Surgery for advanced colorectal cancer? Each patient's needs are unique

January 20, 2015 | by Denise Heady

Surgery is vital in the treatment of cancer – it's used to help diagnose, treat and even prevent the disease – so a new colorectal cancer study linking a decrease in surgeries for advanced cancer to increased survival rates may raise more questions than it answers for some patients.

advance colorectal cancer surgery Treatment options for advanced colorectal cancer depend on the unique needs of each patient. The decision needs to individualized, said Stephen Sentovich, a board-certified colon and rectal cancer surgical expert at City of Hope.

The surgery-and-survival study, conducted by researchers at MD Anderson Cancer Center and published recently in JAMA Surgery, found that although surgery is still the most-used treatment for Stage 4 colorectal cancer, it has become less common. Surgical rates decreased from 74.5 percent in 1988 to 57.4 percent in 2010, with survival rates doubling from 8.6 percent in 1988 to 17.8 percent in 2009.

The trend reflects a greater use of new chemotherapy drugs and targeted treatment options and highlights the overall improvements made in the treatment of colorectal cancer. But Stephen Sentovich, M.D., M.B.A., a board-certified colon and rectal cancer surgical expert at City of Hope, cautions against making broad assumptions about the best treatment options.

Treatment choices aren’t always black and white, he says. Decisions needs to be individualized, based on the unique needs of each patient.

“Patients with Stage 4 cancer should be treated at centers that offer a multidisciplinary approach with treatment decisions made jointly by colorectal surgeons, surgical oncologists, medical oncologists and radiation oncologists,” Sentovich said.

"Offering a multidisciplinary approach to these patients is really the way forward because everyone's Stage 4 disease is a little bit different," he added in an interview with Medscape Medical News.

In the new study, Sentovich noted, many of the individual treatment details for each patient were unknown.

Researchers reviewed 64,157 patients from the National Cancer Institute’s Surveillance, Epidemiology, and End Results colorectal cancer registry who were diagnosed with Stage 4 colon or rectal cancer (CRC) between 1988 and 2010. Overall, 67 percent of patients underwent surgery to treat their cancer, but the details of the treatment were not revealed.

“We don't have any of the details on any of these patients in terms of why certain things were done," Sentovich told Medscape Medical News. "You have these trends over time, but the study is not following individual patients or figuring out if a certain thing is working or not working for them; it's just looking at what happened over a period of time.”

One specific reason can't explain the upward trend in survival, but Sentovich pointed out that improvements in imaging can help make more accurate decisions on who is and isn’t a candidate for surgery.

The bottom line, again, is that every patient need is different.

"I think the decision to use PTR (primary tumor resections) or not really needs to be individualized for the patient with Stage 4 CRC," Sentovich said.

That decision requires expertise because, in cancer, expertise matters.


Learn more about colorectal cancer treatment at City of Hope.

Learn more about becoming a patient or getting a second opinion at City of Hope by visiting our website or by calling 800-826-HOPE (4673). City of Hope staff will explain what's required for a consult at City of Hope and help you determine, before you come in, whether or not your insurance will pay for the appointment.


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