At stage IV, the disease has spread to other parts of your body, but it can still be treated. Your doctor has options to help you live longer. Most of the time a cure is not possible unless the spread is limited and able to be surgically removed. To get the best care, see a doctor who specializes in treating this stage of the condition.
Which treatment you get depends on where in your body the cancer has spread. It often spreads to the liver. It also can reach the lungs, lining of the abdomen, or lymph nodes in other parts of your body. You'll get the treatment that's most likely to work for you.
Your choices may include:
- Ablation and cryotherapy
- Targeted therapies
You may get more than one of these treatments.
Surgery sometimes can be used if the cancer has spread to your liver or lungs. It may cure patients who have limited spread to those organs. But in others, it may only ease symptoms.
Your surgeon will remove the part of your colon, liver, or lungs where the cancer is. They will also remove nearby lymph nodes, because cancer can spread through them to other parts of your body.
After removing the part of your colon that has cancer, your surgeon may sew the ends of your intestines together so that stool can continue to pass through. You might get a colostomy, which attaches the end of your colon to an opening in your belly, where waste will leave your body.
Some people only need to use a pouch while they heal from surgery. Once the colostomy is removed, you can use the bathroom normally again.
If there isn't enough colon left, the end of your small intestine will be attached to the opening. This is called an ileostomy. Either way, you'll wear a pouch on the outside of your body to collect waste.
After surgery, you might be in some pain. Some people have bowel problems like constipation or diarrhea. These side effects often go away. It might take a few weeks or months for your bowel habits to get back to normal after surgery.
If the tumor blocks your colon, the surgeon could put in a tube called a stent to keep the bowel open. You'll get that stent put in during a colonoscopy.
Chemotherapy uses drugs to kill cancer cells. You get chemotherapy through a tube in a vein or as a pill that you swallow.
You may get chemotherapy before surgery to shrink tumors so they're easier to remove. Chemo is sometimes given after surgery to destroy any cancer cells left behind. You might get only chemo if you can't have surgery.
There are several kinds of chemo drugs used to treat stage IV colon cancer. You may get more than one of them. Sometimes, doctors combine chemo with targeted therapy (see below).
Chemo drugs can cause side effects like:
- Nausea and vomiting
- Numbness, tingling, and weakness from nerve damage in your feet and hands
- Mouth sores
- More infections than usual
You've probably heard of people losing their hair when they get chemotherapy. But the types of chemo drugs used to treat stage IV colon cancer usually don't make hair fall out.
Your doctor has ways to help you manage chemo side effects and feel better during treatment. Side effects should improve once you finish treatment.
If the cancer is in your liver, you might get a treatment called "hepatic artery infusion chemotherapy." Your doctor places a pump that delivers the chemo drug straight into your liver through an artery. Because the medicine doesn't go through your whole body -- just into your liver -- you can get a higher dose without having more side effects.
Radiation uses high-energy X-rays to kill cancer cells. This treatment probably won't cure your cancer, but it can shrink your tumor and relieve some of your symptoms.
You'll get radiation therapy 5 days a week for a certain number of weeks. For this treatment, you'll visit your doctor's office or a hospital. A machine will aim the X-rays at your body. This is called external-beam radiation therapy. There are other types of radiation:
Stereotactic radiation therapy comes from a machine outside your body. It targets a small area, like an area in the lung or liver where the disease has spread.
Intraoperative radiation therapy is a high dose that you get once, during surgery.
Selective internal radiation therapy (SIRT). This uses radioactive microspheres that are sent through an artery in your liver to the area of the liver tumor.
Radiation can have side effects such as:
- Skin redness
- Bloody stools
These side effects typically stop once your treatment ends.
Ablation and Cryotherapy
These treatments often can be used if your cancer has spread to the liver. Ablation uses heat to kill cancer cells. Cryotherapy uses cold.
A CT or ultrasound scan will help your surgeon guide a thin probe to the tumor. The probe delivers high-energy radio waves to heat the tumor or very cold gas to freeze it.
You'll go home from the hospital on the same day or on the day after your procedure.
Side effects from these treatments are usually mild and can include:
Targeted therapies block substances that cancer cells need to grow and spread. They slow or stop cancer growth while sparing healthy cells. This means you may have fewer side effects than you would with chemo drugs.
Targeted therapies for stage IV colon cancer include:
Anti-angiogenesis drugs. Cancer cells need blood vessels to "feed" them oxygen-rich blood so they can grow and survive. Bevacizumab (Avastin), ramucirumab (Cyramza), and ziv-aflibercept (Zaltrap) block a protein called VEGF, which helps blood vessels grow. Without a blood supply, the tumors "starve." You may get these drugs along with chemo.
EGFR inhibitors.Cetuximab (Erbitux) and panitumumab (Vectibix) slow cancer growth by blocking a protein called EGFR that helps cancer cells grow. These drugs don't work well in cancers that have changes (mutations) to a gene called RAS. Your doctor will test you to make sure you don't have the RAS gene change before you get one of these drugs.
To get targeted therapy, you will visit a hospital or medical center once every 2 to 3 weeks. You take some of these drugs through your vein, but some come in the form of a pill.
Side effects depend on which drug you get. They can include:
- Loss of appetite
- Weight loss
- Dry mouth
- Sores in the mouth or throat
- Numbness or tingling in the arms or legs
Serious side effects are rare. They can include:
- Slow wound healing
- Severe bleeding or bruising
- A hole in the wall of the stomach or intestine
Your doctor may suggest you try:
Immune checkpoint inhibitors. Nivolumab (Opdivo) and pembrolizumab (Keytruda) block PD-1 protein on immune cells called T cells. They help shrink and stop the growth of tumors. Ipilimumab (Yervoy) targets a different protein and can be used with nivolumab (Optivo).
Side effects can include:
- Shortness of breath
- Skin rash
- Nausea or diarrhea
- Loss of appetite
- Muscle or joint pain
Other, more serious side effects happen less often. Checkpoint inhibitors work by removing the brakes on your body's immune system. As a result, the immune system starts attacking other parts of your body, which can lead to serious, sometimes life-threatening problems in your lungs, intestines, liver, hormone-making glands, kidneys, or other organs.
Scientists also look for new ways to treat stage IV colon cancer in clinical trials. These trials test new drugs to see if they are safe and if they work. They often are a way for people to try new medicine that isn't available to everyone. Your doctor can tell you if one of these trials might be a good fit for you.
Your Treatment Plan
Which of these treatments you get will depend on things like your age and where the cancer has spread. Talk over all of your options with your doctor. The more you know, the more empowered you'll be to make decisions about your care.