10 Questions About Advanced Colon Cancer Treatment

“我对分期进行思考的方式是如果你在结肠外部看到癌症，那是转移性疾病，那是第四阶段，”波士顿达纳 - 法国胃肠癌癌症治疗中心的肿瘤学家Leah Miller，M.D。医生通过进行成像测试（CT扫描或，有时，MRIS或PET扫描）以及手术去除肿瘤来抵达该号码。如果扫描显示身体的其他部位癌症 - 你的肺部，你的肝脏或结肠外的淋巴结，那就是第4阶段。

第4阶段结肠癌有时可治愈，但可悲的是，对于大多数患者而言，它不是。5年生存率（五年过去诊断的人的百分比）是令人生畏的14％。但这并不意味着你的癌症是不可治疗的，尸科科医生专门从事费城福克斯追逐癌症中心的胃肠道癌症。“目标是保持某人越来越长，在此过程中保持合理的生活质量。”治疗将有助于减少症状。

Yes, quite probably. Every patient’s case is different, but you most likely will be treated with a combination of medications and maybe surgery and radiation, says Dr. Jain. Chemo is sometimes used before surgery to shrink tumors to make them easier to remove. It’s also used after surgery, especially in combination with other types of therapies, to kill cancer cells that may have been left behind after surgery and relieve symptoms.

Again, probably yes. But in order to know what type of drug will work for you, it’s important that a pathologist does genetic testing on the tumor to check for certain mutations, says Dr. Biller. This is something that should be done for all stage 4 patients, regardless of whether your tumor turns out to have the exact mutations for treatments already in use. “There may also be clinical trial options and drugs that are used for a different type of cancer with that mutation,” she says.

These are drugs that attack specific genes and proteins in cancer cells. They’re often used in combination with chemotherapy (which kills cancer cells but also, unfortunately, healthy ones). There are two types of targeted therapy, says Dr. Biller. One “works on targeting blood vessel growth. Those can be used in stage 4 patients generally. The majority of the other targeted therapies are directed to a specific mutation or something specific about the pathology of the tumor itself.” Meaning if testing shows your tumor has one of these markers, these drugs are another treatment option for you.

You get both types via IV infusions. Let’s start with the anti-angiogenesis therapy—angiogenesis means the development of new blood vessels, and these drugs prevent that from happening. (In fact, if you’re going to have surgery or have just had it, you won’t get anti-angiogenesis therapy because your wound wouldn’t heal as quickly.) Stopping blood vessel growth is important for cancer treatment because tumors need more blood vessel growth than other parts of the body, says Dr. Biller.

These are therapies that block various proteins that help cancer cells grow. Which one you get (if any) depends on the genetic mutations doctors find when they test your tumor—or whether they find any at all. If you’re a candidate, you might hear the names of such drugs as Erbitux (cetuximab), Braftovi (encorafenib), and Stivarga (regorafenib).

“Immunotherapy basically helps rev up your own immune system so that it can target the cancer,” says Dr. Biller. It can be effective, but there’s a catch: “Immunotherapy is only used in colon cancers that have a certain molecular feature that's called microsatellite instability.” So it only benefits about 5% of stage 4 colon cancer patients (usually the ones with Lynch syndrome, an inherited genetic mutation). Currently, there are clinical trials to see if different combinations of immunotherapy drugs will work for the other 95%, says Dr. Jain.

No matter what medications you’re taking, they sometimes just stop working. “Somehow the cancer becomes resistant to either the chemotherapy or the targeted therapy, but there's still a lot that we don't know about why,” says Dr. Biller. In that case, there are many other types of drugs or combinations of drugs that doctors will try, and if those are exhausted, that’s where clinical trials can come in: You can volunteer to receive newer, not-yet-approved treatments that may work better.

博勒马博士说，过去五年来过去五年的最大变化一直是批准治疗结肠癌的药物数量，而且有针对性疗法的使用。与您的医生讨论您提供的整个治疗范围（并确保您的肿瘤获得转基因测试）。Miller博士还建议她的患者提前获得姑息治疗，以帮助管理治疗的症状和副作用（既有身体和情感）。一项研究发现，姑息治疗减少了疲劳和疼痛的症状。