Colorectal cancer is treated by a multi-disciplinary approach with surgery, chemotherapy and radiotherapy. Surgery forms the foundation of treatment while chemotherapy or radiotherapy play supportive or adjuvant roles. Significant advances in surgery for colorectal cancer have been made in the last 10 to 15 years: it is much safer; hospital stay is much shorter and less uncomfortable; return to activity and work is faster; functional results are much better with less rectal patients requiring permanent colostomies and the local recurrence rate and cure rate are significantly better. It is now accepted that for colorectal cancer especially rectal cancer, surgical technique is of paramount importance in achieving the best results. This is clearly demonstrated in Norway when a nation-wide project was adopted in 1993 to implement the best operative technique for rectal cancer called Total Mesorectal Excision, the local recurrence rate dropped from 28% to 6% and survival improved from 60% to 73%.
For cancer which has spread to lymph nodes, chemotherapy is added to colon cancer and chemotherapy and radiotherapy are given to rectal cancer following surgery. For large or fixed rectal cancer, radiotherapy and sometimes in combination with chemotherapy is administered to shrink or down-stage the tumour before surgery. When colorectal cancer is incurable, a lot can be done to relieve symptoms, such as pain, with a combination of practical care, medications, surgery, radiotherapy or chemotherapy according to palliative care or hospice care principles.
