Following clinical evaluation of rectal cancer, the cancer is referred to as Stage IV rectal cancer if the final evaluation shows that the cancer has spread to distant locations in the body, which may include the liver, lungs, bones, or other sites.
A variety of factors ultimately influence a patient’s decision to receive treatment of cancer. The purpose of receiving cancer treatment may be to improve symptoms through local control of the cancer, increase a patient’s chance of cure, or prolong a patient’s survival. The potential benefits of receiving cancer treatment must be carefully balanced with the potential risks of receiving cancer treatment.
The following is a general overview of the treatment of Stage IV rectal cancer. Circumstances unique to your situation and prognostic factors of your cancer may ultimately influence how these general treatment principles are applied. The information on this Web site is intended to help educate you about your treatment options and to facilitate a mutual or shared decision-making process with your treating cancer physician.
Most new treatments are developed in clinical trials. Clinical trials are studies that evaluate the effectiveness of new drugs or treatment strategies. The development of more effective cancer treatments requires that new and innovative therapies be evaluated with cancer patients. Participation in a clinical trial may offer access to better treatments and advance the existing knowledge about treatment of this cancer. Clinical trials are available for most stages of cancer. Patients who are interested in participating in a clinical trial should discuss the risks and benefits of clinical trials with their physician. To ensure that you are receiving the optimal treatment of your cancer, it is important to stay informed and follow the cancer news in order to learn about new treatments and the results of clinical trials.
Certain patients with Stage IV rectal cancer can be cured of their cancer and others derive meaningful palliative benefit from treatment. Patients with Stage IV rectal cancer can be broadly divided into two groups: those with cancer that may be possible to remove with surgery and those with more widespread cancer.
While some patients have a single site of metastatic cancer that can be treated with curative intent, the majority of patients with Stage IV rectal cancer have more widespread cancer that cannot be completely removed with surgery.
If the cancer is extensive but not causing symptoms, treatment oven involves chemotherapy. Several different chemotherapy regimens are available, and the choice of which to use will depend on factors such as your health and previous treatment history. In some cases, chemotherapy may shrink the cancer enough that surgery to remove it becomes possible.
Chemotherapy may be given in combination with other drugs known as targeted therapies. Targeted therapies are anticancer drugs that interfere with specific pathways involved in cancer cell growth or survival. Some targeted therapies block growth signals from reaching cancer cells; others reduce the blood supply to cancer cells; and still others stimulate the immune system to recognize and attack the cancer cell. Depending on the specific “target”, targeted therapies may slow cancer cell growth or increase cancer cell death.
Targeted therapies that have shown a benefit for selected patients with metastatic colorectal cancer include Avastin® (bevacizumab), Erbitux® (cetuximab), and Vectibix® (panitumumab). Avastin blocks a protein (VEGF) that plays a key role in the development of new blood vessels. By blocking VEGF, Avastin deprives the cancer of nutrients and oxygen and inhibits its growth. Erbitux and Vectibix slow cancer growth by targeting a protein known as EGFR. Cancers with certain gene mutations are unlikely to respond to Erbitux or Vectibix, and tests are available to detect these mutations before treatment decisions are made.
If patients are experiencing symptoms from their rectal cancer, they may also receive treatments such as radiation therapy, surgery, or stenting to relieve problems such as bowel obstruction.
Rectal cancer may spread (metastasize) to the liver, lung or other locations in the body. When the site of metastasis is a single organ, such as the liver or lungs, patients may benefit from local treatment directed at that single site of metastasis
Highly selected patients with isolated areas of rectal cancer can be cured if the primary cancer in the rectum and the isolated area of cancer outside the rectum can be surgically removed.
Treatment of the liver: The most common site of metastasis for patients with rectal cancer is the liver. When it’s possible to completely surgically remove all liver metastases, surgery is the preferred treatment. Some patients may have both the liver and the rectum treated in a single operation, and others may have two operations: one to treat the rectum and one to treat the liver. Chemotherapy or chemotherapy plus radiation therapy may be used before and/or after surgery.
Although surgery offers some patients the chance for a cure, a majority of patients with liver metastases are not candidates for surgery because of the size or location of their tumors or their general health. Some of these patients may become candidates for surgery if initial treatment with chemotherapy shrinks the tumors sufficiently. If the tumors continue to be impossible to remove surgically, other liver-directed therapies may be considered. These other therapies include radiofrequency ablation (use of heat to kill cancer cells), cryotherapy (use of cold to kill cancer cells), delivery of chemotherapy directly to the liver, and radiation therapy. Relatively little information is available from clinical trials about the risks and benefits of these other approaches, but they may benefit selected patients.
Managing Side Effects.
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