The treatment of colon cancer really depends on the stage of the colon cancer. Colon cancer is divided into four different stages. Stage 1 would be a small colon cancer, that’s really localized to the lining of the colon, doesn’t involve any nodal involvement. And that would particularly be fine with just surgical resection and those patients have a great outcome with just surgery alone. Stage 2 is when the tumor is a bit bigger, it’s invaded into the muscle or more, but still there are no lymph nodes that are positive.
Now for Stage 3 patients those patients basically have nodal involvement of their cancer and those patients benefit from surgical resection of the tumor, followed by six months of chemotherapy. And the goal there is so that we can treat micro metastatic disease, meaning that small cancer cells that are either in the blood stream or the lymphatics so that we can reduce the risk of a reoccurrence.
And Stage 4 is when the tumor has spread to another site, like the liver or the lung. But even in those patients, we used to say this was incurable and we have found that we have had great success in treating patients with Stage 4 cancer. We also have other types of agents, what we call biologic agents that actually are considered to be targeted therapies that target particular molecular pathways that have been shown to have an important part in colon cancer.
These biologic agents do have an important role in Stage 4 colon cancers and that would When the patients have a biopsy or a specimen, usually in the metastatic setting is when We look for any potential genetic mismatch repair protein defects, which might potentially cancer. this is important not only for the patients, but also their families, because then we can identify whether particular screening methods need to be performed for this particular family if there is a lynch syndrome or a concern for lynch syndrome. Kin The main challenges in removing tumors that occur in the colon and the rectum are anatomy based.
So patients who have say a tumor in the colon, we have to make sure that all the lymph nodes that are associated with that tumor come out. and especially in the rectum, there are more structures that could potentially get injured. So that’s why it’s really important to have someone who does rectal surgery all the time, someone who is familiar with all the structures to have an operation where there is minimal effect on any surrounding structures. I think some of the most exciting things are the minimally invasive techniques.
So, we do most of our operations with laparoscopy meaning that you get small incisions instead of a big long incision. And we can see up close in ways that we couldn’t before. The other big development recently in pelvic surgery — so for rectal cancers, is robotic surgery. And that’s been really exciting too because it really minimizes the size of the incisions, it reduces the length of stay in the hospital after surgery, and also there is a good cosmetic outcome.
After the cancer surgeon is done with removing the tumor, you end up having a space within, that area that the tumor was occupying. And, that has to be filled with something. And that’s where a reconstructive plastic surgeon would come in to do that. We try and take tissue from another part of the body and move it into that space to help fill that space to help prevent, that, that gravitational dependent fall that happens inside the belly. off of blood vessels, because the tissue that you move has to have, an appropriate blood based ona small blood vessel.
and either we detach that and then re-attach it to another part of the body and have that tissue live off of that blood supply, or we keep it attached and are able to move it from one area to the body to another area of the body. And the process is, actually, pretty complex. Collaboration and Tumor boards As a patient, I think it would be a really great cohesive experience to be seen at the Stanford Cancer Center, and that’s because we have the benefit of the Tumor Board and this Tumor Board is a multidisciplinary meeting where we have medical oncologists and we have colorectal surgeons, we have liver surgeons, we have thoracic surgeons, then we have the, pathologists, the, the radiologist, and nurses and just a bunch of people, anyone who could possibly be involved in your care talking about you for a long time.
And everyone is looking at your images on the screen, and everyone is talking about okay, what’s the best approach for this person, and we try to come up with a really good comprehensive and holistic plan.
I think everyone is at the top of their field here, and we all collaborate well together. We’ve had many patients who show up on our door step that have had tumors that were deemed either unresectable previously, or were a lost cause in the past. And we’ve managed to take care of them. If there’s a solution, we’ll find it.