Challenges in Treating Recurrent Colon Cancer with Organ Adhesions

Colorectal cancer recurrence with tumor adhesion to the stomach, pancreas, and other organs?

Dear Dr.
Ke,
My father is 60 years old.
Last August, he was taken to the emergency room due to unbearable abdominal pain.
After examination, he was diagnosed with intestinal obstruction caused by a malignant tumor.
He underwent emergency surgery to create a colostomy, followed by tumor resection surgery in September.
He started chemotherapy (5-FU) in November, receiving a total of 12 sessions until May of this year.
In May, he experienced gastric bleeding and underwent an endoscopy, which revealed a tumor outside the colon (with biopsy results from the stomach).
The doctor indicated that this is a recurrence of colon cancer, and due to the tumor adhering to the stomach and pancreas, the surgical team assessed that surgery would be risky.
They recommended proceeding with 6 sessions of targeted therapy first.
While waiting for the approval of the targeted medication, he was treated with 5-FU in combination with another chemotherapy drug.
After discharge, he was readmitted due to severe side effects (nausea, vomiting, diarrhea, dizziness).
The vomiting issue has not improved, and the attending physician indicated that it is caused by tumor compression.
Currently, my father is unable to eat and is relying solely on nutritional injections and IV fluids.
The surgical team reassessed and concluded that surgery is not an option, and only targeted therapy can be pursued.
I would like to ask Dr.
Ke if the tumor's adhesion to the pancreas makes surgical resection impossible? If the continuous vomiting caused by tumor compression prevents normal eating, wouldn't that hinder the administration of targeted therapy as well? Do you have any other opinions or suggestions?

Jin, 30~39 year old female. Ask Date: 2016/06/14

Dr. Ke Fangxu reply Surgery

Based on your description, the condition seems to be quite severe.
If there are multiple metastases in the abdominal cavity after surgery, it can be said that Western medicine has no possibility of a cure.
Targeted therapy can effectively extend survival by 3 to 6 months.
Surgical treatment is not recommended because it is not possible to completely remove the cancer cells.
A few physicians perform peritoneal resection combined with intraperitoneal chemotherapy, which is said to extend survival by 6 to 12 months, but it remains a painful and uncertain treatment option.
Most physicians at this stage will assess the patient's physical condition; if the patient is still in relatively good health, targeted therapy may be an option.
However, if the patient is already physically weak and unable to eat, it may be time to consider initiating palliative care.

Reply Date: 2016/06/14

More Info

When dealing with recurrent colon cancer, especially in cases where there are organ adhesions, the treatment landscape becomes quite complex. In your father's situation, the recurrence of the tumor and its adhesion to critical organs such as the stomach and pancreas pose significant challenges for surgical intervention. Here’s a comprehensive overview of the issues at hand and potential pathways forward.

Understanding Organ Adhesions and Their Impact on Surgery
Organ adhesions occur when scar tissue forms between organs, often as a result of previous surgeries or inflammatory processes. In the context of cancer, these adhesions can complicate surgical options significantly. When a tumor adheres to surrounding structures, such as the pancreas or stomach, it can make surgical resection risky. Surgeons must weigh the potential benefits of removing the tumor against the risks of damaging adjacent organs, which could lead to severe complications or even death.

Treatment Options for Recurrent Colon Cancer
1. Chemotherapy and Targeted Therapy: Given that your father has already undergone chemotherapy (5-FU) and is now being considered for targeted therapy, this approach is quite standard. Targeted therapies can help manage the disease by specifically attacking cancer cells while sparing normal cells, which may reduce some side effects compared to traditional chemotherapy. However, the effectiveness of these treatments can vary based on the tumor's genetic makeup and other factors.

2. Nutritional Support: Since your father is currently unable to eat due to vomiting and other complications, nutritional support is crucial. This may involve total parenteral nutrition (TPN), which provides essential nutrients intravenously. Maintaining nutritional status is vital for overall health and can help improve tolerance to further treatments.

3. Palliative Care: Given the severity of your father's condition, palliative care should be an integral part of his treatment plan. This approach focuses on relieving symptoms and improving quality of life, rather than attempting to cure the disease. Palliative care teams can provide support for managing pain, nausea, and other distressing symptoms.

4. Surgical Considerations: If the tumor is causing significant obstruction and is not amenable to resection due to adhesions, surgeons may consider alternative procedures. For instance, they might perform a bypass surgery to alleviate the obstruction without removing the tumor. However, this decision will depend on the overall health of your father and the specific characteristics of the tumor.

5. Clinical Trials: Depending on the specifics of your father's case, it may be worthwhile to explore clinical trials. These trials often provide access to cutting-edge therapies that are not yet widely available and may offer new hope for patients with recurrent cancer.

Addressing the Vomiting and Nutritional Challenges
The persistent vomiting your father is experiencing could be due to several factors, including the tumor's pressure on the stomach or other gastrointestinal complications. It is essential to address this symptom aggressively. This may involve:
- Medications: Antiemetics can help control nausea and vomiting. If standard medications are ineffective, there are other options that can be explored.

- Gastrostomy Tube: If oral intake remains impossible, a gastrostomy tube may be considered to provide nutrition directly to the stomach, bypassing the need for oral intake.

Conclusion
In summary, your father's case presents significant challenges due to the recurrence of colon cancer and its adhesion to surrounding organs. While surgical options may be limited, chemotherapy and targeted therapies remain viable pathways. Ensuring adequate nutritional support and managing symptoms through palliative care are critical components of his treatment plan. It is essential to maintain open communication with his healthcare team to explore all available options and make informed decisions about his care. If you have further questions or concerns, consider seeking a second opinion or consulting with a specialist in palliative care or oncology.

Similar Q&A

Post-Colon Cancer Complications: Adhesions and Bowel Incontinence Solutions

Hello, Doctor. My father was diagnosed with stage II colon cancer four years ago. He initially underwent chemotherapy to shrink the tumor before having surgery to preserve his anus, which unfortunately resulted in fecal incontinence. However, subsequent tests showed no issues. Re...

Dr. Lai Yicheng reply Oncology
Hello, Sir: Question 1: Regarding new technologies, it would be better to consult a surgeon for more clarity. Question 2: Postoperative adhesions are often caused by previous abdominal surgeries, pelvic inflammatory disease due to infections, or even as a result of chemotherapy...

Preventing Intestinal Adhesions After Sigmoid Colon Cancer Surgery: Tips and Insights

Hello Dr. Chen, I would like to ask about postoperative care for patients with sigmoid colon cancer. After starting oral chemotherapy a few days post-surgery, if a patient suddenly develops intestinal adhesions, how can this be prevented? Are there dietary recommendations, exerci...

Dr. Chen Junyi reply Oncology
This may not be related to chemotherapy; please consult a colorectal surgeon.

Managing Non-Healing Wounds and Colon Cancer Complications

Hello, my mother underwent laparoscopic surgery (Da Vinci) for stage III colon cancer two years ago, followed by radiation and chemotherapy. She has been regularly monitored at the hospital, and doctors have stated that there is no evidence of metastasis. Two months ago, she was ...

Dr. Huang Zhihui reply Surgery
Without observing the condition, it is not possible to determine the cause.

Managing Bowel Issues After Ovarian Cancer Surgery: Tips and Solutions

Hello doctor, my mother has been diagnosed with ovarian cancer and has developed intestinal adhesions after surgery, leading to abdominal bloating and difficulty in bowel movements. This has happened three to four times, and she often visits the emergency room. What methods can h...

Dr. Cai Anshun reply Gastroenterology and Hepatology
Hello: To avoid constipation and fecal impaction, it's important to incorporate fruits and vegetables, adequate hydration, and probiotics into your diet. Exercise and massage can also be beneficial. If there is severe intestinal adhesion leading to bowel obstruction, surgica...