10 Facts About Advanced Colon Cancerby Stephanie Wood Health Writer
Late-stage colon cancer, also known as Stage IV or metastatic colon cancer, isn’t considered curable, but treatment advances are leading to extended survival rates and a better quality of life for many patients. Through these new therapies, colon cancer can become a manageable chronic disease, like diabetes or heart disease. Here are 10 key facts you should know about treating and living with advanced colon cancer.
Fact 1. “Late-stage” means cancer has spread to other organs
Colon cancer spreads via the bloodstream and lymphatic system. “It goes to the lymph nodes first, then typically to the liver, followed by the lungs and bones,” says David Rivadeneira, M.D., director of colorectal surgery at Huntington Hospital and professor of surgery at Hofstra University Northwell Health School of Medicine, both on Long Island, NY. This doesn’t mean you have liver or lung cancer; the cells that spread continue to look like colon cancer cells. Colon cancer is the “primary cancer,” and the organ it has spread to is the “secondary cancer.”
Fact 2. People with metastatic colon cancer are living longer
According to the American Cancer Society, deaths resulting from colon cancer have decreased, due to improved treatment, changed patterns in risk factors, and screening, which leads to earlier diagnoses. New therapies are emerging too, so ask your doctor about the latest options. “There are multiple lines of chemo we can try at Stage IV, as well as newer targeted therapies,” says Andrea Cercek, M.D., a medical oncologist at Memorial Sloan Kettering Cancer Center in New York City and Stand Up to Cancer Colorectal Dream Team investigator.
Fact 3. Metastasized colon cancer may cause no symptoms for weeks to months
That’s why follow-up appointments with imaging tests are so important: They can detect cancer that’s spreading before symptoms start. When symptoms of metastatic colon cancer emerge, they may include weight loss, poor appetite and nausea, fever, fatigue, enlarged spleen, discomfort in the upper right abdomen, jaundiced or yellowish skin and whites of the eyes, and abdominal swelling due to the accumulation of fluid, says Ryan Merkow, M.D., a surgical oncologist who specializes in advanced colorectal cancer at Northwestern Memorial Hospital in Chicago.
Fact 4: Most people with Stage IV don’t need a colostomy
Colon cancer patients often fear they’ll need a colostomy—surgery that creates an opening for the colon through the abdomen—and then have to wear an outside ostomy bag for stool collection. But in most cases, surgeons can piece the colon back together so it continues to function. “A temporary colostomy may be necessary while you’re healing from surgery, but the procedure is usually reversed later,” says Dr. Rivadeneira. “Rectal cancer patients are slightly more likely to need a permanent ostomy bag if cancer extends into the sphincter muscles.”
Fact 5. The array of effective treatments is expanding
One new option is targeted therapy: drugs that attack specific genes and proteins in cancer cells (as opposed to chemotherapy, in which the cancer-killing medicines also damage healthy cells). Another is immunotherapy, which uses drugs known as checkpoint inhibitors to unleash immune-system cells that had been turned off so they can destroy cancer cells. Right now, immunotherapy is approved only for patients with tumors that have a high microsatellite instability (MSI-H), which means they mutate faster. Ongoing research will likely identify more biomarkers and treatments to target them.
Fact 6. A major operation may not be necessary
Minimally invasive robotic and laparoscopic procedures are increasingly becoming an option for removing tumors. That’s very good news, because those procedures result in smaller incisions, less pain, and shorter hospital stays, Dr. Merkow says. Recent research at Memorial Sloan Kettering Cancer Center in New York City has also found that new surgical treatments for metastatic tumors, in combination with chemo, are allowing patients to survive more than 10 years.
Fact 7. Cancer that has spread to the liver can be effectively treated
“In some patients, we can now completely remove all disease in the liver,” notes Dr. Merkow. The first step is often chemotherapy to shrink tumors so surgical removal is possible, followed by therapies known as “regional”—they’re directed only at the liver to minimize side effects. For instance, hepatic artery infusion pump chemotherapy shoots chemo meds directly into the liver via a pump. And in ablation therapy, tumors are zapped with microwave energy or radiofrequency waves through a needle or probe inserted directly into the mass.
Fact 8. It’s important to find a comprehensive colorectal cancer center
For the best prognosis, go to an established center that offers state-of-the-art treatments—the minimally invasive procedures that allow for a faster recovery, as well as the newest, most promising therapies and current clinical trials. You’ll also get to work with a multidisciplinary team that includes surgeons, medical and radiation oncologists, gastroenterologists, nutritionists, and social workers. “Metastatic colorectal cancer represents an incredibly diverse pattern of spread,” notes Dr. Merkow, “and it takes a team of experts to determine the best treatment plan for each individual.”
Fact 9. There’s reputable info online, but you have to know where to look
Of course you’re eager to learn about new treatments and breakthroughs—you’re here, aren’t you?—but be skeptical of websites with claims like “Treats all forms of cancer” and “Miraculously kills cancer cells and tumors.” Grandiose promises are warning signals that the “cure” is actually a fraud. The National Comprehensive Cancer Network recommends these websites as reliable colon cancer resources: the American Cancer Society, Cancer Support Community, Colon Cancer Alliance, Fight Colorectal Cancer, National Cancer Institute (NCI), National Coalition for Cancer Survivorship, and NCCN for Patients.
Fact 10. You’re going to need support
Everyone with cancer benefits from having someone come with them to doctor appointments to take notes, ask questions, and clarify info they may have missed or didn’t understand. That goes double for people with advanced colorectal cancers because there are so many options to consider. Also helpful: taking advantage of any support groups offered by your cancer center for advice and moral support on diet, adjusting to physical changes, and managing anxiety.