Colon cancer is one of the oncological diseases with a good prognosis. Excellent results have been achieved in its treatment, including terminal cancer. New methods have been introduced that allow for its control for a very long time. In this blog post, the Booking Health team talks about new treatment for colon cancer stage 4.

Surgery for terminal cancer

Colon cancer is one of the few cancers for which surgery is performed even in the advanced stages. The type of surgery depends on the type of tumor spread.

Surgery can be used in the following cases:

• The presence of a small number of metastases in a single anatomical area, such as the lung. In this case, it is possible to perform combined surgery to remove the part of the colon where the primary tumor is located and the part of the lung with metastases.

• The detection of metastases after primary tumor removal (in the late period after colon resection). In this case, the part of the organ affected by the metastatic process can be removed.

• The spread of cancer to the abdomen. This type of cancer progression is called peritoneal carcinomatosis. It is treated with cytoreductive surgery, in which the doctor tries to remove all the tumor foci he can find.

Surgery is very effective even for terminal colon cancer. It offers patients five-year survival rates of up to 50-70%, which is comparable to the results of treating many cancers even at early stages.

Regional types of chemotherapy

In developed countries, several regional chemotherapies are used to treat cancer by administering chemotherapy drugs into the abdominal cavity. The following two methods have proven themselves to be the best:

Hyperthermic intraperitoneal chemoperfusion (HIPEC). It is performed intraoperatively. Immediately after cytoreductive surgery to remove tumors in the abdominal cavity, it is rinsed with a heated solution of chemotherapy drugs to destroy the remaining cancer cells.

Pressurized intraperitoneal aerosol chemotherapy (PIPAC). This is performed as a stand-alone procedure through a minimally invasive laparoscopic approach. Doctors spray a chemotherapy solution into the abdominal cavity, causing tumors to shrink.

Treatment of liver metastases

Blood flows from the intestine to the liver through the portal vein system, which is why metastases are most common here in stage 4. Palliative procedures that lead to the destruction of metastases or a significant reduction in their volume help to manage them.

Procedures:

• Ablation. There are radiofrequency, microwave, chemical, and cryoablation. The essence of the procedure is that small tumors are destroyed by various energies in a minimally invasive procedure.

• Chemoembolization. This is an endovascular procedure performed from inside the blood vessels. The arteries that feed the tumor are blocked with chemotherapy drug-loaded microspheres. The tumor is deprived of its blood supply and damaged by the drugs.

• Radioembolization. This is a similar procedure, but the microspheres with radioactive substances are used instead of cytostatics.

Less commonly, radiation therapy is used to control intrahepatic metastases. Some clinics use electroporation and high-intensity focused ultrasound, which are new and have not yet been adequately studied, but they are considered promising because they have shown good results in clinical trials and offer safety advantages over conventional methods.

Systemic therapies

All patients with terminal cancer receive systemic therapy. In developed countries, this includes not only chemotherapy, but also targeted therapy with biologics (monoclonal antibodies). It is selected individually. Tumor oncogene testing is required to select the optimal treatment regimen.

Some patients are considered candidates for immunotherapy if they have high levels of microsatellite instability. Immunotherapy uses PD-1 inhibitors, possibly in combination with a CTLA-4 inhibitor. These drugs are called immune checkpoint inhibitors. They prevent cancer cells from pretending to be normal cells, thereby improving the work of anti-tumor immunity.

Booking Health is a great place to visit if you are planning to travel abroad for an examination to clarify a diagnosis, have a biopsy, or benefit from new treatments. On the website, you can see prices and make an appointment for your preferred dates.