Rectal cancer ranks fourth among all first-time malignancies worldwide, after breast, prostate, and lung cancer, averaging about 12% of all cases, with a dramatic increase predominantly in developed countries.
Treatment options for stage 4 rectal cancer
Stage 4 rectal cancer involves cancer cells detected in other organs (distant metastases) regardless of the size of the primary tumour and the presence or absence of regional lymph nodes.
Treatment options for this stage vary from case to case and depend primarily on the breadth of the disease.
If complete removal of both the primary tumour and its metastases (e.g. single liver and/or lung metastases) is likely, one of the following treatment options are possible:
- Extensive combined surgery with rectal resection and removal of metastases followed by chemotherapy.
- Preoperative chemotherapy followed by surgery to remove the tumour and its metastases and postoperative chemotherapy.
- Preoperative chemotherapy and radiotherapy followed by surgery, and then even stronger postoperative chemotherapy.
These options can significantly prolong life and, in some rare cases, even cure cancer. If rectal cancer cannot be removed by surgery, chemotherapy is the main treatment option.
As in the case of other oncological diseases, the treatment for stage 4 rectal cancer in the modern view includes the integrated application of different methods.
To ensure maximum effect, as well as preserve the quality of life of the patient (both during and after treatment), a multidisciplinary consultation involves doctors from different specialities: clinical oncologist, surgeon, radiotherapist, radiosurgeon, chemotherapist, etc.
It is this approach that distinguishes the practice of oncological care provided for people with stage 4 rectal cancer, which corresponds to the practice of the world’s best oncological centres.
When will surgery help?
Rectal cancer is possible to treat surgically in 70% of patients without signs of metastatic disease, with unfortunately the percentage being significantly lower for patients with stage 4 rectal cancer. For rectal cancer treatment, the extent of surgery depends on how far from the anus the tumour is located.
If it is necessary to remove the rectum completely, a permanent colostomy (a surgically created opening in the anterior abdominal wall to expel the intestine) is created, through which the intestinal contents will be emptied into a colostomy bag.
Given today’s medical advances and colostomy care devices, the negative effects of this surgery are minimized.
When cancer has spread to the liver in unresectable patients, removal of a limited number of metastases is recommended as a further surgical treatment option.
This surgery is performed if the primary tumour has been completely removed, the liver metastasis is in one lobe of the liver, and there are no extrahepatic metastases. The 5-year survival rate after surgery is 6-25%.
Chemotherapy and targeted treatments for stage 4 rectal cancer
Considering the statistics (late detection and high mortality rate), the treatment of rectal cancer is one of the most urgent tasks of modern oncology.
This translates into increased attention to the development of drugs to fight the primary tumour and its metastases. Today, chemotherapy is an important part of concomitant treatment, and its side effects (mainly nausea) are effectively controlled by modern supportive therapies.
In addition, opportunities for non-surgical targeted treatment for stage 4 rectal cancer are widely studied, and every year oncologists add new drugs to their arsenal, acting not on all cells of the body, but only on cancer cells with one or more specific vulnerabilities (identified by immunohistochemistry), which are managed by targeted therapy.
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