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.