NCCN Guidelines for Patients® | Colon Cancer - page 44

1
About colon cancer
Genetic counseling | Treatment
NCCN Guidelines for Patients
®
Colon Cancer, Version 1.2014
42
5
Treatment guide
Stag IV c lon ca cer
5.3 Stage IV colon cancer
This section is for people with metastases in the
liver, lungs, or both organs but not elsewhere. Colon
cancer most often spreads to the liver. Among
100 people with colon cancer, 20 to 34 people will
have liver metastases at diagnosis. Research on
metastases other than in the liver is limited. As
a result, the information below focuses on liver
metastases but also applies to lung metastases.
Treatment for other stage IV cancers found at
diagnosis is discussed in Part 7.
Option 2
1
st
treatment
2
nd
treatment
3
rd
treatment
4
th
treatment
• FOLFIRI ± bevacizumab,
• FOLFOX ± bevacizumab,
• CapeOX ± bevacizumab, or
• If normal
KRAS/NRAS
gene:
– FOLFIRI ± panitumumab,
– FOLFIRI ± cetuximab, or
– FOLFOX ± panitumumab
• Colectomy
• Metastasectomy
(at time of colectomy
or afterward)
• Follow-up testing,
or
• Short course of
chemotherapy
Chart 5.3.1 Surgical options
Option 1
1
st
treatment
2
nd
treatment
3
rd
treatment
• Colectomy
• Metastasectomy
(at time of colectomy or afterward)
• FOLFOX, or
• CapeOX
Option 3
1
st
treatment
2
nd
treatment
3
rd
treatment
4
th
treatment
• Colectomy
• FOLFIRI ± bevacizumab,
• FOLFOX ± bevacizumab
• CapeOX ± bevacizumab, or
• If normal
KRAS/NRAS
gene:
– FOLFIRI ± panitumumab,
– FOLFIRI ± cetuximab, or
– FOLFOX ± panitumumab
• Metastasectomy
• Follow-up testing,
or
• Short course of
chemotherapy
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