Exploring Advanced Treatment Options for Stage IV Colon Cancer Pain Management

Q: Exploring Advanced Treatment Options for Stage IV Colon Cancer Pain Management

Hello： After reading the description, your mother was already diagnosed at stage IV, which is terminal, meaning it has essentially metastasized. <br>All treatments for stage IV are merely to delay the inevitable; a cure is not possible. <br>1. <br>Can monoclonal antibodies or bis

Cancer treatment

Hello Doctor: Last year, my mother was diagnosed with stage IV colorectal cancer.
The doctor prescribed chemotherapy and targeted therapy, and for a while, her condition was well-controlled; she could eat, sleep, and move around like a normal person.
However, I feel that the doctor has been quite pessimistic lately.
When my mother asked if there would be any improvement, the doctor directly said there would not be, only an extension of life, which gave no hope to the patient.

In June of this year, my mother started experiencing pain in her left side.
Despite multiple reports of this pain, the doctor said it was unrelated to chemotherapy and did not conduct further examinations.
She went to an orthopedic doctor on her own, had an X-ray, and was told there was nothing serious, just a strain.
However, the pain has progressively worsened, extending to her back and spine, causing widespread discomfort.
After undergoing a CT scan, it was finally revealed that she had a fracture, which might be due to bone metastasis causing the pain.
The doctor then suggested changing the chemotherapy regimen (after a long delay in suggesting a change), as the cancer cells had already spread uncontrollably.
With the continuous advancements in medicine, are there any other treatment options available for my mother's condition? 1.
Would subcutaneous monoclonal antibodies or intravenous bisphosphonates help alleviate the pain caused by bone metastasis? 2.
Is radiation therapy only effective for pain relief, or can it also inhibit tumor growth? 3.
Since there are various types of radiation therapy, what potential side effects should we be aware of? 4.
Are there any other treatment options available for my mother's condition?

vicky, 40~49 year old female. Ask Date: 2021/12/21

Dr. Chen Yunfang reply Oncology

Hello: After reading the description, your mother was already diagnosed at stage IV, which is terminal, meaning it has essentially metastasized.
All treatments for stage IV are merely to delay the inevitable; a cure is not possible.
1.
Can monoclonal antibodies or bisphosphonate drugs relieve pain? Anticancer drugs themselves do not relieve pain, as they are not analgesics.
The strongest and fastest pain relief comes from morphine, which begins to take effect within 20 minutes of ingestion.
2 and 3 fall under the scope of radiation oncology; I am in hematology and oncology, and there is a significant difference in our specialties, so I cannot answer those.
4.
I cannot answer this because she is not my patient, and I am not familiar with her condition.
You should discuss treatment options thoroughly with her attending physician.
Thank you.

Reply Date: 2021/12/21

More Info

When dealing with advanced stage IV colon cancer, particularly when it has metastasized to other organs such as the liver or bones, managing pain and exploring treatment options can be quite complex. Your mother's situation, where she has been undergoing chemotherapy and targeted therapy, yet is experiencing significant pain, particularly in her bones, raises several important considerations.

Firstly, it's crucial to understand that stage IV colon cancer is often associated with a poor prognosis, but this does not mean that treatment options are exhausted. The primary goal of treatment at this stage is to manage symptoms, improve quality of life, and potentially prolong survival. Pain management is a critical component of this care.

1. Monoclonal Antibodies and Bisphosphonates: Subcutaneous monoclonal antibodies, such as denosumab, and intravenous bisphosphonates like zoledronic acid, are often used to manage bone-related complications in cancer patients. These medications can help reduce the risk of skeletal-related events, such as fractures, and may alleviate some pain associated with bone metastases. They work by inhibiting osteoclast activity, which is responsible for bone resorption, thus stabilizing the bone structure and potentially reducing pain.

2. Radiation Therapy: Radiation therapy can indeed be effective in managing pain caused by bone metastases. It is often used as a palliative treatment to relieve pain and improve function. While radiation may not directly inhibit tumor growth, it can shrink tumors in the bone, which may alleviate pressure on nerves and other structures, thereby reducing pain. The side effects of radiation can vary depending on the area being treated but may include fatigue, skin irritation, and, in some cases, localized pain. However, these side effects are generally manageable.

3. Other Treatment Options: In addition to the aforementioned therapies, there are several other approaches that could be considered. Palliative care specialists can provide comprehensive pain management strategies, including the use of opioids or other analgesics, which may be necessary if the pain becomes unmanageable. Additionally, integrative therapies such as acupuncture, physical therapy, and psychological support can also play a role in improving quality of life.

4. Communication with Healthcare Providers: It is essential to maintain open communication with your mother's healthcare team. If you feel that her current oncologist is not addressing her pain adequately or is not providing hope, it may be beneficial to seek a second opinion or consult with a palliative care specialist. Palliative care focuses on providing relief from the symptoms and stress of serious illness, and it can be provided alongside curative treatments.

5. Clinical Trials: Given the rapid advancements in cancer treatment, exploring clinical trials may also be an option. These trials often investigate new therapies that could be more effective than current standard treatments. Discussing this possibility with her oncologist could open doors to innovative treatment options.

In conclusion, while stage IV colon cancer presents significant challenges, there are various avenues to explore for pain management and treatment. Engaging with a multidisciplinary team that includes oncologists, palliative care specialists, and pain management experts can provide a comprehensive approach to your mother's care. It is important to advocate for her needs and ensure that her pain is taken seriously, as effective pain management is a fundamental aspect of cancer care.

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