Post-Surgery Treatment Considerations for Stage IVA Colon Cancer

Q: Post-Surgery Treatment Considerations for Stage IVA Colon Cancer

Hello： The most suitable respondent to these questions is the attending physician responsible for the treatment (to clarify the responsibility). <br>Medical care is not a mechanical job; each person's experience and skills vary. <br>I will answer based on my approach. <br><br>1.

Postoperative treatment issues for colorectal cancer?

Hello Doctor: A senior in their seventies has undergone surgery for a malignant tumor in the rectum, confirmed to be stage IVA, with a CEA level in the fifties, and multiple tumors of varying sizes present in both lobes of the liver.
(The senior shows slight signs of hypoxia, but overall assessment is still considered normal.) Given this situation...

1.
How long after intestinal surgery should treatment begin?
2.
The attending physician indicated that after the follow-up visit for suture removal, chemotherapy with Xeloda and Irinotecan could be initiated depending on the condition; subsequently, once the wound heals, treatment with Avastin could be added.
Do you also find this approach feasible?
3.
However, the senior's attending physician did not mention the need for a port for the upcoming Irinotecan treatment.
If a port is not placed initially, can it still be done later if the patient cannot tolerate it? Or is it better to have it placed from the start? In your opinion, should the senior have a port placed or not?
4.
What is the critical CEA level for colorectal cancer beyond which there is little hope?
5.
If chemotherapy is initiated, how many cycles should be expected at a minimum? If the patient experiences unbearable suffering, how long can treatment be paused?
6.
In this situation, what are the chances of hope with and without treatment?
7.
Based on information from Google, it seems that for patients at this stage, the medications provided are considered palliative care.
Does this mean there is truly no hope?
8.
Do you have any other recommendations? Thank you, Doctor, for your response!

nili, 30~39 year old female. Ask Date: 2020/06/05

Dr. Chen Yunfang reply Oncology

Hello: The most suitable respondent to these questions is the attending physician responsible for the treatment (to clarify the responsibility).
Medical care is not a mechanical job; each person's experience and skills vary.
I will answer based on my approach.

1.
Generally, chemotherapy will begin about a month after surgery.
2.
Yes, it is a standard and formal treatment.
3.
It is recommended to have a vascular access device placed beforehand for safety, as chemotherapy drugs should not extravasate.
4.
It is difficult to say; usually, when CEA levels exceed a thousand, the prognosis is poor.
5.
In stage IV, chemotherapy typically does not stop, as it is mainly to control the disease; a cure is not possible.
6.
There is insufficient patient information to provide an answer.
7.
Yes, in stage IV, any treatment is considered palliative care.
Thank you for the above responses.

Reply Date: 2020/06/05

More Info

Post-surgery treatment for Stage IVA colon cancer, especially in elderly patients with multiple liver metastases, is a complex and nuanced decision that requires careful consideration of various factors, including the patient's overall health, the extent of the disease, and the potential benefits and risks of treatment options.

1. Timing for Starting Treatment: Generally, chemotherapy can begin about 4 to 6 weeks after surgery, once the patient has sufficiently healed and any surgical wounds have closed. This timeframe allows the body to recover from the stress of surgery while also ensuring that the cancer treatment does not get delayed too long, as timely intervention can be critical in managing advanced cancer.

2. Proposed Chemotherapy Regimen: The suggested chemotherapy regimen of Xeloda (capecitabine) combined with Irinotecan, followed by the addition of Avastin (bevacizumab) after wound healing, is a standard approach for treating metastatic colon cancer. This combination can be effective in controlling disease progression and potentially prolonging survival. However, the decision should be based on the patient's tolerance and overall health status, especially considering the patient's age and any existing comorbidities.

3. Central Venous Access: Regarding the placement of a central venous catheter (CVC) for administering chemotherapy, it is generally advisable to have one in place before starting treatment, especially for regimens that may require multiple infusions or have a risk of causing vein irritation. If the patient experiences discomfort or difficulty with peripheral access during treatment, a CVC can be placed later, but it is often more convenient and safer to have it ready from the start.

4. CEA Levels and Prognosis: The carcinoembryonic antigen (CEA) level is a tumor marker used to monitor treatment response and disease progression. While there is no strict cutoff for when treatment becomes futile, significantly elevated CEA levels (e.g., above 100 ng/mL) can indicate advanced disease and a poorer prognosis. However, treatment decisions should not be based solely on CEA levels but should consider the overall clinical picture.

5. Chemotherapy Treatment Duration: The number of chemotherapy cycles can vary based on the specific regimen and the patient's response. Typically, a regimen may consist of 6 to 12 cycles, depending on how well the patient tolerates the treatment and the effectiveness in controlling the cancer. If the side effects become intolerable, the treatment can be paused or adjusted, but this should be done under the guidance of the oncologist.

6. Treatment vs. No Treatment: The hope for treatment versus no treatment can vary significantly. With treatment, especially in advanced stages, the goal is often to control the disease and improve quality of life rather than achieve a cure. Without treatment, the prognosis may be limited, but the decision should be made based on the patient's values and preferences.

7. Palliative Care Considerations: At Stage IVA, treatment may indeed be considered palliative, focusing on symptom management and quality of life rather than curative intent. However, this does not mean there is no hope; many patients can live for extended periods with appropriate treatment and supportive care.

8. Additional Recommendations: It is crucial to maintain open communication with the healthcare team, including oncologists, palliative care specialists, and nutritionists, to ensure a comprehensive approach to treatment. Supportive care, including pain management and nutritional support, can significantly enhance the quality of life during treatment.

In conclusion, the management of Stage IVA colon cancer in an elderly patient requires a tailored approach, considering the patient's overall health, preferences, and the potential benefits and risks of treatment options. Regular follow-ups and adjustments to the treatment plan may be necessary based on the patient's response and tolerance to therapy.

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