Stage 4 colon cancer occurs when
cancer in the colon spreads, or metastasizes, to other tissues and organs.
Colon cancer most often spreads to the liver, but it may also reach the lungs,
the lymph nodes, or the lining of the abdominal cavity.
The American Cancer Society (ACS) note
that the 5-year relative survival rate for people with stage 4 colon
cancer that has spread is 14%.
However, everyone is different, and other
factors contribute to a person's survival rate.
Diagnosis
The correct diagnosis of colon cancer may take
patience, as doctors use many tests to detect and locate cancer.
If they identify cancer, they will also use
more tests to see whether it has spread.
The tests and processes that can aid a colon
cancer diagnosis include:
a physical
examination
blood tests
a colonoscopy to
look inside the rectum
a biopsy, in which
the doctor takes a sample of tissue and sends it to a laboratory for analysis
molecular testing
to help identify specific characteristics of the tumor that
may be important for treatment
imaging tests,
such as CT, PET, ultrasound, or MRI scans, to see whether
cancer has spread
a chest X-ray to
check whether cancer has spread to the lungs
After running all of the necessary tests, a
doctor will discuss the diagnosis with the individual.
Decisions
Anyone who receives a stage 4 colon cancer
diagnosis will have to make some decisions about the way forward, particularly
regarding treatment options.
It is important to discuss all of the options
with a doctor and to understand the goal of each treatment.
Treatment options
The treatment options available to people with
stage 4 colon cancer are more limited than those suitable for the earlier
stages of this cancer. However, there are still some treatment options to
consider, as well as other factors to keep in mind.
Surgery
When cancerous cells have spread to distant
organs and tissues, surgery is unlikely to cure cancer. There are some cases in
which surgery may still be a good option, though.
If a scan reveals that the cancer has only
spread to a few small areas, surgery may still be possible. By surgically
removing the cancerous cells, doctors hope to help the person live longer.
These surgeries will involve the removal of
part of the colon as well as the nearby lymph nodes. Additional
surgery may remove the areas of tissue into which the cancer has spread.
Doctors will typically also recommend chemotherapy,
either before or after the surgery.
If the tumor cells are too large to remove, or
there are too many of them, doctors will recommend chemotherapy before the
person undergoes any surgical procedures. If this shrinks the tumors, they may
then ask a surgeon to proceed with the surgery.
Doctors may also need to perform additional
surgical procedures if the cancerous growth is likely to obstruct the colon or
is already blocking it. In some cases, minimally invasive surgery, such as
placing a stent, may be possible. Surgeons can place a stent, which is a hollow
tube that typically consists of mesh metal or plastic, into the colon during a
colonoscopy. When successful, a stent may help keep the colon open and make
more invasive surgery unnecessary.
Doctors may also recommend a diverting
colostomy, which essentially cuts the colon above the cancerous tissue and
diverts the waste from the body out through a small opening in the skin.
Chemotherapy
If the colon cancer has spread too far for
surgery to be effective, chemotherapy is the primary treatment option.
Most people with stage 4 colon cancer will
receive chemotherapy or specific targeted therapies to help control the cancer
progression or symptoms.
Doctors may recommend some treatment regimens
that include a targeting drug, which targets either the vascular endothelial
growth factor (VEGF) pathway or the epithelial growth factor receptor (EGFR)
pathway.
The choice between regimens will vary in each situation.
The most suitable option will depend on the types of treatment that a person
has had before, their overall health, and their responsiveness to treatment.
It is not uncommon for doctors to try multiple
treatments. If the cancer does not respond to the first treatment, they may
stop that treatment and start another instead.
Radiation therapy
Doctors may also recommend radiation
therapy in late-stage colon cancer to help reduce symptoms such
as pain and discomfort. This treatment might even shrink the tumor for a time,
but it will not usually cure the cancer.
Hepatic artery
infusion
A hepatic artery infusion may be a treatment
option for people with colon cancer that has spread to the liver. Hepatic
artery infusion is a type of regional chemotherapy, which involves delivering a
chemotherapy drug directly into the hepatic artery in the liver. This treatment
may help destroy cancer cells without harming the healthy liver cells in the
process.
Ablation or
embolization
Ablation or embolization may be appropriate for
people who have metastatic or reoccurring colorectal
cancer that causes a few tumors in the lung or liver that are
less than 4 centimeters across.
Ablation uses either radio frequencies,
microwaves, or alcohol — which people also call percutaneous ethanol injection
(PEI) — to target and kill cancer cells while leaving the surrounding tissues
relatively unharmed.
During embolization, a doctor will inject
substances into the blood vessels to try to block or reduce the blood flow to
cancer cells in the liver.
Palliative care
If cancer progresses to many distant organs and
tissues, surgery may not help extend a person's lifespan. Other treatment
options can cause discomfort and may produce additional symptoms that make the
person's quality of life worse.
In these cases, people may decide against
medical treatment that seeks to cure the cancer and instead opt for palliative
care to try to make living more comfortable.
Palliative care will typically involve finding
ways to manage pain and reduce a person's symptoms so that they can live
comfortably for as long as possible.
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