Surgery to remove the part of the colon containing tumor is the primary treatment. Depending on the stage of the cancer, surgery is generally followed with chemotherapy. If the tumor is particularly large, you may need radiation before or after surgery.
Some medications or supplements may help prevent the development of polyps or colorectal cancer. Making lifestyle changes, especially eating less red meat, losing weight, quitting smoking, and getting more exercise, may help prevent the disease -- even in people with a family history of the condition.
Even if you have no family history of colorectal cancer, an unhealthy lifestyle can increase your risk of developing the disease. Some experts believe making healthy lifestyle changes may decrease the risk of developing colorectal cancer by as much as 70% for some people.
Many studies support the association between colorectal cancer and lack of exercise and obesity. Research continues to show that exercise and low calorie diets may help to prevent colorectal cancer.
A large, population based study of men and women in Hawaii found that the following lifestyle factors were linked with colorectal cancer:
- Heavy alcohol consumption
- History of diabetes
- Frequent constipation
- High calorie diet
- Physical inactivity
- Low vegetable fiber intake (evidence here is mixed)
- High levels of insulin (hormone that controls blood sugar levels)
- Meat consumption
After surgery, chemotherapy (the use of anticancer drugs to destroy cancer cells) may be given to kill any cancerous cells that remain in the body. Chemotherapy controls the spread of the disease and improves survival rates over time. The following chemotherapeutic medications are often used alone or in combination to treat colorectal cancer:
- FOLFOX -- a type of combination chemotherapy used to treat colorectal cancer. It includes the drugs fluorouracil, leucovorin, and oxaliplatin.
- Camptosar -- used when colon cancer has spread (metastasized) or returned; may be combined with other drugs.
- Bevacizumab (Avastin) -- used when colorectal cancer has spread, it starves tumors of blood and oxygen.
- Cetuximab (Erbitux) -- used when colorectal cancer has spread despite the use of another drug, irinotecan (Camptosar), or when patients cannot take Camptosar alone. It works to stop cancer cells from reproducing.
- Panitumumab (Vectibix) -- used when colorectal cancer has spread despite chemotherapy. It works similar to Erbitux.
Long term use of aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) are being investigated in the prevention and treatment of colorectal cancer. However, these drugs have risks of their own, including an increased risk of stomach bleeding. NSAIDs may also increase risk of heart problems.
Surgery and Other Procedures
Surgery is the treatment of choice for colorectal cancer, and is best when the disease is found at an early stage. Polyps can be removed during a colonoscopy, before becoming cancerous. When colon cancer is present, a person may need a partial or total removal of the colon (colectomy) and rectum (rectal resection). It depends on how severe the cancer is, where it is located, and whether or where it has spread. During surgery, the surgeon also examines other organs for signs of cancer. If cancer has spread to the liver, a portion of the liver may be removed as well. After removing the tumor and nearby tissue, the surgeon reconnects the healthy portions of the colon or rectum. If the healthy parts of the colon or rectum cannot be reconnected, a temporary or permanent opening (stoma) is made through the wall of the abdomen to provide a path for waste material to leave the body. This procedure is called a colostomy. Radiation may also be used before or during surgery to shrink the tumor, and it may be recommended after surgery to reduce the risk of recurrence. After surgery, colonoscopies are performed every 3 - 6 months for 3 years.
Nutrition and Dietary Supplements
Colorectal cancer should never be treated with nutrition and dietary supplements alone. However, a comprehensive treatment plan for colorectal cancer may include a range of complementary and alternative therapies. Some supplements and herbs may help reduce side effects from conventional medications. Others may help reduce the risk of developing colorectal cancer. Mind body therapies such as meditation, relaxation techniques, yoga, and qi gong may reduce the effects of stress and enhance your response to treatment. Ask your team of health care providers about the best ways to incorporate these therapies into your overall treatment plan.
Always tell your health care provider about the herbs and supplements you are using or considering using. Many supplements may interfere with conventional cancer treatments, including chemotherapy.
Follow these nutritional tips for overall health:
- Eat antioxidant foods, including fruits (such as blueberries, cherries, and tomatoes), and vegetables (such as squash and bell peppers). Antioxidants help protect against cancer.
- Avoid refined foods, such as white breads, pastas, and especially sugar.
- Eat foods rich in fiber, especially cruciferous vegetables, such as broccoli, cauliflower, and cabbage.
- Eat fewer red meats and more cold water fish, tofu (soy, if no allergy) or beans for protein. Studies suggest that people who eat less meat are at lower risk of developing colorectal cancer. Quality protein sources, such as organic eggs, whey, and vegetable protein shakes, can be used to help gain muscle mass and prevent wasting that can sometimes be a side effect of cancer therapies.
- Use healthy oils, such as olive oil or vegetable oil.
- Eliminate trans-fatty acids, found in commercially baked goods such as cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and margarine.
- Reduce saturated fats, especially red meat.
- Avoid caffeine and other stimulants, alcohol, and tobacco.
- Drink 6 - 8 glasses of filtered water daily.
- Exercise at least 30 minutes daily, 5 days a week.
These supplements may also help reduce risk of colorectal cancer:
- A multivitamin daily, containing the antioxidant vitamins A, C, E, the B-complex vitamins, and trace minerals, such as magnesium, calcium, zinc, and selenium.
- Omega-3 fatty acids, such as fish oil, 1 - 2 capsules or 1 - 3 tablespoonfuls oil daily. Population studies suggest that omega-3 fatty acids may reduce the risk of developing colon, breast, or prostate cancer. A few preliminary studies seem to suggest that fish oil might help reduce the growth rate of colon cancer cells, but more research is needed to know for sure. Ask your doctor before taking high doses of supplemental fish oil, which can increase the risk of bleeding. Cold water fish, such as salmon or halibut, are good sources to add to your diet.
- Probiotic supplement (containing a mixture of organisms including Lactobacillus acidophilus), 5 - 10 billion CFUs (colony forming units) a day. These "friendly" bacteria help keep the digestive tract healthy. Preliminary evidence suggests that probiotics might help reduce recurrence of tumors in people who have had surgery to remove colon cancer. You should refrigerate your probiotic supplements for best results.
- Calcium, 1,000 - 1,200 mg daily. Calcium binds to ionized fatty acids and secondary bile acids to reduce mucosal toxicity and/or directly reduce intestinal proliferation. In fact, studies show a 14% reduction in risk among subjects with the highest versus the lowest categories of intake.
- Vitamin D NOTE: Preliminary studies suggest that vitamin D supplementation alone may be associated with up to a 50% reduction in colon cancer risk. More research is needed. Dosing guidelines for Vitamin D have been a subject of much controversy of late with some experts recommending conservative dosing of 400 - 1000 IU per day for adults while others hold that this is far too low and are recommending much higher doses. Also some megadose Vitamin D supplements have now appeared in health food stores. Speak to your doctor about proper amounts of Vitamin D for your particular case.
Herbs are generally a safe way to strengthen and tone the body's systems. However, herbs alone should never be used to treat colon cancer, and you should talk to your doctor before taking any herbs if you are being treated for colon cancer. Some herbs can interfere with chemotherapy and other treatments. As with any therapy, you should work with your health care provider to diagnose your problem before starting treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, make teas with 1 tsp. herb per cup of hot water. Steep covered 5 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink 2 - 4 cups per day. You may use tinctures alone or in combination as noted.
- Green tea (Camellia sinensis) standardized extract, 250 - 500 mg daily. Green tea contains antioxidants and can help boost the immune system. It may help prevent cancer, although studies haven't been able to prove that. Use caffeine-free products. You may also prepare teas from the leaf of this herb. Green tea can worsen symptoms in patients with Glaucoma and may be contraindicted in cerain patients who suffer from liver disease and osteoporosis; speak with your physician.
- Reishi mushroom (Ganoderma lucidum) standardized extract, 150 - 300 mg 2 - 3 times daily. Animal studies suggest it may have cancer fighting properties. One study in humans found it strengthened the immune system response, which is often weakened during chemotherapy. You may also take a tincture of this mushroom extract, 30 - 60 drops 2 - 3 times a day. Medications that slow blood clotting (Anticoagulant / Antiplatelet drugs) interacts with Reishi mushroom.
- Maitake mushroom (Grifola frondosa) standardized extract (D-fraction), 600 mg twice daily. Preliminary studies suggest it may help the body fight cancer, although more research is needed to know for sure. You may also take a tincture of this mushroom extract, 30 - 60 drops 2 - 3 times a day.
- Turmeric (Curcuma longa) standardized extract, 300 mg 3 times a day. Turmeric or curcumin has been shown to kill cancer cells in test tubes. Studies are underway to see if it has the same effect in humans. Don't take Turmeric if you have gallstones or bile duct obstruction. Medications that slow blood clotting (Anticoagulant / Antiplatelet drugs) interacts with Turmeric.
Acupuncture is not used as a treatment for cancer itself. But evidence suggests it can help reduce cancer related symptoms (particularly the nausea and vomiting that often accompanies chemotherapy). Studies show that acupuncture may help reduce pain and shortness of breath. Acupressure (pressing on rather than needling acupuncture points) may also help in controlling breathlessness. People can learn this technique and use it to treat themselves.
Some acupuncturists prefer to work with a patient only after conventional medical cancer therapy. Others will provide acupuncture or herbal therapy during active chemotherapy or radiation. Make sure you discuss these treatments with your medical team before proceeding. Acupuncturists treat cancer patients based on an individualized assessment of the excesses and deficiencies of qi located in various meridians. In many cases of cancer related symptoms, a qi deficiency is usually detected in the spleen or kidney meridians.
Mind Body Medicine
Relaxation techniques can help people undergoing surgery. One study found that patients who received standard care plus use of guided imagery audiotapes before, during, and after surgery experienced significantly better sleep and less pain following the surgery than patients who received only standard care.
Abeloff: Abeloff's Clinical Oncology, 4th ed. Colon Cancer. Churchill Livingstone. 2008. Ch. 81.
Albanes D, Malila N, Taylor PR, et al. Effects of supplemental a-tocopherol and ß-carotene on colorectal cancer: results from a controlled trial (Finland). Cancer Causes Control. 2000;11:197-205.
Alimi D, Rubino C, Leandri EP, Brule SF. Analgesic effects of auricular acupuncture for cancer pain [letter]. J Pain Symptom Manage. 2000;19(2):81-82.
Anti M, Armelau F, Marra G, et al. Effects of different doses of fish oil on rectal cell proliferation in patients with sporadic colonic adenomas. Gastroenterology. 1994;107(6):1892-1894.
Baron JA, Beach M, Mandel JS, et al. Calcium supplements for the prevention of colorectal adenomas. N Eng J Med. 1999;340:101-107.
Bast A, Haenen GR. Lipoic acid: a multifunctional antioxidant. Biofactors. 2003;17(1-4):207-13.
Baur JA, Sinclair DA. Therapeutic potential of resveratrol: the in vivo evidence. Nat Rev Drug Discov. 2006;5(6):493-506.
Bonithon-Kopp C, Kronborg O, Giacosa A, Rath U, Faivre J. Calcium and fibre supplementation in prevention of colorectal adenoma recurrence: a randomised intervention trial. European Cancer Prevention Organisation Study Group. Lancet. 2000;356:1300-1306.
Bushman JL. Green tea and cancer in humans: a review of the literature. Nutr Cancer. 1998;31(3):151-159.
Chang H, Mi M, Ling W, Zhu J, Zhang Q, Wei N, Zhou Y, Tang Y, Yuan J. Structurally related cytotoxic effects of flavonoids on human cancer cells in vitro. Arch Pharm Res. 2008 Sep;31(9):1137-44.
Dahm CC, et al. Dietary fiber and colorectal cancer risk: a nested case-control study using food diaries. J Natl Cancer Instit. 2010;102(9):614-26.
Davies MJ, Bowey EA, Adlercreutz H, Rowland IR, Rumsby PC. Effects of soy or rye supplementation of high-fat diets on colon tumour development in azoxymethane treated rats. Carcinogenesis. 1999;20(6):927-931.
de Deckere EAM. Possible beneficial effect of fish and fish n-3 polyunsaturated fatty acids in breast and colorectal cancer. Euro J Cancer Prev. 1999;8:213-221.
Doron S, Gorbach SL. Probiotics: their role in the treatment and prevention of disease. Expert Rev Anti Infect Ther. 2006;4(2):261-75.
Douillard JY, Cunningham D, Roth AD, Navarro M, James RD, Karasek P, et al. Irinotecan combined with fluorouracil compared with fluorouracil alone as first-line treatment for metastatic colorectal cancer: a multicentre randomised trial. Lancet. 2000;355:1041-1047.
Ezzo J, Berman B, Hadhazy VA, Jadad AR, Lao L, Singh BB. Is acupuncture effective for the treatment of chronic pain? A systematic review. Pain. 2000;86:217-225.
Filshie J, Penn K, Ashley S, Davis CL. Acupuncture for the relief of cancer-related breathlessness. Palliat Med. 1998;10:145-150.
Flood A, Schatzkin A. Colorectal cancer: does it matter if you eat your fruits and vegetables? J Natl Cancer Inst. 2000;92(21):1706-1707.
Giardiello FM, Offerhause GJ, DuBois RN. The role of nonsteroidal anti-inflammatory drugs in colorectal cancer prevention. Eur J Cancer. 1995;31A(7-8):1071-1076.
Giovannucci E, Colditsz GA, Stampfer MJ, Willett WC. Physical activity, obesity, and risk of colorectal adenoma in women (United States). Cancer Causes Control. 1996;7:253-263.
Greenberg ER, Baron JA, Tosteson TD, et al. A clinical trial of antioxidant vitamins to prevent colorectal adenoma. N Engl J Med. 1994;331:141-147.
Holt PR. Dairy foods and prevention of colon cancer: human studies. J Am Coll Nutr. 1999;18(suppl 5):379S-391S.
Jänne PA, Mayer RJ. Chemoprevention of colorectal cancer. N Engl J Med. 2000;342(26):1960-1968.
Kaur M, Mandair R, Agarwal R, Agarwal C. Grape seed extract induces cell cycle arrest and apoptosis in human colon carcinoma cells. Nutr Cancer. 2008;60 Suppl 1:2-11.
Kawamori T, Lubet R, Steele VE, et al. Chemopreventive effect of curcumin, a naturally occurring anti-inflammatory agent, during the promotion/progression stages of colon cancer. Cancer Res. 1999;59:597-601.
Kodama N, Komuta K, Nanba H. Effect of Maitake (Grifola frondosa) D-Fraction on the activation of NK cells in cancer patients. J Med Food. 2003;6(4):371-7.
LaValle JB, Krinsky DL, Hawkins EB, et al. Natural Therapeutics Pocket Guide. Hudson, OH:LexiComp; 2000: 452-454.
La Vecchia C, Braga C, Negri E, et al. Intake of selected micronutrients and risk of colorectal cancer. Int J Cancer. 1997;73:525-530.
Le Marchand L, Wilkens LR, Hankin JH, Kolonel LN, Lyu LC. Independent and joint effects of family history and lifestyle on colorectal cancer risk: Implications for prevention. Cancer Epidemiol Biomarkers Prevent.1999;8:45-51.
Le Marchand L, Hankin JH, Wilkens LR, Kolonel LN, Englyst HN, Lyu L. Dietary fiber and colorectal cancer risk. Epidemiology. 1997a;8:658-665.
Le Marchand L, Wilkens LR, Kolonel LN, Hankin JH, Lyu LC. Associations of sedentary lifestyle, obesity, smoking, alcohol use, and diabetes with the risk of colorectal cancer. Cancer Res.1997b;57:4787-4794.
Maa SH, Gauthier D, Turner M. Acupressure as an adjunct to a pulmonary rehabilitation program. J Cardiopulm Rehabil. 1997;17(4):268-276.
Marshall J. Prevention of Colorectal Cancer: Diet, Chemoprevention, and Lifestyle. Gastroenterology Clinics. 2008;37(1).
Mayer RJ. Gastrointestinal tract cancer. In: Fauci AS, Braunwald E, Hauser SL, et al, eds. Harrison's Principles of Internal Medicine. 17th ed. New York, NY: McGraw-Hill; 2008:573-580.
Messina M, Bennink M. Soy foods, isoflavones and risk of colonic cancer: A review of the in vitro and in vivo data. Bailliéres Clin Endocrinol Metab. 1998:12(4):707-728.
Michels KB, Giovannucci E, Joshipura KJ, et al. Prospective study of fruit and vegetable consumption and incidence of colon and rectal cancers. J Natl Cancer Inst. 2000;92:1740-1752.
Milacic V, Banerjee S, Landis-Piwowar KR, Sarkar FH, Majumdar AP, Dou QP. Curcumin inhibits the proteasome activity in human colon cancer cells in vitro and in vivo. Cancer Res. 2008 Sep 15;68(18):7283-92.
Narisawa T, Fukaura Y, Hasebe M, et al. Prevention of N-methylnitrosourea-induced colon carcinogenesis in F344 rats by lycopene and tomato juice rich in lycopene. Jpn J Cancer Res. 1998;89:1003-1008.
Owen RW, Giacosa A, Hull WE, Haubner R, Spiegelhalder B, Bartsch H. The antioxidant/anticancer potential of phenolic compounds isolated from olive oil. Eur J Cancer. 2000a;36(10):1235-1247.
Pan CX, Morrison RS, Ness J, Fugh-Berman A, Leipzig RM. Complementary and alternative medicine in the management of pain, dyspnea, and nausea and vomiting near the end of life: a systematic review. J Pain Symptom Manage. 2000;20(5):374-387.
Piazza GA, Alberts DS, Hixson LJ, et al. Sulindac sulfone inhibits azoxymethane-induced colon carcinogenesis in rats without reducing prostaglandin levels. Cancer Res. 1997;57(14):2909-2915.
Potter JD. Nutrition and colorectal cancer. Cancer Causes Control. 1996;7:127-146.
Power D, Gloglowski E, Lipkin S. Clinical Genetics of Hereditary Colon Cancer. Hematology/Oncology Clinics of North America. 2010;24(5).
Renzi C, Peticca L, Pescatori M. The use of relaxation techniques in the perioperative management of proctological patients: preliminary results. Int J Colorectal Dis. 2000;15(5-6):313-316.
Schatzkin A, Lanza E, Corle D, et al. Lack of effect of a low-fat, high-fiber diet on the recurrence of colorectal adenomas. NEJM. 2000;342(16):1149-1155.
Shen J, Wenger N, Glaspy J, et al. Electroacupuncture for control of myeloablative chemotherapy-induced emesis. JAMA. 2000;284(21):2755-2761.
Shimizu M, Fukutomi Y, Ninomiya M, Nagura K, Kato T, Araki H, et al. Green tea extracts for the prevention of metachronous colorectal adenomas: a pilot study. Cancer Epidemiol Biomarkers Prev. 2008 Nov;17(11):3020-5.
Simopoulos AP. Essential fatty acids in health and chronic disease. Am J Clin Nutr. 1999;70(3 suppl):560S-569S.
Slattery ML, Benson J, Curtin K, Ma K-N, Schaeffer D, Potter JD. Carotenoids and colon cancer. Am J Clin Nutr. 2000;71:575-582.
Sung MK, Lautens M, Thompson LU. Mammalian lignans inhibit the growth of estrogen-independent human colon tumor cells. Anticancer Res. 1998;18(3A):1405-1408.
Thiagarajan D, Bennink MR, Bourquin LD, Kavas FA. Prevention of precancerous colonic lesions in rats by soy flakes, soy flour, genistein, and calcium. Am J Clin Nutr. 1998;68(suppl):1394S-1399S.
Turowski GA, Rashid Z, Hong F, Madri J, Basson MD. Glutamine modulates phenotype and stimulates proliferation in human colon cancer cell lines. Cancer Res. 1994;54:5974-5980.
Vickers AJ. Can acupuncture have specific effects on health? A systematic review of acupuncture antiemesis trials. J R Soc Med. 1996;89:303-311.
Wang CZ, Yuan CS. Potential role of ginseng in the treatment of colorectal cancer. Am J Chin Med. 2008;36(6):1019-28.