Colorectal cancer is the third most common cancer in the United States, and the second leading cause of cancer death.

Surgeons at City of Hope are world leaders in advancing the applications of robotic-assisted surgery to colorectal cancer patients. (Photo credit: Markie Ramirez.)

For community physicians treating patients at risk of colorectal cancer or patients who have been diagnosed, City of Hope provides a wide array of resources from screening through treatment and post-operative care. Our robust Gastrointestinal Oncology Program is focused on improving outcomes and quality of life for patients based on institutional strengths in several areas: significant experience in colorectal cancer diagnosis and staging, surgery, chemotherapy and radiation therapy; access to advanced technologies and clinical trials; and a coordinated focus on whole-patient care. Multidisciplinary teams bring together professionals from all relevant fields including minimally invasive surgery, medical and radiation oncology, radiology, stoma therapies and a complete range of social services.

Surgery

Research studies consistently demonstrate that surgical patients who are treated at high-volume hospitals have better outcomes than those treated at lowervolume facilities. In general, perioperative mortality and long-term survival improve with hospital surgical volume. Many variables contribute to these results, including the availability of board-certified colorectal surgeons, state-of-the-art surgical technologies, and more experienced surgical teams. Additionally, the quality of clinical care during the post-operative period, including the administration of adjuvant therapies, plays a significant role in improving outcomes.

As an National Cancer Institute-designated Comprehensive Cancer Center, City of Hope offers community physicians and their patients an innovative surgical team for treating colorectal cancer. Members of the Department of Surgery have specific expertise in the surgical treatment of colon, rectal and anal cancers, from early stage disease treatable by endoluminal approaches, to metastatic and recurrent disease requiring extensive procedures that involve several surgical specialties.

The possibility of colostomy can raise severe anxieties for patients and their families. Unless a case is so advanced and the resection so radical as to require permanent colostomy, other surgical strategies are pursued whenever possible. Increasingly, sphincter-sparing techniques for rectal cancer are replacing standard abdominoperineal resection and colostomy, with signficant benefits in quality of life without compromising cure.

Minimally Invasive and Robotic Techniques

Minimally invasive techniques offer colorectal cancer patients considerable advantages over traditional open surgery. Among them are smaller incisions, reduced blood loss, fewer transfusions, less pain, more rapid recovery, shorter hospital stays, fewer post-operative complications and a quicker return to normal activities. Decades of combined experience position our surgeons to take full advantage of evolving surgical technologies, while exploring the potential for better results with new and experimental procedures.

Surgeons at City of Hope are world leaders in advancing the applications of robotic-assisted surgery to colorectal cancer patients. The da Vinci S HD Surgical System (the most sophisticated robotic system currently available) is routinely employed for colorectal resections and related procedures. The system is operated by board-certified oncologic and colorectal surgeons who are skilled in open, laparoscopic and robotic-assisted procedures. Currently, research at City of Hope is focusing on a comparative evaluation of conventional laparoscopic surgery and robotic-assisted surgery.

Radiation and Chemotherapy

In addition to standard-of-care therapies, surgeons at City of Hope aggressively pursue both adjuvant and neoadjuvant strategies to improve outcomes at all stages of colorectal cancer. Increasingly, investigational efforts are being directed at innovative combinations of chemotherapy and radiation, exploring the potential for chemoradiation to reduce the scope of surgery in some patients, and even to eliminate the need for surgery altogether in some cases. These strategies result in significant improvements in quality of life for many patients with colorectal cancer.

City of Hope radiation oncologists are at the forefront of radiotherapy with the availability of helical TomoTherapy, which combines ultra-precise imaging of tumors via spiral computed tomography scanning with the targeted delivery of intensity modulated radiation therapy. Daily imaging tracks tumor location, size and shape, allowing the radiation dose to be sculpted to match. In addition to delivering higher, more therapeutic doses, TomoTherapy treatments provide better results for colorectal patients, including fewer side effects with a more rapid return to normal activities.

In addition, an array of protocols combining radiation with various chemotherapy regimens are being pursued in clinical trials, including agents such as capecitabine, leucovorin calcium, oxaliplatin and 5-FU. These investigations are often conducted as part of a multicenter trial seeking to improve patient outcomes. Separately, multiple drug studies are evaluating variations of specific combination therapies such as irinotecan/5-FU/leucovorin or oxaliplatin/5-FU/leucovorin with bevacizumab or cetuximab. Many of these are directed at patients with advanced and metastatic disease who may otherwise be facing limited options. Radioimmunotherapy is also being explored for advanced cases involving metastatic invasion of the liver.

Additionally, efforts are under way to better establish the prognostic role of biomarkers in patients at high risk of recurrence.

“Whole-patient” Resources

Patients with colorectal cancer may be overwhelmed by personal fears and concerns specific to coping with problems of digestion and elimination, as well as impacts of their disease and treatment on lifestyle and daily activities. City of Hope provides all patients access to the newly opened Sheri & Les Biller Patient and Family Resource Center, providing a wide array of support and educational services.

At the center, patients and their loved ones have the opportunity to work with a coordinated group of social workers, psychiatrists, psychologists, patient navigators, pain management specialists and spiritual care providers, as well as participate in music therapy, meditation and other programs designed to alleviate stress and encourage a positive mental and emotional outlook.

Screening and Referrals

To improve outcomes via early detection, City of Hope provides full screening services for colorectal cancer, including sigmoidoscopy and colonoscopy, fecal occult blood testing and related evaluations.