of the disease may have been eliminated during those initial rounds of treatment, it’s possible that a few cancer cells remained dormant or undetectable — even by powerful scans — before they began growing again somewhere else in your body.
Although a cure is more difficult at this advanced stage, there are treatments that can help you continue enjoying your favorite activities as much as possible.
Our experts at the OSUCCC – James use a multidisciplinary approach for your cancer care. Your care plan may include multiple types of treatment. Our focus will be on delivering the best outcome in a way that’s not only effective, but well tolerated.
Surgery
Whenever possible, colorectal cancer tumors are removed surgically. For large tumors, we may recommend radiation or chemotherapy to try shrinking your tumor prior to surgery.
For tumors in the actual colon or rectum, specially trained colorectal surgeons at the OSUCCC – James use cutting-edge techniques, including minimally invasive laparoscopic and robotic methods, so you have smaller incisions, less blood loss and a potentially faster recovery. U.S. News & World Report has even recognized our team as “high performing” in colon cancer surgery. This rating is based on the surgical outcomes of our colon cancer patients over age 65 using measures such as complication rates, readmission and length of hospitalization.
HIPEC (hyperthermic intraperitoneal chemotherapy)
This specialized surgery is used to treat cancers that have spread to the peritoneum, which is the lining of the abdomen. After removing all visible signs of cancer, heated chemotherapy drugs are placed directly into the belly cavity to destroy any remaining cancerous cells.
If your tumor is larger or more advanced, your doctors may recommend resection, also called a colectomy. This is when a larger incision is used to open your abdomen so the surgical oncologist can remove any cancerous parts of your intestine before reconnecting the two healthy sections back together. This more traditional, open surgery gives your surgical team access to all parts of your abdomen so they can make sure the entire tumor is removed. Depending on what’s found, the surgical oncologist may also remove nearby tissue and lymph nodes, so no cancer cells are left behind.
Resection with colostomy or ileostomy
If the surgeon cannot reconnect the two healthy parts of your intestines following tumor removal, a colostomy or ileostomy may be needed. This involves creating an opening to the outside of your body where a disposable bag will be attached to collect your digestive waste.
The different procedure names are dependent on which part of your intestines is involved. For the colon, it’s a colostomy. For the small intestines, it’s an ileostomy.
Use of the external bag may be permanent, or it may be a temporary solution that allows your body to heal before your colon is reconnected.
Nonsurgical treatments
Chemotherapy
A specially mixed “cocktail” of liquid drugs is created and delivered through a port or injected into a vein (IV). The intent may be to shrink your tumor before surgery, destroy any remaining cancer cells following surgery or to stop those that exist from dividing and multiplying.
Immunotherapy
This treatment has been a tremendous advancement in cancer care, especially for patients who have a tumor that can’t be removed with surgery. However, immunotherapy is only appropriate for patients with colorectal cancer who have specific gene changes, including a high level of microsatellite instability (MSI-H) or changes in one of the mismatch repair (MMR) genes.
By identifying the specific biomarkers of your own cancer cells, we’ll be able to determine if you’re a candidate for immunotherapy. If you are, we’ll extract some of your healthy cells to teach them how to target and destroy your cancer cells. Once these retrained healthy cells are injected back into your body, your immune system does the rest.
Although very effective, immunotherapy — like other oncology treatments — can have unwanted side effects. Our Immunotherapy Management Clinic can help minimize these.
Targeted therapies
A variety of new targeted therapies are designed to kill cancer cells without harming the healthy cells around them. This advanced cancer treatment may be referred to using terms such as "molecularly targeted drugs", "precision medicine" or related words. Whether given in pill form or through infusions, it’s designed to interfere with the specific proteins that control how cancer cells grow, divide and spread.
Radiation and proton therapy
X-rays or other targeted radiation may be used to destroy your cancer cells, often following surgery, but sometimes to reduce the size of a tumor before surgery. In most cases, you’ll receive treatment over a few days or weeks. CT scans or MRIs will be used to make sure the radiation is being delivered to the exact location needed.
In addition, the OSUCCC – James now offers proton therapy at a dedicated facility on Ohio State’s West Campus. For complex, inoperable tumors, proton therapy delivers a more potent proton beam that can be targeted to just the tumor, thus eliminating damage to surrounding normal tissues and organs. This precision protects a patient’s quality of life during and many decades after treatment.
Radiofrequency or microwave ablation
For colorectal cancer that’s spread to the liver, a probe with electrodes is placed inside the liver to destroy the cells that have spread from the colon. This can be done during other liver surgery, as a minimally invasive procedure on its own or sometimes without any surgery required as the ablation is delivered through a tiny tube inserted through the skin.
Radioembolization
This is another option for colorectal cancer that’s spread to the liver. For this treatment, radioactive beads are injected into the hepatic artery, which feeds your tumors. A thin, flexible tube called a catheter is used to get the beads to just the right location. This kills the cancer cells but doesn’t harm your healthy liver cells because they get their blood supply from the portal vein.
Clinical trials
At any given time, there are more than 100 active colorectal clinical trials going on at the OSUCCC – James. One of these may offer a treatment that makes all the difference. Clinical trial participation can happen before, during or after standard cancer treatment, affording you the chance to try some of the most advanced therapies available, some found only at the OSUCCC – James or just a few locations nationwide. You can find an active trial using “colorectal cancer” in the search bar.
Cancer Supportive Care Clinic
We understand that fighting advanced colorectal cancer can take a toll on the physical and mental health of you and your caregivers. That’s why the OSUCCC – James offers hundreds of support groups, activities and events. This includes special programming for adolescents and young adults, survivorship resources, pain management, fertility planning, counseling, art and music therapy and more.
You are so much more than a cancer patient. Let’s work together to help you manage treatment so you can focus on living a life that you love.
Helpful links
Genetic counseling at the James
Innovations in Gastroenterology and GI and Colorectal Surgery
Division of General and GI Surgery
Division of Colon and Rectal Surgery