Adjuvant therapy for rectal cancer

Colorectal cancer is a term that refers to a malignant tumor which develops inside the colon or the rectum. This is a quite frequent malignant tumor which affects both genders and is more common in older people. Still, colorectal cancer can also occur in younger individuals, particularly those with a family history of colorectal cancer and those suffering from familiar adenomatous polyposis.

Treatment for such cancer can start only when the definitive diagnosis is confirmed. There are two treatments in such case, neoadjuvant and adjuvant. In case of neoadjuvant cancer patients receive specific treatments such as chemotherapy, radiation therapy or the combination of the two prior surgical resection of the tumor. On the other hand, adjuvant therapy includes treatments which are initiated after surgical removal of the tumor.

Adjuvant Therapy for Colorectal Cancer

This type of treatment can only start when a person has undergone surgical removal of the tumor and nearby lymph nodes. The goal of the treatment is to sterilize the operated area and kill all the cancer cells that might have spread to nearby or even distant organs. Adjuvant chemotherapy is treatment option for patients suffering from colon cancer. It is highly beneficial for all patients in whom the cancer has spread to regional lymph nodes.

This treatment includes several chemotherapeutics such as fluorouracil (5-FU) plus leucovorin (folinic acid) and capecitabine (Xeloda). Fluorouracil and leucovorin represent the most common combination for colon cancer used in adjuvant treatment of the disease. It is essential to mention that folinic acid is actually not a chemotherapeutic agent but a biochemical modulator capable of increasing efficacy of fluorouracil. These drugs are always administered intravenously.

Xeloda is taken in a form of pills (much easier way of treatment) and is considered equally efficient as the combination of fluorouracil and leucovorin.

And finally, in some patients who receive fluorouracil and leucovorin doctors decide to add one more drug called oxaliplatin. Still there are no data regarding better efficacy of such treatment and administration of oxaliplatin carries a risk of serious side effects such as neuropathy.

Newer drugs that have recently started to be administered in patients suffering from colon cancer include bevacizumab, cetuximab and irinotecan.

Recurrence of rectal cancer is much more common comparing to colon cancer. If the tumor returns, it may easily affect different organs and tissues inside the pelvis such as the bladder, ureters, bones , nerves etc. Because of that adjuvant therapy for rectal cancer apart from chemotherapy includes radiation therapy. Similarly to colon cancer patients suffering from rectal cancer receive 5-FU chemotherapy and then undergo radiation therapy. They may also benefit from Xeloda. In fact treatment with Xeloda generally begins after completion of radiation therapy and lasts for several months.

New drugs that may be frequently used in future in patients suffering from rectal cancer include oxaliplatin, irinotecan, bevacizumab and cetuximab.