NCCN Guidelines for Patients® | Colon Cancer - page 45

NCCN Guidelines for Patients
®
Colon Cancer, Version 1.2014
43
5
Treatment guide
Stage IV colon cancer
Research has shown that colon cancer with liver
metastases can sometimes be cured. Thus, a cure is
the goal when possible. Surgery is needed for a cure,
but most people with liver metastases can’t have
surgery. Surgery is only done when all tumors can be
fully removed and your liver won’t be too small after
surgery.
To enlarge your liver, your doctor may suggest portal
vein embolization. Portal vein embolization is the
blocking of the blood vessel to the liver tumor. This
blockage causes the healthy part of the liver to grow
larger. In some patients who have small metastatic
tumors that cannot be removed with surgery, ablation
can be used as treatment.
Chemotherapy is recommended with surgery if you
haven’t had it before. The best order of chemotherapy
and surgery is unknown, so
Chart 5.3.1
presents
three options.
Option 1
starts with surgery. You will have a
colectomy and metastasectomy followed by
chemotherapy. FOLFOX and CapeOX are preferred
regimens. Six months of chemotherapy is preferred.
Option 2
starts with chemotherapy with or without
targeted therapy. Panitumumab and cetuximab should
only be used for tumors that have normal
KRAS
and
NRAS
genes. There are benefits and risks to starting
with drug treatment. Some of these are:
Benefits:
• You may receive early treatment of possible
cancer not yet found.
• Knowing your response to chemotherapy early
can help with treatment planning.
• If the cancer grows while taking chemotherapy,
you can avoid local treatment.
Risks:
• Fat may build up in your liver and your liver may
swell.
• You may become unable to have surgery if the
cancer grows too much or if tumors shrink too
much.
• Injury to small blood vessels may occur in your
liver.
After 2 to 3 months of chemotherapy, you will have
a colectomy and metastasectomy. Sometimes, more
chemotherapy will be given after surgery. Together,
chemotherapy given before and after surgery should
not exceed 6 months.
Option 3
starts with colectomy. Afterward, you will
have chemotherapy with or without targeted therapy
for 2 to 3 months. Panitumumab and cetuximab
should only be used for tumors that have normal
KRAS
and
NRAS
genes. After chemotherapy, the
surgery for metastases will be done. Sometimes,
more chemotherapy is given after surgery. Together,
chemotherapy given before and after surgery should
not exceed 6 months.
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