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Factors Determining the Treatment Options for Metastatic Colon Cancer
Though the liver is the most common site for metastatic colon cancer, not all patients with liver metastatic receive the same treatment. There are various factors to consider in choosing the treatment options for metastatic colon cancer. They include:
1) Extent and Location of the Tumor Involvement: Surgical resection may be an option if only limited liver cells are involved. A tumor located too near to vessels may complicate the surgical resection.
2) Existing Liver Diseases like Cirrhosis: Condition like liver cirrhosis may impair the liver functions and resection could further burden the remaining liver tissues for its functions.
3) Existing Medical Diseases: Hypertension, diabetes mellitus and obesity can pose additional risk for surgery.
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Surgical Resection as a Metastatic Colon Cancer Treatment
A surgical oncologist would be consulted based on the investigation findings and patient’s fitness to decide if the liver metastatic is “respectable" or “nonresectable". The benefits of surgery resection as a metastatic colon cancer treatment must be more than the risk of the procedure. Up to 30 percent of patients may be cured if metastases in the liver can be successfully removed. Favorable prognostic factors for these patients are:
1) Well differentiated tumor
2) Absence of vascular invasion
3) Tumors size less than 5 cm in diameter
Chemotherapy may be given to shrink the tumor size in facilitating the surgical resection. This is done before the surgery though the metastasis may be confined to the liver. Additional chemotherapy combination is usually recommended after surgery as well: FOLFOX (Oxaliplatin+5-FU+leucovorin), FOLFIRI (Irinotecan+5-FU+leucovorin), XELOX ( Oxaliplatin+ Capecitabine).
Chemotherapy can be administered via hepatic intra arterial method, directly into the liver as compared to the usual intravenous administration. However, the effect for this hepatic intra arterial method is unclear.
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Chemotherapy for Unresectable Colon Cancer
Chemotherapy plays an important role in both respectable and unresectable cancers. For respectable cancer it is used as adjuvant therapy while in unresectable colon cancer, it is recommended for relief of symptoms, to improve quality of life and to prolong survival.
In most cancer types, individual chemotherapy drugs are given continuously until the cancer cells no longer respond towards them. A new regime is then introduced- “second line therapy". This is termed as continuum of care concept.
In metastatic colon cancer treatment, such concept is not applied but a few combinations of drugs are given at the same time. Thus, the number of doses of drugs can be minimized, reducing the treatment related side effects. Aggressive treatment in between the maintenance phase of chemotherapy should be individualized so that the quality of life is not further compromised.
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1) Stage IV Liver Surgery, John Hopkins Medicine, Colorectal Cancer http://www.hopkinscoloncancercenter.org/CMS/CMS_Page.aspx?CurrentUDV=59&CMS_Page_ID=F8D44AA8-C114-4C69-9A45-256284D9D0A9
2) Colorectal cancer treatment; metastatic cancer Authors: Axel Grothey, MD, Jeffrey W Clark, MD Section Editor, Kenneth K Tanabe, MD http://www.uptodate.com/contents/patient-information-colorectal-cancer-treatment-metastatic-cancer#H11