Colon cancer can be divided into 4 stages from 1 to 4. Treatment options vary depending on the stage of colon cancer along with other factors. Here, we will be discussing the treatment options depending on stage.
Stage 1 Colon Cancer Treatment
Stage 2 Colon Cancer Treatment
Stage 3 Colon Cancer Treatment
Stage 4 Colon Cancer Treatment
Now, we come to metastatic or stage 4 colon cancer treatment. It may present as metastasis to liver or lungs. It may also present as metastasis to both, lungs and liver. To peritoneum in the form of peritoneal or omental deposits. Very rarely, it may also spread to brain or bones. For most cases of metastatic disease, chemotherapy with/without targeted therapy is the treatment of choice.
Treatment of metastatic disease depends on whether it is resectable or non-resectable.
Non-Resectable Stage 4 Disease
Most cases of metastatic disease are treated with chemotherapy with/without targeted therapy. Immunotherapy is also an option for treatment of metastatic colon cancer.
Resectable Stage 4 Disease
In some selected cases, with limited metastasis to liver and/or lungs, tumor resection may be possible. Also in unresectable disease, it may become resectable if it responds nicely to treatment. When limited liver metastasis involves only a small part of liver, surgical resection may be tried. Similarly, if lung metastasis is localised to only a small part, that can be removed safely, resection may be done.
Other modalities like radiotherapy, surgery or bone-directed therapy, may also be used, for palliation or relief of symptom. Always remember that the treatment for metastatic colon cancer is not generally curative, so the main intent for the treatment is a prolongation of life, reduction of symptoms and improvement of the quality of life. With this, we come to the end of metastatic colon cancer treatment.
Role of Targeted Therapy
- Cetuximab and Panitumumab target epidermal growth factor receptor (EGFR) protein.
- Bevacizumab targets vascular endothelial growth factor (VEGF) receptor.
- They are generally used alone or in combination with chemotherapy for the treatment of higher stage disease.
Role of Immunotherapy
Pembrolizumab and nivolumab have been approved as the second- or third-line therapy for patients with unresectable or advanced/metastatic, dMMR/MSI-H positive colorectal cancers that have progressed on prior treatment (except a checkpoint inhibitor).
Role of Chemotherapy
Chemotherapy may be used for colon cancer in adjuvant setting (after surgical resection of tumor) or metastatic setting (palliative intent). Various chemotherapy regimens have been approved for colon cancer treatment.
Some drugs that are a part of treatment regimens for colon cancer include-