Advanced Stage 4 Colon Cancer Survival Rates and Modern Treatment Strategies

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• Improved Survival Rates for Metastatic Colon Cancer
• Multimodal Treatment Approach for Liver Metastases
• The Role of the Multidisciplinary Team
• The Complex Treatment Timeline
• The Possibility of a Long-Term Cure
• Full Transcript

Improved Survival Rates for Metastatic Colon Cancer

Survival rates for stage 4 metastatic colon cancer have improved dramatically. Dr. Graeme Poston, MD, a leading liver cancer surgeon, provides specific data on these advancements. For patients whose liver metastases are resectable, either initially or after conversion with chemotherapy, the five-year survival rate is now 50%. A quarter of these patients are completely disease-free at the five-year mark. Most impressively, the ten-year survival rate for this group is now approaching 30%.

Dr. Graeme Poston, MD, also notes that even for patients with unresectable liver metastases, median survival has increased. For fit patients receiving modern treatment, median survival now exceeds 30 months. This represents a significant improvement over historical outcomes for advanced colorectal cancer.

Multimodal Treatment Approach for Liver Metastases

The key to improved prognosis in stage 4 colon cancer is a multimodal treatment strategy. Dr. Graeme Poston, MD, stresses that this involves a carefully orchestrated combination of therapies. Treatment typically includes systemic chemotherapy, radiation therapy, and extensive surgical resection of tumors. The goal is to eliminate all visible disease, including the primary colon tumor and any metastases in organs like the liver or lungs.

Dr. Anton Titov, MD, discusses how this approach has transformed patient outcomes. Surgery for liver metastases is a cornerstone of this curative-intent strategy. The success of this method is evidenced by the long-term survival data, showing that a cure is a realistic objective for a significant subset of patients.

The Role of the Multidisciplinary Team

Optimal management of metastatic colorectal cancer requires a specialized multidisciplinary team. Dr. Graeme Poston, MD, explains that his team includes medical oncologists, radiation oncologists, liver surgeons, colorectal surgeons, and chest surgeons. These experts meet together in the same room to review each patient's case and collaboratively design a personalized treatment plan.

This team-based approach is essential for managing complex cases. A patient might present with a large primary rectal tumor, several liver metastases, and a few lung nodules. The multidisciplinary team must devise a coherent strategy that sequences chemotherapy, radiation, and multiple surgeries effectively over many months.

The Complex Treatment Timeline

Treatment for stage 4 colon cancer with liver metastases is a lengthy and intensive process. Dr. Graeme Poston, MD, outlines a potential timeline that can span a full year. A patient might begin with neoadjuvant chemotherapy and radiation for the primary rectal tumor. While that is ongoing, surgeons may operate to remove metastases from the liver.

Dr. Graeme Poston, MD, is clear with patients about the demanding nature of this journey. He informs them to expect multiple surgical operations, extensive chemotherapy, and radiation therapy. The primary tumor is often the last component to be surgically removed. Despite the difficulty, this aggressive, staged protocol offers the best chance for achieving a disease-free state and long-term survival.

The Possibility of a Long-Term Cure

A central message from Dr. Graeme Poston, MD, is that cure is now a achievable goal in metastatic colon cancer. Data from leading cancer centers shows that patients who reach the 10-year mark disease-free have a survival curve that remains flat out to 20 years. This statistical evidence strongly supports the conclusion that these patients are cured of their cancer.

Dr. Graeme Poston, MD, personally has patients who are 20-year survivors after resection of liver metastases from stage 4 colon cancer. These individuals ultimately die from other causes, such as old age, not from a cancer recurrence. This represents an amazing progress in oncology and underscores the life-saving potential of modern, multimodal cancer care.

Full Transcript

Dr. Anton Titov, MD: What are the overall expectations for survival of patients with metastatic colorectal cancer? What is the prognosis when liver metastases are present in colon cancer?

Dr. Graeme Poston, MD: Sometimes the patient has completely unresectable liver metastases from colorectal cancer. Such stage 4 colon cancer patients with liver metastases might never convert to resectable liver lesions. But we are still looking at median survival now in excess of 30 months if patients are fit enough to receive treatment for stage 4 metastatic colon cancer.

For those colon cancer patients that have resectable liver metastases upfront, or for those stage 4 colon cancer patients whose liver metastases convert to resection, five-year survival of such patients is 50% now. Half of those who survive 5 years, or 25% of stage 4 colon cancer patients with resectable liver metastases, are disease-free at 5 years.

Ten-year survival for stage 4 colon cancer patients in whom we can resect liver metastases is now approaching 30%.

I have 20-year survivors from metastatic stage 4 colorectal cancer with liver metastases resected. They die of old age. But I now have 20-year survivors from metastatic colon cancer.

Dr. Anton Titov, MD: That is an amazing progress in metastatic colon cancer treatment. This underscores the value of multimodality therapies for colon cancer.

Dr. Graeme Poston, MD: Yeah, absolutely. That is the key to metastatic colon cancer treatment and improved prognosis. It is multimodal therapy. It is absolutely essential that metastatic colon cancer patients are managed by multidisciplinary teams that can work together.

In my group, we have not just the medical oncologist and radiation oncologist, but we have the liver surgeon, the colorectal surgeon, and the chest surgeon. They are all in the same room at the same time discussing the colon cancer patient's treatment options.

We are frequently looking at patients who present in stage 4 rectal cancer with a big rectal tumor and several liver metastases. They possibly have two or three lung metastases. We have to work out a stage 4 colorectal cancer treatment strategy for the next 12 months for that patient.

Because oftentimes, these metastatic colorectal cancer patients will need a long course of neoadjuvant chemotherapy for the primary tumor in the rectum. In the interim, we should treat colorectal cancer metastases in the liver and in the lungs. Surgical operation on a liver happens whilst they are receiving the neoadjuvant chemotherapy.

Dr. Anton Titov, MD: Stage 4 colorectal cancer patients get first chemotherapy and then liver metastases resection. The last treatment is the primary tumor being removed. In the meantime, they have had the liver metastases removed and the lung metastases removed. The patient had a long course of neoadjuvant radiotherapy with chemotherapy.

Dr. Graeme Poston, MD: You have to tell that metastatic stage 4 colon cancer patient, "It is going to be hard work for the next 12 months. You are going to have probably three surgical operations. You are going to have a lot of radiation and systemic colon cancer chemotherapy." But hopefully this time next year, you will be disease-free from stage 4 metastatic colorectal cancer.

Dr. Anton Titov, MD: The primary colorectal cancer tumor will be removed at the last stage.

Dr. Graeme Poston, MD: The primary colorectal cancer tumor may be the last thing to come out, yes.

Dr. Anton Titov, MD: That is very impressive progress in metastatic stage 4 colorectal cancer treatment, especially when liver metastases or lung metastases are present.

Dr. Graeme Poston, MD: Stage 4 metastatic colon cancer prognosis update: 20-year survival after liver metastases resection is possible. Choose leading surgeon and chemotherapy protocols wisely.