Stage IV Colon Cancer: Treatment Options and Metastasis Insights

Stage IV colorectal cancer

My mother was unfortunately diagnosed with stage IV colon cancer this year, which has metastasized to the lungs.
Due to her condition, she cannot undergo surgery and is currently receiving chemotherapy and targeted therapy.
Recently, the tumor has shrunk, and the medical oncologist indicated that surgery might be possible.
However, the surgical oncologist suggested waiting until the targeted therapy is completed to reassess whether the lung tumor has disappeared, and to proceed with surgery only for the colon tumor.
I would like to know if, after the targeted therapy, if the lung tumor has indeed disappeared, is it possible to avoid surgery for the lung tumor and only operate on the colon tumor? Or should both the lung and colon tumors be surgically removed at this stage, followed by continued chemotherapy? Additionally, I would like to ask if it is common for colon cancer to metastasize to the lungs, and is it possible for lung cancer to metastasize to the colon?

Li Li, 20~29 year old female. Ask Date: 2021/11/29

Dr. Cai Jinji reply Gastroenterology and Hepatology

Dear Ms.
Li,
I am not very clear about your mother's condition.
I recommend discussing it further with your doctor.
Alternatively, you could obtain a copy of her medical records and schedule an appointment for a consultation, which would provide a clearer understanding.

Sincerely,
Director Cai Jin-ji
Department of Hepatobiliary and Gastroenterology, Nantou Hospital

Reply Date: 2021/11/29

More Info

Stage IV colon cancer is a complex and challenging diagnosis, particularly when it has metastasized to other organs such as the lungs. In your mother's case, the treatment plan involving chemotherapy and targeted therapy is a standard approach for managing advanced cancer. The goal of these treatments is to shrink the tumors and control the disease, potentially making surgical intervention possible.

When it comes to the surgical options, the decision to operate on the primary tumor in the colon and any metastatic tumors in the lungs depends on several factors. If the targeted therapy successfully reduces the size of the lung tumors to the point where they are no longer detectable, it may lead to a discussion about whether surgery is necessary. However, the surgical team will consider the overall health of your mother, the extent of the disease, and the potential benefits and risks of surgery.

In general, if the lung tumors have completely disappeared after the targeted therapy, the surgical team may decide to focus solely on the colon tumor. This is because the primary goal is to remove the source of the cancer and prevent further spread. However, if there is still evidence of lung metastasis, even if it is minimal, the surgical team may recommend removing both the lung and colon tumors to ensure that all cancerous tissue is addressed.

Regarding your question about the possibility of lung cancer metastasizing to the colon, it is indeed possible, although it is less common. Typically, colon cancer spreads to the liver and lungs, but any cancer can metastasize to any organ. The pattern of metastasis often depends on the type of cancer and its biological behavior. In the case of colon cancer, the most frequent sites of metastasis are the liver and lungs, but it can also spread to other areas, including the peritoneum and distant lymph nodes.

In conclusion, the treatment strategy for Stage IV colon cancer with lung metastasis should be a collaborative decision made by the oncologist and surgical team, taking into account the response to therapy, the patient's overall health, and the potential for surgical success. It is essential to maintain open communication with the healthcare team to understand the rationale behind each treatment decision and to ensure that your mother's care is tailored to her specific situation. Regular follow-ups and imaging studies will be crucial in monitoring her progress and making informed decisions about her treatment plan.

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