Chemo Alone Is Best for Advanced Colon Cancer

Better drugs have rendered surgery unnecessary in most cases, study finds

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SATURDAY, May 30, 2009 (HealthDay News) --Surgery is no longer the best treatment option for most patients with advanced colorectal cancer that has spread to other organs, a new study suggests.

Immediate colon resection (surgical removal) following diagnosis of stage IV metastatic colorectal cancer had previously been the standard procedure, followed by chemotherapy several weeks after the operation. Surgery was thought to guard against symptoms and complications from the primary tumor, which chemotherapy was thought not to affect.

However, "if the colon tumor is not causing obstruction, perforation or bleeding we've found these patients are best treated with chemotherapy. By moving straight to chemotherapy, patients can avoid the risk of surgical complications and can start treatment for all sites of disease without delay," study author Philip Paty, a surgical oncologist at Memorial Sloan-Kettering Cancer Center, said in a news release issued by the center.

The recommendation is based on a finding that 93 percent of advanced metastatic colorectal cancer cases treated over a six-year period at Sloan-Kettering did not present the complications that failure to remove the primary tumor were expected to cause. Advances in chemotherapy that do a better job at shrinking both the primary colon tumor and the metastases are thought to be responsible for this change.

"We now know that the routine use of surgery for these patients is based on old thinking, and we're beyond that. There will always be the need for individual exceptions based on the clinical situation, but our default position should be not to operate," said Paty, who plans to present the findings Saturday at the American Society of Clinical Oncology annual meeting, in Orlando, Fla.

Colorectal cancer is the second leading cause of cancer-related death in the United States.

More information

The American Cancer Society has more about colorectal cancer.

SOURCE: Memorial Sloan-Kettering Cancer Center, news release, May 30, 2009

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