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48

NCCN Guidelines for Patients

®

:

Colon Cancer, Version 1.2017

5

Metastatic disease

Metastases at diagnosis

Metastases at diagnosis

This section explains treatment options for

metastases found at diagnosis. These cancers are

stage IV. Options for colon cancer that can be treated

with surgery are explained first. However, most

people with metastases can’t have surgery. If you

can’t have surgery, treatment options are explained

on page 50.

Guide 11

presents surgical options for liver or lung

metastases at diagnosis. Surgery is only an option if

1) all tumors can be fully removed and 2) your liver

won’t be too small after surgery.

To enlarge your liver, you may receive 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.

This procedure will be done before surgery.

Surgery with chemotherapy is advised to treat

metastases. The best order of chemotherapy and

surgery is unknown. Thus, three options are given.

Option 1

Option 1 starts with surgery. Surgery may consist

of a colectomy and metastasectomy. They can be

done together during one operation or apart in two

operations. Local therapy to the liver or lung may be

added.

Instead of metastasectomy, local therapy with

colectomy may be an option. Local therapy includes

ablation and SBRT. However, NCCN experts prefer

metastasectomy over local therapy.

Guide 11. Surgical options

Option 1

Primary treatment

Adjuvant treatment

• Colectomy + metastasectomy ± local treatment

• Colectomy + local treatment

• FOLFOX or CAPEOX

• Capecitabine or 5-FU/LV

Option 2

Neoadjuvant treatment

Primary treatment

Adjuvant treatment

• FOLFOX or CAPEOX

• FOLFIRI

• Colectomy + metastasectomy

• FOLFOX or CAPEOX

• Capecitabine or 5-FU/LV

Option 3

Primary treatment

Adjuvant treatment

Primary treatment

Adjuvant treatment

• Colectomy

• FOLFOX or CAPEOX

• FOLFIRI

• Metastasectomy

• FOLFOX or CAPEOX

• Capecitabine or 5-FU/LV