Colon Cancer Treatment (PDQ®): Treatment - Health Professional Information [NCI] - Stage IV and Recurrent Colon Cancer Treatment
Stage IV colon cancer denotes distant metastatic disease. Treatment of recurrent coloncancer depends on the sites of recurrent disease demonstrable by physical examination and/or radiographic studies. In addition to standard radiographic procedures, radioimmunoscintography may add clinical information that may affect management. Such approaches have not led to improvements in long-term outcome measures such as survival.
Treatment Options for Stage IV and Recurrent Colon Cancer
Incidence and mortality
Colorectal cancer (CRC) is the third most common malignant neoplasm worldwide  and the second leading cause of cancer deaths (irrespective of gender) in the United States. It is estimated that there will be 142,820 new cases diagnosed in the United States in 2013 and 50,830 deaths due to this disease. Between 2005 and 2009, CRC incidence rates in the United States declined by 4.1% per year among adults aged 50 years and older. For the past...
Treatment options for stage IV and recurrent colon cancer include the following:
Surgical resection of locally recurrent cancer.
Surgical resection and anastomosis or bypass of obstructing or bleeding primary lesions in selected metastatic cases.
Resection of liver metastases in selected metastatic patients (5-year cure rate for resection of solitary or combination metastases exceeds 20%) or ablation in selected patients.[2,3,4,5,6,7,8,9,10,11]
Resection of isolated pulmonary or ovarian metastases in selected patients.
Clinical trials evaluating new drugs and biological therapy.
Clinical trials comparing various chemotherapy regimens or biological therapy, alone or in combination.
Treatment of Liver Metastasis
Approximately 50% of colon cancer patients will be diagnosed with hepatic metastases, either at the time of initial presentation or as a result of disease recurrence. Although only a small proportion of patients with hepatic metastases are candidates for surgical resection, advances in tumor ablation techniques and in both regional and systemic chemotherapy administration provide for a number of treatment options. These include the following:
Hepatic metastasis may be considered to be resectable based on the following:[5,7,13,14,15,16]
Limited number of lesions.
Intrahepatic locations of lesions.
Lack of major vascular involvement.
Absent or limited extrahepatic disease.
Sufficient functional hepatic reserve.
For patients with hepatic metastasis considered to be resectable, a negative margin resection resulted in 5-year survival rates of 25% to 40% in mostly nonrandomized studies, such as the NCCTG-934653 trial.[5,7,13,14,15,16] Improved surgical techniques and advances in preoperative imaging have allowed for better patient selection for resection. In addition, multiple studies with multiagent chemotherapy have demonstrated that patients with metastatic disease isolated to the liver, which historically would be considered unresectable, can occasionally be made resectable after the administration of chemotherapy.
Patients with hepatic metastases that are deemed unresectable will occasionally become candidates for resection if they have a good response to chemotherapy. These patients have 5-year survival rates similar to patients who initially had resectable disease.
Radiofrequency ablation has emerged as a safe technique (2% major morbidity and <1% mortality rate) that may provide for long-term tumor control.[18,19,20,21,22,23,24] Radiofrequency ablation and cryosurgical ablation [25,26,27,28] remain options for patients with tumors that cannot be resected and for patients who are not candidates for liver resection.