Colon and Rectal Cancer

Overview

Cancers of the colon and the rectum are the fourth-most commonly diagnosed cancers in the U.S. Because of their similarities, they are merged into a single category known as colorectal cancer. Although this disease is the third-leading cause of cancer death, thanks to more rigorous screening and regular treatment advances, the percentage of deaths from colorectal cancer continues to drop.

 

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Our approach to treating colon and rectal cancers starts with personalized care — not just for your cancer, but the kind that makes you feel supported throughout your treatment. City of Hope's world-class colorectal team combines a multidisciplinary team approach with the newest, leading-edge colorectal genetic screening to provide you with the most accurate diagnosis and treatment path.

New drugs and combinations of drugs are more effective, surgical treatments have been refined and improved, and most patients are candidates for minimally invasive surgical techniques that have less pain and faster recovery."  Steve Sentovich, M.D., M.B.A., Chief, Colon and Rectal Surgery Section

City of Hope is internationally recognized for its research and breakthrough treatments, has been named one of America’s top cancer hospitals by U.S. News & World Report for more than a decade and is a National Cancer Institute-designated comprehensive cancer center. City of Hope community practices are located throughout Southern California with its main campus northeast of Los Angeles.

Our commitment to providing the best care for you includes:

  • Surgeons expert in minimally invasive techniques, including robotic and laparoscopic surgeries, for smaller incisions, less pain and faster recovery.       
  • Surgeons who know how to do everything possible to avoid a colostomy.
  • Colorectal surgeons specializing in complicated, late-stage cancers using combined colon and liver operations performed with our world-renowned liver surgery team.
  • Ultraprecise radiation and chemotherapy to target tumors and preserve healthy tissue.
  • Hyperthermic intraperitoneal chemotherapy, a complex treatment that involves removing widespread cancer then delivering heated chemotherapy directly to the abdomen.
  • Expertise in hereditary cancer syndromes, including use of next-generation DNA sequencing methods.
  • Genetic targeting used to figure out a tumor’s specific biology and to design treatments to stop it from growing.
  • Supportive care that continues long after treatment ends, including helping you and your family adjust to post-treatment diet and lifestyle changes.

At City of Hope we see complicated colon and rectal cancer cases every day, so we are experts at treating advanced and recurrent disease. That treatment happens just steps away from groundbreaking research and clinical trials — happening right on City of Hope’s campus — that could directly impact how we treat your cancer.  

When we care for you at City of Hope, we are not just focused on leading-edge care and innovation — we are working to make you whole again.

NEWS & BREAKTHROUGHS

We have made great advancements in the field and the majority of colon cancers are curable." Kurt Melstrom, M.D., colorectal surgeon

What is colorectal cancer?

The colon and the rectum are both part of the large intestine. Because they share so many common features, colon cancer and rectal cancer are often grouped together and called colorectal cancers. Not including skin cancers, colorectal cancers are the fourth most commonly diagnosed cancer in the United States, for both men and women.
  • More than 135,000 people will get colorectal cancer in the United States this year.
  • About one in 21 men and one in 23 women will get the disease during their lifetimes.
  • Colorectal cancer is the third leading cause of cancer death in women, and the second leading cause of cancer death in men. However, the death rate from colorectal cancer has been dropping steadily over the last few decades, most likely due to better screening and treatment.

Types of colorectal cancer

There are several types of colon and rectal cancers:                 

  • Adenocarcinoma is the most common type of colorectal cancer. These tumors begin in the cells that make the mucus lining on the inside of the colon and rectum. Ninety-five percent of colorectal cancers are adenocarcinomas.

Other types of cancer that can start in the colon and rectum are much less common:

  • Gastrointestinal stromal tumors (GISTs) start in special cells found in the wall of the GI tract, called the interstitial cells of Cajal. These cells play a role in the autonomic nervous system, which regulates automatic body processes such as digestion. GISTs can form in the stomach or anywhere along the digestive tract, but they rarely occur in the colon.
  • Lymphomas are a types of cancer that typically start in immune system cells, but can also start in the colon, rectum or other organs.
  • Carcinoid tumors start in specialized hormone-making cells called neuroendocrine cells that are scattered throughout the intestine and other organ systems. These tumors are sometimes called neuroendocrine tumors.
  • Sarcomas are rare cancers that can start in blood vessels, muscle or connective tissue in the wall of the colon and rectum.

How colon cancer develops

The colon is a five-foot-long tube, shaped like a giant question mark, stretching from the small intestine to the rectum. It is part of the large intestine. When you eat food, it travels from the stomach and through the small intestine — where it is digested and absorbed — then it goes through the colon, where any leftover water and salt are absorbed.

The last six inches of the large intestine includes the rectum, a receptacle for the waste that is left before it leaves your body — and the anus. Cancers of the colon tend to be grouped with rectal cancer, and called colorectal cancer, because they are so similar.

Getting colon cancer

Getting colorectal cancer means abnormal cells in your colon or rectum are growing and dividing at a rapid pace — so fast that cells in your immune system that fight disease cannot keep up.

Layers of tissue inside the colon and rectum form what is called the wall. The innermost layer of that wall, called the mucosa, is where colorectal cancer usually starts. When cells in the mucosa grow uncontrollably, they join together to form a small, bulb-like growth called a polyp. Most polyps are benign, which means they do not cause cancer, but some can turn into cancer over time.

There are three main types of polyps:

  • Adenomatous polyps: The most common type of polyp, also called an adenoma. The cells that form these polyps grow and divide abnormally compared with normal colon cells, but only sometimes become cancer.
  • Hyperplastic polyps: Cells in this type of polyp grow fast but rarely become cancer. This is a common type of polyp and usually is found in the lower part of the colon or rectum.
  • Inflammatory polyps: These often appear after a bout with inflammatory bowel disease. They rarely become cancer.

If it is caught early through routine screening, colorectal cancer is very treatable. In more advanced cases, cancer cells will have grown through the colon wall and eventually spread to other parts of the body — a process called metastasis. Colorectal cancer that has metastasized tends to travel through the blood or lymph system, to the liver, lung and peritoneum.

What increases your risk of colon cancer?

A risk factor is something that increases your chances of developing a disease. Some risk factors for colorectal cancer are things you’re born with or other things, like age, that you cannot control. Yet many lifestyle choices can also raise or lower your risk of developing the disease. Factors such as diet, weight and exercise, for instance, are strongly linked to colorectal cancer.

Controllable risk factors for colon cancer include:

  • overweight or obesity, especially excess fat around the waist
  • physical inactivity
  • type 2 diabetes
  • cigarette smoking
  • drinking alcohol excessively
  • a diet high in red, processed or charred meats
  • low vitamin D levels
Uncontrollable risks for colon cancer include:
  • age. (Colorectal cancer risk is more common after age 50.)
  • personal history of colorectal polyps
  • personal history of inflammatory bowel disease, ulcerative colitis or Crohn’s disease
  • family history of colorectal polyps
  • family history of cancer of the colon, rectum, ovary, endometrium or breast
  • being of African-American or Ashkenazi Jewish descent
  • having an inherited syndrome associated with colorectal cancers, including:
    • Lynch syndrome
    • Familial adenomatous polyposis
    • Turcot syndrome
    • Peutz-Jeghers syndrome
    • MUTYH-associated polyposis
    • genetics

Genetic testing can help identify inherited gene changes that increase your risk of colorectal cancer.

Hereditary causes of colorectal cancer

Having close relatives with colorectal cancer increases the risk of developing the disease (and being diagnosed earlier in life) and could direct or change the treatment for some patients. Up to 10 percent of people with colorectal cancer have an inherited genetic abnormality that is associated with developing the disease.

Two of the most common inherited conditions that influence your risk of disease include:

  • Lynch syndrome is a condition that increases the risk of colorectal and other cancers — including stomach, liver, ovarian, endometrial, brain, skin and small intestine cancers. The syndrome is also referred to as hereditary nonpolyposis colorectal cancer.
  • Familial adenomatous polyposis involves developing multiple noncancerous polyps in the colon early in life that may later progress to colorectal cancer. This condition appears at a much earlier age than normally developing colorectal cancers.


Although hereditary factors account for less than 5 percent of colorectal cancers, your chances of having one of these conditions is higher if several of your close family members have been diagnosed.

If your family history suggests an increased risk of colorectal cancer, City of Hope’s Hereditary Colorectal Cancer Multidisciplinary Program offers genetic counseling and screening that can identify whether inherited conditions influence your risk — and guide you to the best treatments.

Colon cancer prevention

More than most other cancers, colorectal cancer is affected by things you can control, like what you eat and how much you exercise. Eating a diet that includes plenty of vegetables, fruits, and whole grains — and that is low in animal fat — has been linked with a lower risk of colorectal cancer. Other lifestyle changes like quitting smoking, drinking less and exercising regularly may help lower your risk.

And getting screened for colorectal cancer starting at age 50 (or younger if you have a family history) may help doctors to find and remove polyps before they turn into cancer.

What are the symptoms of colorectal cancer?

Colorectal cancer does not always cause symptoms during the early stages of the disease. Polyps can grow in the colon wall for months or years without causing bleeding or pain. Symptoms are more likely to appear during the later stages of disease, after the cancer has grown or spread.
 
Typical colorectal cancer symptoms include:
  • a change in bowel habits (such as diarrhea, constipation or narrow stools) lasting more than a few days
  • a persistent urge to have a bowl movement that doesn’t go away after you have one
  • bleeding of the rectum
  • blood in the stool (bright red or dark)
  • abdominal pain or cramping
  • bloating or a feeling of being full
  • a diagnosis of anemia               
  • weakness and fatigue
  • unintended weight loss
  • nausea or vomiting
Many of these symptoms can also be caused by noncancer conditions such as hemorrhoids, irritable bowel syndrome, inflammatory bowel disease or infection. Still, if you have any of these problems for more than two weeks, it’s important to see your doctor right away to pinpoint and treat the cause.
 

Screening for colorectal cancer

Screening involves looking for cancer before you have symptoms. Polyps containing cancer cells can stay lodged in the colon wall for months or years without causing bleeding, pain or any other symptoms. Screening increases the chances of catching colorectal cancer at an early stage, before it has spread and when it is more likely to be cured.

At City of Hope we are dedicated to increasing the number of lifesaving screenings for colorectal cancer. To support that effort, we offer state-of-the-art diagnostic tools, including:

  • Colonoscopy: This test uses a long, flexible tube with a tiny light and video camera on one end to examine your colon and rectum.
  • Stool DNA testing: This test examines stool to look for certain gene changes that are associated with colorectal cancer.
  • Genetic screening: Our trained genetic counselors can review your personal and family history, help you determine cancer risk and provide recommendations to reduce cancer risk and detect cancer earlier. Genetic screening also helps our treatment teams make the most accurate diagnosis and develop a clearly defined treatment path.


Screening saves lives

Colorectal cancer is one of the most curable cancers, yet research shows tens of millions of people are skipping out on potentially lifesaving screening. The biggest reason is fear:
Fear of bowel preparation. Fear of the test. Fear of the results.

But most of those concerns are unfounded. The gold standard for colorectal cancer screening — colonoscopy — is a painless exam that happens while a patient is sedated (sleeping), and is usually over in less than 30 minutes.

The research is clear that colorectal cancer screening saves lives.

Who should be screened?

Colonoscopies are recommended for everyone over age 50.

You should start routine colorectal cancer screening at age 50 if you:

  • have no symptoms
  • have no personal or family history of benign or precancerous polyps
  • have no personal or family history of colorectal cancer


Your screening should begin before age 50, and have more frequent follow-ups, if you:

  • have developed polyps or colorectal cancer in the past
  • have a history of inflammatory bowel diseases such as Crohn’s disease or ulcerative colitis
  • have first-degree relatives (parents, siblings) who developed colorectal cancer before age 50
  • have family history of inherited conditions associated with colorectal cancer, such as Lynch syndrome or familial adenomatous polyposis
     

Related articles on colorectal screening

colorectal cancer screening

Colorectal cancer is the fourth most common type of cancer and the second deadliest. Despite those grim statistics, in most states less than 20 percent of racial and ethnic minorities have been screened for CRC within the past year. For physicians and scientists at City of Hope, that number is far too low.


polyp detection during colonoscopy

Should you get a colonoscopy? Watch Donald David, M.D., chief of City of Hope's division of gastroenterology, explain the pros and cons of the four most popular screening options.


Melstrom-Kurt

Surgeon Kurt Melstrom, M.D., clinical professor of surgery at City of Hope, explains the main causes of colorectal cancer, the importance of screening and the growing list of treatments for the disease.


Stephen Sentovich

Stephen M. Sentovich is a clinical professor in the Department of Surgery with extensive experience in the surgical treatment and management of colon and rectal cancers.


Hereditary causes of colorectal cancer

Having close relatives with colorectal cancer increases the risk of developing the disease — and being diagnosed earlier in life — and could direct or change the treatment for some patients. Up to 10 percent of people with colorectal cancer have an inherited genetic abnormality that associated with developing the disease. Two of the most common inherited conditions that influence your risk of disease include:

  • Lynch syndrome is a condition that increases the risk of colorectal and other cancers — including stomach, liver, ovarian, endometrial, brain, skin and small intestine cancers. The syndrome is also referred to as hereditary nonpolyposis colorectal cancer.
  • Familial adenomatous polyposis involves developing multiple noncancerous polyps in the colon early in life that may later progress to colorectal cancer. This condition appears and is diagnosed at a much earlier age than normally developing colorectal cancers.

Although hereditary factors account for less than 5 percent of colorectal cancers, your chances of having one of these conditions is higher if several of your close family members have been diagnosed.

If your family history suggests an increased risk of colorectal cancer, City of Hope’s Hereditary Colorectal Cancer Multidisciplinary Program offers genetic counseling and screening that can identify whether inherited conditions influence your risk — and guide you to the best treatments.

Diagnosing colon cancer

At City of Hope, we use a number of tests and tools to detect colorectal cancer.

  • Colonoscopy: This test uses a long, lighted tube with a video camera on the end to examine your colon and rectum. While you are sedated (asleep), a specialist inserts the tube into your rectum and through your colon to look for polyps or other abnormal growths. During a colonoscopy, such growths can be removed (biopsied) for testing.
  • Flexible sigmoidoscopy: This test is similar to colonoscopy, but may not require sedation. It involves using a thin, lighted tube with a small video camera on the end to examine your rectum and the lower part of your colon. It looks for polyps or other abnormal areas, which can be removed and sent to a lab for testing.


Imaging tests can be useful for diagnosing colon cancer, determining how far the cancer has spread, and whether the cancer is responding to treatment:

  • CT scan: Computed tomography (CT or CAT) scans use X-rays to make detailed images of cross-sections of the body. They are useful in determining whether colorectal cancer has spread to other organs.
  • Virtual colonoscopy (CT colonography): This test is a special type of CT scan that creates a 3-D picture of the colon and rectum.
  • Double-contrast barium enema: A chalky white liquid called barium is put into the rectum, making it easier to see abnormal areas on an X-ray.
  • Endoscopic ultrasound: This test uses sound waves to create an image of the inside of the body. In this procedure, an instrument is inserted into the rectum. It is useful for determining how far colorectal cancer has spread.
  • MRI: MRI uses radio waves to create detailed images of the body’s soft tissues. It is useful for determining how far colorectal cancer has spread.
  • PET scan: This procedure uses a form of radioactive sugar to detect cancer cells, which take up sugar more quickly than healthy cells. This test can be helpful for determining whether abnormal areas seen on other tests are cancerous or not.

Other tests can help doctors diagnose cancer, determine how far it has spread and suggest the best treatments:

  • Blood tests: Blood tests can show if you have anemia (low red blood cells), which can be associated with colorectal cancer. Blood tests can also detect tumor markers, or substances made by colorectal cancer cells that can be present in the blood. Such tumor markers include carcinoembryonic antigen (CEA) and CA 19-9.
  • Fecal occult blood test or fecal immunochemical test: These are tests you can do at home to detect blood in the stool. If the tests find blood in the stool, your doctor will recommend further tests, such as colonoscopy.
  • Stool DNA test: This test looks for DNA changes in cells in the stool that might be signs of cancer. The stool sample is sent to a lab for testing.
  • Gene tests: When doctors find cancerous cells in the colon or rectum, they may test them for certain gene changes that can help determine how best to treat the cancer.

A colonoscopy is the only test that lets the provider see your entire colon and rectum, and can remove polyps and tissue samples at the same time. If you have any of the other tests and something uncertain is found, you will likely need a colonoscopy.

Stages of colorectal cancer

After a diagnosis of colorectal cancer, doctors will determine if it has spread. This is known as staging. There stages of colorectal cancer are:

  • Stage 0: This is the earliest stage of cancer. At this point, the cancer has not grown beyond the inner lining of the colon or rectum.
  • Stage 1: The cancer has spread further into the colon or rectum but has not spread to nearby lymph nodes or other organs.
  • Stage 2: The cancer has grown into the outermost layers of the colon or rectum and may have grown into nearby organs, but has not spread to lymph nodes.
  • Stage 3: The cancer has spread to nearby lymph nodes but has not spread to distant sites in the body.
  • Stage 4: The cancer has spread to distant organs, such as the liver or lung.

The most important thing about being an oncologist is to be there for your patient all along — to have an honest and ongoing discussion of what’s going on." Marwan Fakih, M.D., medical oncologist

How is colorectal cancer treated?

City of Hope’s approach to treating colorectal cancer is focused on precision medicine. That means we apply precise and minimally invasive surgical techniques — and test individual cancer cells to find drug combinations that would work best for your specific cancer.

We are a leader in targeting therapy to individual patients and have many options for treating complex colorectal cancers including:

  • Sphincter-saving surgery that drastically reduces the need for permanent colostomy
  • Expertise in cancer that has spread to the liver, including combination surgeries with our world-renowned hepatobiliary surgery team
  • Expertise in HIPEC, or hyperthermic intraperitoneal chemotherapy, a treatment that involves removing tumors, then delivering heated chemotherapy directly to the abdomen
  • Clinical studies that are regularly finding new drug therapies and combinations to treat advanced cases

City of Hope is one of the few centers in the country that treats colorectal cancer using a comprehensive, team-based approach, by a team whose only focus is treating this type of cancer.

Your care includes regular interaction and input from a team of colorectal surgeons, oncologists, gastroenterologists, radiologists and pathologists — along with nurses, genetic counselors, nutritionists and specially trained support staff.

That comprehensive approach to your care means better care and a strong potential for you to live longer.

What type of doctors will I see?

Your care team is likely to include several types of cancer specialists, including:

  • Medical oncologists are often the primary doctor for people with cancer. They have special training in diagnosing and treating cancer using chemotherapy, hormonal therapy, biological (immunological) therapy and targeted therapy.
  • Surgical oncologists are trained in performing biopsies and treating cancer with surgery.
  • Radiation oncologists are experts in using radiation therapy to treat patients with cancer.

I find great satisfaction in identifying a tumor, removing it and restoring the body to normal functioning. My inspiration comes from the individual challenge that each patient brings and finding the best way to treat them." Kurt Melstrom, M.D., colorectal surgeon

What are the different types of surgeries?

City of Hope’s surgeons are world leaders in robotically assisted and minimally invasive colorectal surgery that is focused on avoiding colostomy. Our surgeons work on a team to determine the best way to treat your cancer and preserve your bowel function and quality of life.

Some surgeries are performed for either colon cancer and rectal cancer:

  • Polypectomy involves removing a polyp, often during a colonoscopy. It does not require an incision.
  • Local excision involves removing the cancer and a small area of the tissue around it. It is typically done during a colonoscopy to remove very shallow tumors. Sometimes it may be done in the operating room.
  • Endoscopic mucosal resection is similar to colonoscopy, but allows doctors to carefully lift and remove abnormal cells that are flat, rather than raised like polyps. The procedure is performed with a long, narrow tube that has a light, video camera and instruments on one end.
  • Radiofrequency ablation is a technique that uses high-energy radio waves to heat and destroy tumor cells. It is a good option for people who have cancer that cannot be cured by surgery.
  • Cryosurgery destroys tumors by freezing them. In this procedure, a thin metal probe is guided into the tumor, and cold gasses are passed into the tissue.
  • Diverting colostomy is performed when tumors are blocking the colon. It involves cutting the colon and attaching it to a stoma, or opening, in the skin of the abdomen to let stool out.  

Other surgeries differ depending on where the cancer is located.

Surgeries for colon cancer

  • Colectomy/Hemicolectomy involves removing the part of the colon where the cancer occurs, as well as a small amount of normal colon tissue on either side and nearby lymph nodes. This surgery is required when colon cancer has grown beyond the colon wall. When part of the colon is removed, it is called a hemicolectomy. Removal of the entire colon is known as total colectomy.

    Colectomy and hemicolectomy may be performed in two ways:
    • Open colectomy is performed through an incision in the abdomen.
    • Laparoscopy is performed using long, narrow instruments inserted through small incisions. The instruments contain a video camera to allow the surgeon to see inside the body.
  • Endoluminal stents are sometimes used if a tumor has blocked the colon. A stent is a hollow metal or plastic tube that is placed into the colon to hold it open and relieve the blockage. It’s usually done for a short time to prepare for surgery.
  • Lymphadenectomy is a surgery that involves removing and testing lymph nodes for cancer.

Surgeries for rectal cancer

  • LAR, or lower anterior resection, removes the part of the rectum that has cancer. The colon is then reattached to the remaining rectum.
  • Proctectomy with coloanal anastomosis removes the whole rectum. The colon is then joined to the anus.
  • APR, or abdominoperineal resection, removes the anus and the tissues surrounding it, including the sphincter muscle.
  • Pelvic exenteration is an extensive surgery that removes the rectum as well as nearby organs that the cancer has spread to, including the bladder, the prostate (in men) or the uterus (in women).

Chemotherapy or radiation may be given before surgery to shrink the tumor; and after surgery to try and wipe out any remaining cancer cells.

Chemotherapy

Chemotherapy is a treatment that uses drugs to either kill cancer cells or stop them from growing.

Exciting advances in chemotherapy at City of Hope are allowing patients with advanced disease to get combinations of drugs to shrink tumors, making it easier to take them out later with surgery — or melt them away and avoid surgery altogether. If you have failed all standard chemotherapy, City of Hope has several experimental approaches — including immunotherapy and targeted therapy — designed to target your specific tumor and extend your life.And for cancer that has spread to the liver, we offer leading-edge therapies like hepatic arterial infusion: a small disc implanted under the skin that sends chemotherapy drugs directly into the artery that feeds the liver.

HAI: Hepatic arterial infusion allows high dose, long-term chemotherapy to be delivered directly to the tumor site in the adjuvant treatment of high risk resected liver metastases, refractory metastatic colorectal cancer to the liver and as a neoadjuvant therapy in potentially resectable metastatic colorectal cancer patients who did not respond adequately to systemic chemotherapy alone.

HIPEC: When advanced colorectal cancer spreads to the inner lining of the body cavity, treatment can become especially difficult. City of Hope offers hyperthermic (or heated) intraperitoneal chemotherapy (HIPEC) treatment that may increase survival for these patients. We currently treat cancers of the colon, rectum, appendix, ovary and stomach with this procedure.

HIPEC is an alternative method of delivering chemotherapy. Instead of infusing the medications through a vein, the heated chemotherapy is circulated in the abdominal cavity at the time of surgery. The heated chemotherapy results in a more effective strategy for attacking microscopic residual disease following debulking, therefore reducing the risk of recurrence following surgery. Surgery aims to complete debulking of all visible disease and is followed by HIPEC to address the minimal residual cancer.

City of Hope has one of the busiest HIPEC centers in Southern California. Our  peritoneal surface malignancy team of multidisciplinary experts evaluate each case to present the best treatment option.

Targeted therapies

City of Hope uses the latest targeted therapies, which are designed to attack specific features of cancer cells. Unlike chemotherapy, which can target both healthy cells and cancer cells, targeted therapies hone in on the specific proteins or cell functions that allow cancer cells to grow. Our doctors use the latest technology to spot specific gene changes in cancer cells so that we can choose the drugs or drug combinations that are most likely to be successful for a specific cancer type.

Immunotherapy

Immunotherapy, also known as biological therapy, uses the body’s own immune system to fight cancer. Cancer cells can trick the immune system so that it does not attack them. Immunotherapy works in a variety of ways to help the immune system spot and destroy colorectal cancer cells.

Radiation therapy

Radiation therapy uses high-energy radiation to kill cancer cells and shrink tumors. City of Hope offers advanced radiation treatments that are highly targeted to cancer cells including:

  • Brachytherapy (internal beam radiation) involves placing a radioactive source inside your rectum close to the tumor to deliver radiation internally.
  • Stereotactic body radiation is a type of external beam radiation that delivers a high dose of focused radiation in a single treatment.
  • 3-D conformal radiation therapy shapes the radiation beams to conform to, or match, the shape of the tumor.
  • Intensity modulated radiation therapy is a type of 3-D radiation therapy that uses computer-generated images to focus beams of radiation of different intensities at a tumor from many angles.
  • Image-guided radiation therapy uses imaging techniques such as MRI and CT to help radiation oncologists accurately identify the specific area to focus the radiation.  
  • Radioembolization involves injecting small radioactive beads into the blood vessels. The beads lodge in blood vessels near the tumor and emit radiation over several days.

Meet our colorectal cancer experts

City of Hope’s renowned physicians and researchers use the latest in technology and innovation to treat colon and rectal cancer, coupled with an enduring belief in providing unparalleled compassionate care.

Surgery

Kurt A. Melstrom, M.D., F.A.C.S., F.A.S.C.R.S.

Clinical Specialties

  • Colon and Rectal Surgery
I. Benjamin Paz, M.D., F.A.C.S.

Clinical Specialties

  • Surgical Oncology
Stephen M. Sentovich, M.D., M.B.A.

Clinical Specialties

  • Colon and Rectal Surgery
Lily Lau Lai, M.D., F.A.C.S.

Clinical Specialties

  • Surgical Oncology

Medical Oncology

Joseph Chao, M.D.

Clinical Specialties

  • Medical Oncology
Vincent Chung, M.D., F.A.C.P.

Clinical Specialties

  • Medical Oncology
Marwan G. Fakih, M.D.

Clinical Specialties

  • Medical Oncology
Dean W. Lim, M.D.

Clinical Specialties

  • Medical Oncology

Radiation Oncology

Yi-Jen Chen, M.D., Ph.D.

Clinical Specialties

  • Radiation Oncology

Gastroenterology

James L. Lin, M.D.

Clinical Specialties

  • Gastroenterology

Diagnostic Radiology

Jonathan Kessler, M.D.

Clinical Specialties

  • Diagnostic Radiology
  • Interventional Radiology

From research to therapies: colorectal cancer research at City of Hope

Getting treated for colorectal cancer at City of Hope means you are steps away from labs where new treatments are being developed every day. That proximity means you will benefit from something unique in cancer care — bench to bedside treatment. "Bench to bedside" means exciting new research we are conducting in our labs is moved quickly to the bedside to treat our patients.

Colorectal cancer is an extremely complex disease that can act many different ways in the body. Clinical trials at City of Hope are focused on those differences — and designing therapies that affect how colorectal cancer develops, progresses and spreads:

  • A City of Hope study is looking at a new combination of chemotherapy drugs that target a mutation (a problem with a cell) called BRAF that causes tumors. This mutation is found in 5 to 10 percent of patients with colorectal cancer and tends to resist chemotherapy and lead to poor overall survival. This study is testing whether adding a new combination of chemotherapy drugs will shrink tumors and improve survival for patients.
  • Some patients have metastatic colorectal cancer — cancer that has spread to other parts of the body — that stops responding to chemotherapy drugs. A new study involves giving patients high doses of new, experimental drugs called nintedanib and capecitabine. This drug combination will be studied to see how well it works in patients whose cancer has not responded well to multiple other treatments.
  • A study at City of Hope is testing two new chemotherapy drugs, MEDI4736 and tremelimumab, for colorectal cancer patients whose tumors have figured out how to outsmart the immune system.
  • City of Hope researchers are developing and testing a new chemotherapy drug, COH29, that aims to prevent cancer cells from copying themselves and dividing. The drug is being tested in patients with colon cancer as well as ovarian, pancreatic, stomach and lung cancers.
  • Patients who have a malignant bowel obstructions, or a blockage in the bowels because of cancer or treatment for cancer, may be treated either with surgery or nonsurgical treatment. Both strategies are considered standard of care. This study will compare two groups of patients with this condition and compare the quality of life of those who are treated with surgery and those who receive the best medical management and no surgery.
  • Tissue from patients who have had their colon and/or rectum removed in a surgery gives researchers valuable clues about how to treat the many different types of colorectal cancer. In a study at City of Hope, tissue left over after colorectal surgery will be studied to see how certain types of cancer behave and how best to treat them.
  • City of Hope has a study looking at the psychological and social impact on patients who were cancer-free for a long time, then had their colorectal cancer come back in an advanced stage.

In addition to these clinical trials, City of Hope has several others that will open soon that look at new therapies for patients with specific mutations called RAS, and will explore new immunotherapy approaches, which is a way of helping the patient’s own immune system fight cancer.

Visit our Clinical Trials website for more information.

Related stories about colorectal cancer research

Breakthroughs - ASCO

City of Hope physicians and researchers are headed to Chicago to present groundbreaking research on blood stem cell transplants for HIV patients, immunotherapies, unique treatment options for older adults battling breast cancer and other topics during the American Society of Clinical Oncology’s (ASCO) 2017 Annual Meeting June 2 to 6.


clinical trials for colorectal cancer

Patients with metastatic colorectal cancer need more options. Two clinical trials currently underway at City of Hope could help provide those options. Patients with metastatic colorectal cancer often stop responding to the primary drugs used against the disease, leaving them with few options and little hope.


 
 

Living with colon cancer

When you come to City of Hope, you have access to a strong network of support services and staff to help you and your family along your colon cancer journey. That support includes everything from talk therapy to meditation to being paired up with a patient navigator.

Learn more about the resources listed below at our Living with Cancer or Supportive Care Medicine sites.

Once treatment is complete, City of Hope’s support services include education and training from ostomy nurses who provide specialty care for patients with wounds resulting from colorectal surgery.

Life after colorectal cancer

City of Hope can continue to provide care and support services after treatment for colorectal cancer is complete:
  • Survivorship visits, which can include:
    • Physical examinations
    • Evaluation and management of side effects
    • Assessment to detect cancer recurrence
    • Cancer screening recommendations
    • Health recommendations and support including nutrition, exercise and quitting tobacco
  • Rehabilitation
  • Sexual health and fertility
  • Pain management
  • Supportive care and survivorship resources
For a complete listing of offerings at the Duarte, California, main campus, in your community or online, visit our Patient and Community Events calendar or contact the Sheri & Les Biller Patient and Family Resource Center at 626-218-2273.
 

Hopeful.org

Hopeful.org is an online community, a space for everyone who has been touched by cancer to make connections, share their stories, offer support and seek advice.

It features new stories weekly on everything from recipes to news about immunotherapy and other groundbreaking treatments. No one should have to go through cancer alone, and Hopeful ensures that every person will have a supportive community to lean on.

To connect with fellow breast cancer fighters, caregivers and supporters alike, join our Community of the Hopeful today.

Giving to City of Hope

It takes the help of a lot of caring people to make hope a reality for our patients. City of Hope was founded by individuals' philanthropic efforts more than 100 years ago. Their efforts — and those of our supporters today — have built the foundation for the care we provide and the research we conduct.

For more information about supporting the colorectal cancer program, please contact Donor Relations. Or, you can make a gift to support colorectal cancer research at City of Hope by donating online.

GIVE HOPE

Help us turn innovative ideas in to powerful new treatments.