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Treatment of colon and rectal cancer requires multidisciplinary teams that coordinate the surgical, radiation and chemotherapy treatments these patients often require. Very early cancers may only require surgery. When cancer has spread through the bloodstream to become "metastatic," we rely on chemotherapy alone to shrink it or slow it down, although radiation and surgery may be helpful for cancer implants that are causing specific, "local" problems such as pain, bleeding or bowel obstruction.
Some published outcomes exclude patients who died of non-cancer causes. We report deaths from all causes, including non-cancer deaths, because cancer can play an unsuspected role in deaths from other causes. We also include patients who did not receive all of their cancer treatment at CCCNY.
This curve (below) shows overall survival for all patients under age 80 with colon cancer treated at CCCNY, with separate curves for each stage of cancer. The survival outcomes are similar to those reported in large trials, which usually select younger and healthier patients who are more likely to withstand the side effects of treatment. For patients with cancer that has spread to nearby organs or lymph nodes, multiple-drug “adjuvant” chemotherapy prolongs life by killing cancer cells that have escaped into the bloodstream.
The rectum is the last part of the large bowel, just above the anus. Surgery for rectal cancer is difficult because removing the cancer with a safe margin around it may damage the anal muscles and cause leakage of stool. A group of dedicated specialists including CCCNY surgeons perfected an intricate operation that completely removes the cancer while protecting anal function, called total mesenteric excision (TME).
Most patients with rectal cancer also require radiation and 1-drug chemotherapy, which is often given before surgery, to shrink the tumor and reduce the chance of leaving cancer cells behind after surgery, followed by multiple-drug "adjuvant" chemotherapy to kill cancer cells that have escaped into the bloodstream. The radiation therapy targets the tumor and nearby lymph nodes, which often contain cancer, while sparing organs such as the bladder, small bowel and anal muscles from high radiation doses if the tumor is far enough away.
This curve (below) shows overall survival for all patients under age 80 with rectal cancer treated at CCCNY, with separate curves for each stage of cancer. This includes all causes of death, including non-cancer deaths. The survival outcomes compare favorably with those in large trials.
Minimally invasive vs. traditional open surgery
"Minimally invasive" techniques insert devices (laparoscopes) into the body that allow doctors to see and perform surgery. This approach produces smaller surgical wounds than conventional "open" surgery, which usually leads to briefer hospitalization, use of pain medications and time to recovery. However, sometimes the surgeon who starts a minimally invasive operation discovers circumstances that require converting to an open approach, to allow easier access to the whole surgical site, or "field." From 2010 through 2012, CCCNY staff colorectal cancer surgeons performed 43 open operations (27%) and 116 minimally invasive operations (73%), 5 of which were converted to open surgery, for colon cancer. For rectal cancer surgery, which is more complicated, they performed 40 open operations (49%) and 42 minimally invasive operations (51%), one of which was converted to open surgery.
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