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49

NCCN Guidelines for Patients

®

:

Colon Cancer, Version 1.2017

5

Metastatic disease

Metastases at diagnosis

Results of primary treatment should be assessed

with CT with contrast. Scans of your chest, abdomen,

and pelvis are needed. Imaging should be done prior

to adjuvant treatment.

Chemotherapy follows surgery in Option 1. FOLFOX

and CAPEOX are preferred regimens. Otherwise,

you may receive capecitabine or 5-FU/LV. Six

months of chemotherapy is preferred.

Option 2

Option 2 starts with chemotherapy. FOLFOX

or CAPEOX are preferred but FOLFIRI may be

received. There are pros and cons to starting with

chemotherapy. Some of these are:

Pros

†

†

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.

Cons

†

†

Fat may build up in your liver and your liver

may swell.

†

†

You may become unable to have surgery if the

cancer grows or shrinks too much.

†

†

Injury to small blood vessels may occur in your

liver.

After 2 to 3 months of chemotherapy, you can get

the colectomy and metastasectomy. They can be

done together during one operation or apart in two

operations.

Results of primary treatment should be assessed

with CT with contrast. Scans of your chest, abdomen,

and pelvis are needed. Imaging should be done prior

to adjuvant treatment.

Sometimes, more chemotherapy will be given after

surgery. FOLFOX and CAPEOX are preferred

regimens. Otherwise, you may receive capecitabine

or 5-FU/LV. Together, chemotherapy given before

and after surgery should not exceed 6 months.

Option 3

Option 3 starts with a colectomy. Afterward,

chemotherapy is received for 2 to 3 months.

FOLFOX or CAPEOX are preferred but FOLFIRI may

be received.

After chemotherapy, the surgery for metastases will

be done. Results of primary treatment should be

assessed with CT with contrast. Scans of your chest,

abdomen, and pelvis are needed. Imaging should be

done prior to adjuvant treatment.

Sometimes, more chemotherapy is given after

surgery. FOLFOX and CAPEOX are preferred

regimens. Otherwise, you may receive capecitabine

or 5-FU/LV. Together, chemotherapy given before

and after surgery should not exceed 6 months.

HAI ± 5-FU/LV

Instead of systemic chemotherapy, HAI may be an

option. Systemic 5-FU/LV may be added. NCCN

experts advise that this option should only be

received at treatment centers with much experience

in this method. More research is needed to learn how

well this treatment works.