What are the treatments for Stage IV Colon Cancer?

It's hard to put into words the fear and shock that comes with being diagnosed with Stage IV cancer. It's normal to wonder, "Is it all over now?" But let me tell you, it's not. Medical science has advanced a lot. Even at this stage, there are many treatments that can help you live longer, control your symptoms, and stay healthy. Let's talk about this simply, in a way that you can understand.

What is 'Stage IV'?

Simply put, Stage IV means that the cancer has spread beyond the colon , where it started. This is most often to the liver . It can also spread to the lungs, the lining of the abdomen, or lymph nodes elsewhere in the body.

It can be difficult to get a complete cure at this stage. However, if the cancer has spread to only a few areas, sometimes surgery can be done to completely remove those areas and cure the disease. Therefore, it is best to see a doctor who specializes in treating this type of condition. The treatment you receive will be determined by many factors, such as the location of the cancer, your age, and your overall health.

There are several main treatment methods used:

• Surgery
• Chemotherapy
• Radiation therapy
• Ablation and cryotherapy
• Targeted therapies
• Immunotherapy

Often, you are given more than one of these treatments, or a combination of several.

What is done with surgery?

If the cancer has spread to your liver or lungs, surgery can sometimes be done. As I mentioned earlier, if the cancer is limited, surgery can remove it and you can get a full recovery . In other cases, surgery can also be useful in reducing symptoms caused by the cancer, such as pain and bowel obstruction.

During surgery, the doctor removes the part of the colon, liver, or lung where the cancer is located. At the same time, the lymph nodes around it are removed. This is because cancer cells can easily spread to other parts of the body through these lymph nodes.

After removing the cancerous part of the colon, the doctor will reconnect the two ends of the remaining colon. Then you can have a bowel movement normally. However, sometimes if this connection is not possible, you may need to have a colostomy . This involves connecting one end of the colon to a hole made in the skin of the abdomen. The stool comes out through that hole. The stool is collected in a pouch that is attached to it.

Sometimes, if a large part of the colon is removed, the end of the small intestine is connected to the skin of the abdomen. This is called an ileostomy . However, there may be some pain after the surgery. You may also experience diarrhea or constipation. These side effects will go away after a while.

If the intestine is blocked by cancer, a small tube called a stent can be inserted to keep it open.

What is chemotherapy?

Chemotherapy, or 'chemo' as we call it, is a powerful type of medicine that is given to kill cancer cells. This medicine can be given intravenously or as a pill.

Chemotherapy is given in several main ways:

• Before surgery, the cancerous tumors can be shrunk to make them easier to remove.
• After surgery, destroy any cancer cells that may remain in the body.
• As the main treatment for those who cannot undergo surgery.

There are several types of chemo drugs given for stage 4 colon cancer. Sometimes more than one of these drugs is given in combination. Also, chemo is given in combination with 'targeted therapy', which we will talk about later.

One of the things that most people fear when they hear about chemo is hair loss. However, the types of chemo given for colon cancer usually do not cause hair loss . Don't be alarmed by these side effects. Your doctor can help you manage them and make them more comfortable. These side effects will gradually go away once your treatment is over.

If the cancer has spread to the liver, chemotherapy can also be given using a special method called "hepatic artery infusion chemotherapy." This involves injecting the chemotherapy directly into the main blood vessel that supplies blood to the liver using a pump. Because the medication goes directly to the liver rather than traveling throughout the body, this method can reduce side effects and give a higher dose of the medication.

Radiation therapy and other methods

Radiation Therapy

This involves using high-energy X-rays to destroy cancer cells. Although this treatment is unlikely to completely cure stage 4 cancer, it can help shrink the tumor and reduce symptoms such as pain . This treatment is usually given 5 days a week for several weeks.

Ablation and Cryotherapy

Both of these methods are most often used to destroy cancer cells that have spread to the liver. Ablation uses heat , while cryotherapy uses extreme cold . Using a CT or ultrasound scan, the doctor sends a thin needle-like device to the tumor and either heats it or freezes it to destroy the cancer cells.

Targeted Therapy and Immunotherapy - State-of-the-art Treatments

These are two of the newest and most successful methods in cancer treatment.

Targeted Therapies

Simply put, these drugs specifically target cancer cells. They block the things cancer cells need to grow and spread. This causes very little damage to healthy cells.

• Anti-angiogenesis drugs: These work by stopping the growth of new blood vessels that feed the cancer. It's like stopping the cancer from eating. Bevacizumab (Avastin) and Ramucirumab (Cyramza) are such drugs.
• EGFR inhibitors: Drugs like Cetuximab (Erbitux) and Panitumumab (Vectibix) block a protein called EGFR that helps cancer cells grow. However, for these drugs to work, the cancer must have mutations in certain genes (KRAS, NRAS, BRAF). Your doctor will test to see if these drugs are right for you.
• Other drugs: Modern drugs such as Encorafenib (Braftovi) and Entrectinib (Rozlytrek) are also available today, targeting cancers with specific genetic mutations such as BRAF, NTRK, and RET.

Immunotherapy

This is a very amazing treatment. What you do here is stimulate your own body's immune system and use it to fight cancer cells.

Our immune system has proteins called PD-1 that act like brakes. Cancer cells use these brakes to evade the immune system. Immune checkpoint inhibitor drugs like Nivolumab (Opdivo) and Pembrolizumab (Keytruda) work by turning off these brakes. This allows the immune system to recognize and attack the cancer.

Your treatment plan

The type of treatment you receive depends on many factors. Your doctor will create a treatment plan that is specific to you, taking into account factors such as where the cancer has spread, your age, your overall health, and the genetic characteristics of the cancer.

You may also have the opportunity to participate in clinical trials that test new drugs and treatments around the world. This is a great opportunity to try a new treatment. Talk to your doctor about that too.