Is Surgery A Must For Stage 4?

my friend is still undecided on surgery. she had colon ca stage 4 w/ multiple mets to both sides of liver. surgery was not an option in the beginning due to the size in the colon and location in the liver. she started chemotherapy in November 2008. she recently finished her folfox + avastin regimen x 12 cycles, w/ minimal side effects, no weight loss. she is now back to work and back to normal life.  her pet/ct showed no activity at this time, colonoscopy also shows complete shrinkage of tumor, but her surgeon/oncologist still insists on having her colon and liver surgery to prevent recurrence. she is scared of complications that may arise after or during surgery which may worsen her condition.

i was reading posts on margaret and i'm also having second thoughts on surgery. is surgery a must for stage 4? i mean, we already know it has metastasized, will surgery still provide a cure? prevent recurrence? does it outweigh possible adverse effects? will it definitely lengthen survival time? any of you had stage 4 and had surgery? how long ago? do you recommend it? please help her decide.

I had surgery two weeks ago today, which included removing part of my colon along with a colo-anal reconstruction.  My surgeon did everything laprascopically, so my recovery time will be a lot easier than major abdominal surgery.

I feel good, and even went to the mall over the weekend.  In my own experience, I rest easier knowing the cancerous part of my colon is long gone (I hope!).  My next step is radiation, then chemo.

I was in the hospital for five days, with minimal pain or discomfort.

I Hope my experience helps your friend make a decision.

While it is possible that in a very small group of patients who have spectacular results that chemo can remove all visible traces of cancer, for the very great majority of stage IV patients surgery is the the best way to remove the cancer from the body.  Since no one can say what started the cancer growing in your friend in the first place, no can say how long it will remain stable and she is at constant risk of progression (meaning that the cancer starts growing again).  Also while survival statistics should be taken with a grain of salt because they apply to populations and not individuals, the statistics show that your friend's chances for prolonged survival and possibly even complete removal of the cancer with no recurrence increase if she has the surgery.

Yes, all surgeries come with complications and yes you can find stories of people who have faced significant challenges associated with these surgeries but if you search you will also find stories of people who came through the surgeries with no unexpected complications and who are very glad to have the cancer out of their body. 

To be honest, if your friend were my friend, I would storngly encourage her to have the surgery.  I would tell her that I would like to go to her next appointments with her for moral support (if she didn'tmind and if it's geographically feasible).  I would also tell her to make a list of her questions at home, before she gets to the appointment, and this is important, ---> make two or three copies of the list of questions.  She should hand one to the doctor as soon as the appointment starts (or to the nurse to place in the chart when the nurse greets her to take her virtal signs).  If you or another friend accompanies her, she should give a copy of the list to you too.  By giving the lists to the MD and her moral support she is less likely to skip over questions because they sound silly in the appointment room. She can also tell the MD she would like to make sure to review all the questions so can the MD ensure no questions are passed over (the moral support friend can do this too).

I used to counsel women who were about to undergo hysterectomy to the same thing.  I would also tell them that while your physicians may deal with cancer patients all day, every day, this generally only happes to the patient once so you have every right to have all of your questions answered to your satisfaction.

Yes, surgery is scary, but for stage IV it really is the best hope for a better outcome.  I do hope your friend reconsiders.  We're actually praiying that the MDs will say my husband's liver mets are resectable - we'd be in that OR in no time to get this cancer out of his body!!

Best wishes to your friend and to you!

Juliet

Hi,

It's a tough call.  Surgery might get rid of the cancer, but it also may not.  My mother was diagnosed with lung cancer -- one tiny little tumor stage 1a.  She had a lobectomy and came through the surgery without any problems.  The surgeon and oncologist both felt the cancer was gone, but within six months it was back, and had metasticized.  She died about a year after her surgery.   I will always wonder if the surgery made her situation worse, but of course it is something we will never know.   Roz

I concur with JMM0612.  As a Stage IV colon cancer which spread to the liver survivor, surgery is the best hope for cure.  Statistics prove this.  When I was diagnosed in July of '04, I was originally told I would live for 18 months with treatment, but that I could die at any moment.  I signed up for a Stage II clinical trial.  I have not regretted a single decision I have made.  I have been cancer free since September of '04. 

I would also bring a tape recorder along.  As someone who has transcribed words, I know, more than anyone, how even if you have just heard something, your brain can flip the words around in a second.  Even more so when you are under stress.  Try your own experiement at home.  Record someone saying a sentence, even a paragraph, then record what you think you heard, then transcribe it word for word, you'll see the sentence will change.   

I always brought a huge list of questions.  Once I had over 100.  My onc answered them all.  Here I thought I was the terrorist patient, what with the inquisitions and recordings.  However, he recently asked me to give a speech about my treatment.  Everyone told me I was his favorite patient. 

So don't be intimidated to do this.  He has appreciated the fact that I have been able to help others through him. 

Let us know how we can help. 

Surgery is always the number one thing to do.  What you have to do is weigh the risk of the surgery with the gain.  If there is a lot of metastisis then you are going to have chemo anyhow so you might as well start that first and see if you can shrink the tumors. 

 THERE IS AND OPTION to surgery that you should investigate.

There is a very good option that requires a clinical trial.  I'm sure you fit the paramenters.  Go to clinicaltrials.gov and type in keyword DAVANAT.  I have a friend that I help get DAVANAT through compassionate use and the turnaround has been so dramatic I have to tell everyone about it. 

DAVANAT is designed to target the chemo to only the cancer cells.  If chemo only goes to your cancer cells and leaves your good cells alone then you won't have any side effects.  The clinical trial to date show NO SIDE EFFECTS.  My friend had NO SIDE EFFECTS not even a headache.  DAVANAT allows you to basically take more chemo more often without ravaging the body and creating more problems while you fight the cancer.  You need to research this ASAP. 

If you need my help let me know.  I'm sorry your friend is stage IV but she might be able to qualify for compassionate use of DAVANAT as well.  Just research it and let me know.  I hope this message finds you.

If you e-mail me back I will explain in detail how the DAVANAT works. 

 Mike Sheikh

Arnold

There was a phase II trial that they completed on stage III an IV colon cancer patients.  they met their endpoint of Objective response very quickly so closed it down.  Then they started anothe Phase II trial for line 1 patients with unresectable colon cancer.  When the FDA sanctioned that study they were essentially saying hey - it obviously works have a go on patients with unresectable cancer. 

I hope that helps - if your a numbers guy go to the website and look at the trial resulsts.  Then I can discuss what the numbers mean.

Mike

I agree with you that surgery is the best method right now.  But extrapolate the response rate from the first colon cancer study and you will find out that this will be first line therapy before surgery a year or two from now once the study is done.  The theory is simple when people have a better response rate for unresectable cancer versus the people who have surgery and treatment then the treatment for unresectable cancer should be first line treatment.  This study is designed to prove superiority over the current standard of care.    The preliminary results lean that way.  They have 8 patients and they are stable or have objective responses.

Good questions.  The study isn't done but if you assume the other 8 patients needed in the study to get statiscal significance you will realize that if the trend continued this would be the new first line therapy and they would be able to make a case of doing this before surgery.  That extrapolation is a little bit of a stretch until we see the numbers.  But the results so far on 8 patients is compelling.