Fewer people with advanced colon cancer get bowel resection surgery. But that may still be too many, according to new research from the University of Texas.
About 6 in 10 patients with stage IV colon cancer get surgery, down from 75 percent in 1988. Yet those surgeries may delay chemotherapy – the more effective treatment – by a month or more.
“The patients may have a feeling, ‘I want it out.’ It’s a visceral response that they can get,” said study author George Chang, Chief of Colon and Rectal Surgery at The University of Texas MD Anderson Cancer Center in Houston.
Doctors should be careful in deciding which patients get surgery, Chang said. The study suggests they don’t need to be as concerned about complications from leaving the tumor in.
Most patients with the stage IV colon cancer aren’t eligible for bowel resection surgery, because the cancer has already spread throughout the body. For earlier stage colon cancers, surgery is still the recommended treatment.
For the study, published Jan. 14 in JAMA Surgery, Chang and other researchers reviewed the records of more than 64,000 patients with stage IV colon or rectal cancer from 1988 to 2010.
During that time, surgeries decreased from about 75 percent of cases down to 57 percent – but survival increased. That’s thanks in large part to new chemotherapy drugs introduced in 2001.
“The more effective therapy – you want to make sure you get it into the patient,” said Alan Venook, chief of gastrointestinal oncology at the UCSF Helen Diller Family Comprehensive Cancer Center. “It doesn’t mean you don’t need surgery, it means you have have to be careful and selective with if you need to do surgery or not.”
Colon and rectal cancers are the third most commonly-diagnosed cancer in the United States. About 20 percent of people with colon cancer are diagnosed at stage IV.
Andreas Kaiser, a colorectal surgeon and Professor of Clinical Surgery at Keck Medicine of the University of Southern California, said only about 20 percent of stage IV colon cancer patients might benefit from having the tumor removed – eventually.
“There are some patients where we all know there no way to operate on them. Then there are some who have stage IV disease who are curable,” Kaiser said. “Then there are some who seem initially inoperable but then as a result of chemotherapy become operable.”
All agreed that it’s important for doctors and patients to take the time to evaluate their treatment options.
“You shouldn’t rush these things,” Venook said. “The best care for patients is to stop and take a deep breath – and decide what order to do the interventions.”
Gavin Stern is a national digital producer for the Scripps National Desk.