Colorectal cancer treatments

The different treatments for colorectal cancer are often combined, together or one after the other, according to treatment protocol guidelines.

Surgery

The Paris site of Institut Curie offers all surgical procedures adapted to patients with colorectal cancer, thanks to its modern operating theatres equipped with the latest technologies. 

In the Hauts-de-Seine, the Saint-Cloud site of Institut Curie and the Ambroise-Pare Hospital (AP-HP, Boulogne-Billancourt) are working together to ensure quality care for patients with colorectal cancers. Digestive endoscopy, interventional radiology, and surgery are performed at the Ambroise-Pare Hospital. 

An improved rehabilitation protocol after surgery is proposed to people operated on for a primary colon tumor. At Institut Curie and at the Ambroise-Pare Hospital, the patient actively participates in the treatment of their disease by receiving detailed information pre-operatively. Surgeons prefer micro-invasive techniques and rapid removal of probes. The use of drains is limited. Anesthesiologists ensure optimal postoperative pain management. Starting on the evening of the surgery, the patient is encouraged to get up with the help of caregivers, and they resume a liquid diet. 

This pre-, peri- and post-operative care in digestive surgery improves the quality of life of patients by reducing complications and the length of hospitalization, as well as increases their survival by 5 years.

Radiotherapy 

Radiotherapy isa curative treatment whose objective is to eradicate the tumor and the cancer cells that may have migrated into the neighboring tissues, in particular in the lymph node relays of the pelvis. 

It uses ionizing radiation that current techniques allow to concentrate in the target volumes (tumor, lymph node relays) while sparing healthy tissues and neighboring organs as much as possible in order to limit side effects. 

• For cancers of the anal canal (or relatively rare anal cancer), radiotherapy is associated in the majority of cases with concomitant chemotherapy, which increases the effectiveness and improves the chances of recovery. 
• For rectal cancers, radiotherapy is also most often associated with concomitant oral chemotherapy and is usually followed by surgery. 
• For colon cancers, radiotherapy is only indicated when treating metastatic disease, most often for symptomatic purposes, and/or in the case of so-called oligo-metastatic disease where radiotherapy can reinforce systemic treatments. In these cases, we most often speak of radiotherapy in stereotactic conditions. This technique aims to deliver high doses per fraction at the level of the tumor, as well as a low dose at the periphery of the tumor, in a very small number of sessions.

Medical treatments 

Chemotherapy, which is the main medical treatment for colorectal cancer, aims to destroy cancer cells. In the case of advanced disease with the existence of unresectable metastases, chemotherapy is sometimes the only possible treatment. This is called exclusive chemotherapy. 

The standard treatment is 5-FU or 5-fluorouracil, to which oxaliplatin (FOLFOX) or irinotecan (FOLFIRI) is added and administered every 2 weeks. In the case of metastatic disease, additional tests are performed on the initial biopsy to allow a targeted therapy to be combined with conventional chemotherapy. Depending on the mutational status of the RAS gene, three drugs (monoclonal antibodies) can be used: bevacizumab (anti-angiogenic), cetuximab or panitumumab (anti-EGFR). 

Immunotherapy is a treatment that aims to restore the immune system to destroy cancer cells. For patients with metastatic colorectal cancer, immunotherapy is indicated only in 5% of patients in case of unstable genetic status called "MSI". At Institut Curie, molecular RCP makes it possible to propose clinical trials or precision medicine, also called personalized medicine, targeting these anomalies.