Stage 4 colon cancer life expectancy: Diagnosis and decisions

Stage 4 colon cancer occurs when cancer in the colon spreads or metastasizes to other tissues and organs. The 5-year survival rate for people with stage 4 colon cancer is less than 15%.

The American Cancer Society (ACS) note that the 5-year relative survival rate for people with stage 4 colon cancer that has spread is 14%.

Colon cancer most often spreads to the liver, but it may also reach the lungs, the lymph nodes, or the lining of the abdominal cavity.

However, everyone is different, and other factors contribute to a person’s survival rate.

Share on PinterestA doctor may recommend multiple tests to accurately diagnose colon cancer.

The correct diagnosis of colon cancer may take patience, as doctors use many tests to detect and locate cancer.

If they identify cancer, they will also use more tests to see whether it has spread.

The tests and processes that can aid a colon cancer diagnosis include:

• a physical examination
• blood tests
• a colonoscopy to look inside the rectum
• a biopsy, in which the doctor takes a sample of tissue and sends it to a laboratory for analysis
• molecular testing to help identify specific characteristics of the tumor that may be important for treatment
• imaging tests, such as CT, PET, ultrasound, or MRI scans, to see whether cancer has spread
• a chest X-ray to check whether cancer has spread to the lungs

After running all of the necessary tests, a doctor will discuss the diagnosis with the individual.

Anyone who receives a stage 4 colon cancer diagnosis will have to make some decisions about the way forward, particularly regarding treatment options.

It is important to discuss all of the options with a doctor and to understand the goal of each treatment.

The treatment options available to people with stage 4 colon cancer are more limited than those suitable for the earlier stages of this cancer. However, there are still some treatment options to consider, as well as other factors to keep in mind.

Surgery

When cancerous cells have spread to distant organs and tissues, surgery is unlikely to cure cancer. There are some cases in which surgery may still be a good option, though.

If a scan reveals that the cancer has only spread to a few small areas, surgery may still be possible. By surgically removing the cancerous cells, doctors hope to help the person live longer.

These surgeries will involve the removal of part of the colon as well as the nearby lymph nodes. Additional surgery may remove the areas of tissue into which the cancer has spread. Doctors will typically also recommend chemotherapy, either before or after the surgery.

If the tumor cells are too large to remove, or there are too many of them, doctors will recommend chemotherapy before the person undergoes any surgical procedures. If this shrinks the tumors, they may then ask a surgeon to proceed with the surgery.

Doctors may also need to perform additional surgical procedures if the cancerous growth is likely to obstruct the colon or is already blocking it. In some cases, minimally invasive surgery, such as placing a stent, may be possible. Surgeons can place a stent, which is a hollow tube that typically consists of mesh metal or plastic, into the colon during a colonoscopy. When successful, a stent may help keep the colon open and make more invasive surgery unnecessary.

Doctors may also recommend a diverting colostomy, which essentially cuts the colon above the cancerous tissue and diverts the waste from the body out through a small opening in the skin.

Chemotherapy

Share on PinterestChemotherapy is a primary treatment for advanced cancer.

If the colon cancer has spread too far for surgery to be effective, chemotherapy is the primary treatment option.

Most people with stage 4 colon cancer will receive chemotherapy or specific targeted therapies to help control the cancer progression or symptoms.

Doctors may recommend some treatment regimens that include a targeting drug, which targets either the vascular endothelial growth factor (VEGF) pathway or the epithelial growth factor receptor (EGFR) pathway.

The choice between regimens will vary in each situation. The most suitable option will depend on the types of treatment that a person has had before, their overall health, and their responsiveness to treatment.

It is not uncommon for doctors to try multiple treatments. If the cancer does not respond to the first treatment, they may stop that treatment and start another instead.

Radiation therapy

Doctors may also recommend radiation therapy in late-stage colon cancer to help reduce symptoms such as pain and discomfort. This treatment might even shrink the tumor for a time, but it will not usually cure the cancer.

Hepatic artery infusion

A hepatic artery infusion may be a treatment option for people with colon cancer that has spread to the liver. Hepatic artery infusion is a type of regional chemotherapy, which involves delivering a chemotherapy drug directly into the hepatic artery in the liver. This treatment may help destroy cancer cells without harming the healthy liver cells in the process.

Ablation or embolization

Ablation or embolization may be appropriate for people who have metastatic or reoccurring colorectal cancer that causes a few tumors in the lung or liver that are less than 4 centimeters across.

Ablation uses either radio frequencies, microwaves, or alcohol — which people also call percutaneous ethanol injection (PEI) — to target and kill cancer cells while leaving the surrounding tissues relatively unharmed.

During embolization, a doctor will inject substances into the blood vessels to try to block or reduce the blood flow to cancer cells in the liver.

Palliative care

If cancer progresses to many distant organs and tissues, surgery may not help extend a person’s lifespan. Other treatment options can cause discomfort and may produce additional symptoms that make the person’s quality of life worse.

In these cases, people may decide against medical treatment that seeks to cure the cancer and instead opt for palliative care to try to make living more comfortable.

Palliative care will typically involve finding ways to manage pain and reduce a person’s symptoms so that they can live comfortably for as long as possible.

Share on PinterestA person’s responsiveness to treatment will depend on a number of factors, such as age and general health.

As the ACS note, colon cancer is the third most commonly diagnosed cancer in both males and females in the United States. One in 22 men and one in 24 women will receive a colon cancer diagnosis during their lifetime.

Stage 4 colon cancer is late-stage cancer in which the disease has spread to other tissues or organs in the body and is, therefore, more difficult to treat. Treatment may only be partially successful, and cancer may be more likely to return after treatment.

The ACS note that the 5-year relative survival rate for stage 4 colon cancer is 14%. However, this does not account for other factors that may affect individual survival rates.

For instance, the success of particular treatment methods may vary among individuals, with treatments that work very well for some people having little effect in others.

Additionally, experts base these statistics on past cases. As treatments tend to get better over time, survival rates may also improve as more effective treatments become available.

Individual factors can also play a significant role in a person’s outcome. For instance, the age and overall health of an individual may affect their responsiveness to treatment.

The rate of cancer progression may change the outlook as well. If the cancer causes complications, such as a blockage in the colon or a hole in the bowel wall, the person’s outlook is likely to change.

This survival statistic also only applies to stage 4 colon cancer when doctors first diagnose it. The survival rate will be different for those in whom the cancer has spread further or returned after treatment.

Stage 4 colon cancer is late-stage cancer. Life expectancy is lower than it is for earlier stages of cancer. The 5-year relative survival rate for stage 4 colon cancer that has spread to other parts of the body is about 14%. However, other factors, such as the chosen treatment methods and the person’s overall health, contribute to life expectancy.

Although there are often still several treatment options available, including surgery and chemotherapy, some people with late-stage cancer choose not to have medical treatment and to seek palliative care instead.

Anyone who receives a diagnosis of stage 4 colon cancer should work closely with their medical team to discuss all the treatment options and decide what will best suit their needs.

Stage 4 colon cancer life expectancy: Diagnosis and decisions

Stage 4 colon cancer occurs when cancer in the colon spreads or metastasizes to other tissues and organs. The 5-year survival rate for people with stage 4 colon cancer is less than 15%.

The American Cancer Society (ACS) note that the 5-year relative survival rate for people with stage 4 colon cancer that has spread is 14%.

Colon cancer most often spreads to the liver, but it may also reach the lungs, the lymph nodes, or the lining of the abdominal cavity.

However, everyone is different, and other factors contribute to a person’s survival rate.

Share on PinterestA doctor may recommend multiple tests to accurately diagnose colon cancer.

The correct diagnosis of colon cancer may take patience, as doctors use many tests to detect and locate cancer.

If they identify cancer, they will also use more tests to see whether it has spread.

The tests and processes that can aid a colon cancer diagnosis include:

• a physical examination
• blood tests
• a colonoscopy to look inside the rectum
• a biopsy, in which the doctor takes a sample of tissue and sends it to a laboratory for analysis
• molecular testing to help identify specific characteristics of the tumor that may be important for treatment
• imaging tests, such as CT, PET, ultrasound, or MRI scans, to see whether cancer has spread
• a chest X-ray to check whether cancer has spread to the lungs

After running all of the necessary tests, a doctor will discuss the diagnosis with the individual.

Anyone who receives a stage 4 colon cancer diagnosis will have to make some decisions about the way forward, particularly regarding treatment options.

It is important to discuss all of the options with a doctor and to understand the goal of each treatment.

The treatment options available to people with stage 4 colon cancer are more limited than those suitable for the earlier stages of this cancer. However, there are still some treatment options to consider, as well as other factors to keep in mind.

Surgery

When cancerous cells have spread to distant organs and tissues, surgery is unlikely to cure cancer. There are some cases in which surgery may still be a good option, though.

If a scan reveals that the cancer has only spread to a few small areas, surgery may still be possible. By surgically removing the cancerous cells, doctors hope to help the person live longer.

These surgeries will involve the removal of part of the colon as well as the nearby lymph nodes. Additional surgery may remove the areas of tissue into which the cancer has spread. Doctors will typically also recommend chemotherapy, either before or after the surgery.

If the tumor cells are too large to remove, or there are too many of them, doctors will recommend chemotherapy before the person undergoes any surgical procedures. If this shrinks the tumors, they may then ask a surgeon to proceed with the surgery.

Doctors may also need to perform additional surgical procedures if the cancerous growth is likely to obstruct the colon or is already blocking it. In some cases, minimally invasive surgery, such as placing a stent, may be possible. Surgeons can place a stent, which is a hollow tube that typically consists of mesh metal or plastic, into the colon during a colonoscopy. When successful, a stent may help keep the colon open and make more invasive surgery unnecessary.

Doctors may also recommend a diverting colostomy, which essentially cuts the colon above the cancerous tissue and diverts the waste from the body out through a small opening in the skin.

Chemotherapy

Share on PinterestChemotherapy is a primary treatment for advanced cancer.

If the colon cancer has spread too far for surgery to be effective, chemotherapy is the primary treatment option.

Most people with stage 4 colon cancer will receive chemotherapy or specific targeted therapies to help control the cancer progression or symptoms.

Doctors may recommend some treatment regimens that include a targeting drug, which targets either the vascular endothelial growth factor (VEGF) pathway or the epithelial growth factor receptor (EGFR) pathway.

The choice between regimens will vary in each situation. The most suitable option will depend on the types of treatment that a person has had before, their overall health, and their responsiveness to treatment.

It is not uncommon for doctors to try multiple treatments. If the cancer does not respond to the first treatment, they may stop that treatment and start another instead.

Radiation therapy

Doctors may also recommend radiation therapy in late-stage colon cancer to help reduce symptoms such as pain and discomfort. This treatment might even shrink the tumor for a time, but it will not usually cure the cancer.

Hepatic artery infusion

A hepatic artery infusion may be a treatment option for people with colon cancer that has spread to the liver. Hepatic artery infusion is a type of regional chemotherapy, which involves delivering a chemotherapy drug directly into the hepatic artery in the liver. This treatment may help destroy cancer cells without harming the healthy liver cells in the process.

Ablation or embolization

Ablation or embolization may be appropriate for people who have metastatic or reoccurring colorectal cancer that causes a few tumors in the lung or liver that are less than 4 centimeters across.

Ablation uses either radio frequencies, microwaves, or alcohol — which people also call percutaneous ethanol injection (PEI) — to target and kill cancer cells while leaving the surrounding tissues relatively unharmed.

During embolization, a doctor will inject substances into the blood vessels to try to block or reduce the blood flow to cancer cells in the liver.

Palliative care

If cancer progresses to many distant organs and tissues, surgery may not help extend a person’s lifespan. Other treatment options can cause discomfort and may produce additional symptoms that make the person’s quality of life worse.

In these cases, people may decide against medical treatment that seeks to cure the cancer and instead opt for palliative care to try to make living more comfortable.

Palliative care will typically involve finding ways to manage pain and reduce a person’s symptoms so that they can live comfortably for as long as possible.

Share on PinterestA person’s responsiveness to treatment will depend on a number of factors, such as age and general health.

As the ACS note, colon cancer is the third most commonly diagnosed cancer in both males and females in the United States. One in 22 men and one in 24 women will receive a colon cancer diagnosis during their lifetime.

Stage 4 colon cancer is late-stage cancer in which the disease has spread to other tissues or organs in the body and is, therefore, more difficult to treat. Treatment may only be partially successful, and cancer may be more likely to return after treatment.

The ACS note that the 5-year relative survival rate for stage 4 colon cancer is 14%. However, this does not account for other factors that may affect individual survival rates.

For instance, the success of particular treatment methods may vary among individuals, with treatments that work very well for some people having little effect in others.

Additionally, experts base these statistics on past cases. As treatments tend to get better over time, survival rates may also improve as more effective treatments become available.

Individual factors can also play a significant role in a person’s outcome. For instance, the age and overall health of an individual may affect their responsiveness to treatment.

The rate of cancer progression may change the outlook as well. If the cancer causes complications, such as a blockage in the colon or a hole in the bowel wall, the person’s outlook is likely to change.

This survival statistic also only applies to stage 4 colon cancer when doctors first diagnose it. The survival rate will be different for those in whom the cancer has spread further or returned after treatment.

Stage 4 colon cancer is late-stage cancer. Life expectancy is lower than it is for earlier stages of cancer. The 5-year relative survival rate for stage 4 colon cancer that has spread to other parts of the body is about 14%. However, other factors, such as the chosen treatment methods and the person’s overall health, contribute to life expectancy.

Although there are often still several treatment options available, including surgery and chemotherapy, some people with late-stage cancer choose not to have medical treatment and to seek palliative care instead.

Anyone who receives a diagnosis of stage 4 colon cancer should work closely with their medical team to discuss all the treatment options and decide what will best suit their needs.

symptoms, stages, prognosis, treatment, metastases

Stages of colon cancer

The stage of cancer is an important indicator on which treatment tactics and prognosis for the patient primarily depend. There are 4 main stages in colorectal cancer:

• The first stage is the earliest. Such a tumor is located in the mucous membrane and does not grow deep into the intestinal wall.
• Stage 2 cancer grows deeper, sometimes through the entire intestinal wall.
• In stage 3 colon cancer, tumor cells invade nearby (regional) lymph nodes.
• At stage 4, distant metastases are found, for example, in the liver, bones, brain. Complications develop in the form of peritoneal carcinomatosis and ascites: cancer cells “spread” along the surface of the peritoneum, fluid accumulates in the abdomen. This worsens the patient’s condition and prognosis.

Signs of colon cancer

In the early stages, there are often no symptoms. Because of this, the disease is often diagnosed in the later stages, the prognosis worsens. The first symptoms of colon cancer are nonspecific, they are very similar to manifestations of other diseases, because of this, many patients do not go to the doctor on time:

• Change in the frequency and nature of stools, constipation, diarrhea. This symptom should be alert if it persists for four weeks or longer.
• Blood in the stool, bleeding from the rectum.
• After going to the toilet, there is a feeling that the bowels are not completely emptied.
• Pain, discomfort in the abdomen, feeling of heaviness, increased gas formation.
• Weight loss for no apparent reason.
• Constant weakness, increased fatigue.

Stage 4 colon cancer has various symptoms associated with metastases. The condition worsens significantly with the development of intestinal obstruction, peritoneal carcinomatosis and ascites.

Diagnostic methods. Screening.

Colonoscopy is the main method for diagnosing colon cancer. It is an endoscopic examination, during which an instrument in the form of a thin flexible tube with a video camera at the end is inserted into the intestine through the anus. During a colonoscopy, pathologically altered areas of the mucosa can be detected and a biopsy can be performed – a fragment of the altered tissue can be obtained for examination under a microscope.
Diagnostic methods such as CT, MRI, PET scanning, X-ray of bones, spine, chest, ultrasound of the abdominal cavity, X-ray of the intestine with contrast help to assess the degree of spread of cancer and identify metastases.

Modern methods of treatment

In invasive tumors, colectomy is most often used – removal of all or part of the intestine. The surgeon must remove the tumor with the capture of the overlying and underlying unchanged areas. The remaining ends are connected – anastomosis is applied. If this is not possible, a colostomy is formed – a hole in the skin for the discharge of feces. Most often, a colostomy is applied temporarily, later it is closed. But sometimes it has to be left forever.
If removal of colon cancer is not possible, but the tumor blocks the intestinal lumen and leads to intestinal obstruction, palliative intervention is performed. A stent is installed in the intestinal lumen – a frame with a mesh wall, which restores patency.
If single metastases are found in other organs, sometimes they can also be removed surgically.

Chemotherapy for colon cancer

Chemotherapy for colon cancer helps to solve various problems:

• Shrink the tumor before surgery. This type of chemotherapy is called neoadjuvant chemotherapy.
• Destroy cancer cells that may have remained in the patient’s body and reduce the risk of recurrence after surgery. This is adjuvant chemotherapy.
• For advanced, unresectable cancer, chemotherapy can help manage symptoms and increase life expectancy.

Radiation therapy Radiation therapy is most often used before surgery
to shrink the tumor. It is prescribed alone or in combination with chemotherapy.

Targeted drugs

Targeted therapy is one of the most modern methods of cancer treatment. It is usually used in the later stages. For colon cancer, drugs such as regorafenib, ramucirumab, panitumumab, cetuximab, bevacizumab are prescribed. They can be combined with chemotherapy drugs.

Immunotherapy

Tumor cells use specific molecules – checkpoints – to suppress the activity of the immune system. There are drugs called checkpoint inhibitors. They eliminate the blockage of the immune system, as a result, it begins to attack tumor cells again. In rectal cancer, checkpoint inhibitors such as nivolumab, pembrolizumab are used. They are prescribed for the treatment of advanced tumors in the later stages.

Survival prognosis for colon cancer

The prognosis is determined by the five-year survival rate, which, in turn, depends on the stage:

• In the first stage, colon cancer is treated quite successfully, the five-year survival rate is maximum and is 92%.
• In the second stage – 63-87%, depending on how far the cancer has spread.
• Stage 3 – 53-69%.
• How long do people live with stage 4 colon cancer? The probability of staying alive 5 years after the diagnosis is made is 11%. Chances are low, but treatments are improving. Even if remission is not possible, doctors will try to prolong the life of the patient as much as possible.

Which clinic can provide effective treatment?

Almost all modern treatments are available in Russia, and we know where you can get help. Among the partners of the Center for Integrated Medicine are the best oncological clinics of the capital.

Stage 4 bowel cancer: how long do they live? Symptoms and signs of stage 4 bowel cancer

The main criterion for diagnosing stage 4 bowel cancer in a patient is the presence of distant metastases. In this case, the primary tumor can be of any size, it may or may not grow through the entire intestinal wall. The presence of cancer cells in nearby (regional) lymph nodes is also an optional condition.

According to American statistics, every fifth patient with bowel cancer already has distant metastases at the time of diagnosis.

As a rule, if stage 4 bowel cancer is diagnosed, radical treatment is not possible. This is the last stage of bowel cancer: the malignant tumor has already spread greatly in the body, and it is impossible to remove it completely. But a doctor can prescribe palliative care that helps reduce symptoms and improve quality and life expectancy.

Depending on the number of metastatic foci, stage 4 bowel cancer is divided into two substages:

• Stage IVA: metastases have spread to only one organ.
• Stage IVB: Metastases have spread to two or more organs.

Most often, colon cancer metastasizes to the lungs, liver, peritoneum, bones, less often to other organs.

What are the symptoms of stage 4 bowel cancer?

The clinical picture consists of manifestations associated with the primary tumor and metastases. Colon cancer is asymptomatic for a long time, and when the first symptoms appear, they often resemble signs of other diseases. Therefore, many patients do not go to the doctor in time, and because of this, the diagnosis is often made already at an advanced stage of bowel cancer.

With stage 4 bowel cancer, the patient may experience the following symptoms:

• Blood in the stool. It is dark red in color, or the stool looks black, tarry, and has an unpleasant odor (melena).
• The stool can become thin and long, resembling a pencil in shape. This suggests that there is a tumor in the intestine that narrows its lumen.
• Change in stool pattern, constipation or diarrhoea. These are very ambiguous symptoms, because they occur in many other diseases or simply temporary bowel disorders. But if they are persistent, persist for a long time – this is a cause for concern and a visit to the doctor.
• Bloating and abdominal pain are usually associated with the fact that the tumor blocks the intestinal lumen.
• Nausea and vomiting are the most common manifestations of intestinal obstruction in bowel cancer.

Also, stage 4 colon cancer leads to general symptoms. The patient quickly gets tired, constantly feels weakness, lethargy. If the tumor is constantly bleeding, anemia develops. It is manifested by pallor, weakness, dizziness, headaches. For no apparent reason, body weight decreases. If a person eats as usual, but at the same time has lost 4–5 kg, this is an alarming sign. With bowel cancer, appetite can be greatly reduced.

Stage 4 rectal cancer has similar symptoms. Often, patients take the main symptom of the disease – bleeding – for a manifestation of hemorrhoids, self-medicate for a long time and do not come to see a doctor. This causes a late diagnosis.

Symptoms of lung metastases

If stage 4 colon cancer metastasizes to the lungs, symptoms such as chest pain and difficulty breathing, shortness of breath, chronic cough, blood in the sputum occur.

Symptoms of liver metastases

Often, cancer cells from the intestine enter the liver through the portal vein. At first, while the lesions are small, there are no symptoms. As metastases grow and organ dysfunction occurs, manifestations such as jaundice, itching, swelling in the legs, ascites (accumulation of fluid in the abdomen), nausea and vomiting, loss of appetite, pain in the upper abdomen under the right rib, increased fatigue, weight loss .

Symptoms of bone metastases

Stage 4 colon cancer can metastasize to the bones. Depending on the localization of bone metastases, persistent pains in the arms, legs, neck, back, lower back are disturbing. The weakening of the bones threatens with pathological fractures: they occur when exposed to small mechanical loads, from which healthy bones do not break.

The tumor destroys bone tissue, because of this, calcium is washed into the blood. Hypercalcemia develops, which manifests itself in the form of decreased appetite, nausea, and constipation.

Symptoms of damage to the peritoneum

Peritoneum is a thin film of connective tissue that covers the intestines and other organs of the abdomen, lining the walls of the abdominal cavity from the inside. If, in stage 4 bowel cancer, tumor cells break away from the primary tumor and spread to the peritoneum, this condition is called peritoneal carcinomatosis. It greatly worsens the patient’s condition, the prognosis, because of it the effectiveness of antitumor therapy decreases.

Peritoneal carcinomatosis results in ascites, a condition in which fluid accumulates in the abdominal cavity. Because of this, the stomach externally increases, the work of internal organs is disturbed.

How is stage 4 bowel cancer diagnosed?

The primary tumor is detected using colonoscopy – an endoscopic examination, during which a colonoscope is inserted into the large intestine – a special instrument in the form of a thin flexible tube with a miniature video camera and a light bulb at the end. During a colonoscopy, a doctor can perform a biopsy: obtain a fragment of tumor tissue for histological and cytological examination.

In order to find distant metastases, additional diagnostic methods are used:

• Chest X-ray helps to detect secondary lesions in the lungs.
• Ultrasound examination reveals metastases in the liver, other organs of the abdominal cavity and pelvis.
• CT and MRI are used to examine the organs of the chest, abdomen, and pelvis. For better visualization, a special contrast can be introduced into the patient’s body.
• PET scanning is the “gold standard” for diagnosing metastases in modern oncology. During the study, a radiopharmaceutical is injected into the patient’s body – a “radioactive label”. This drug is safe for the body, it accumulates in cancer cells. Due to this, even the smallest foci become visible in the pictures taken by a special device.

Treatment of stage 4 colon cancer

Stage 4 cancer is very difficult to treat. As a rule, radical treatment is not possible. Doctors use palliative measures that help to cope with pain and other symptoms, improve the patient’s condition, and prolong his life.

The most favorable, but, unfortunately, rare situation is when stage IV colon cancer has single metastases that can be surgically removed. Sometimes there is a remission. During the operation, the surgeon removes the part of the intestine affected by the tumor, regional lymph nodes, and metastases. Adjuvant and neoadjuvant chemotherapy, intra-arterial administration of chemotherapy drugs for liver damage are often prescribed.

In most cases, it is impossible to remove metastases, because there are a lot of them, and many are small. In this case, the following methods of treatment are resorted to:

• Palliative surgery. The surgeon can remove the part of the intestine blocked by the tumor, or install a stent – a hollow cylindrical frame made of metal or polymer material, which expands the lumen of the intestine. Some patients are indicated for a colostomy: during this intervention, the doctor sutures a section of the colon to the wall of the abdominal cavity and forms an opening (colostomy) on the skin through which the stool passes. If a portion of the small intestine is blocked by a tumor, a bypass may be performed.
• In case of liver damage, they resort to chemoembolization, radiofrequency ablation.
• Chemotherapy is given to most patients with stage 4 bowel cancer. Various combinations of chemotherapy drugs are used: FOLFOXIRI (leucovorin + 5-fluorouracil + irinotecan + oxaliplatin), CAPEOX (oxaliplatin + capecitabine), FOLFIRI (leucovorin + 5-fluorouracil + irinotecan), FOLFOX (leucovorin + 5-fluorouracil + oxaliplatin).
• Targeted drugs: bevacizumab, ramucirumab, cetuximab, panitumumab, regorafenib.
• Immunotherapy. Pembrolizumab (Keytruda) is a monoclonal antibody that is a checkpoint inhibitor. It blocks the molecules by which a malignant tumor suppresses the immune system.
• Painkillers. With cancer in the later stages, many patients experience excruciating pain, so it is important to prescribe effective pain relief. Various types of drugs are used. If the “softer” ones do not help, they switch to more powerful ones, up to narcotic analgesics.
• Radiation therapy helps to slow tumor growth and reduce pain.

A serious complication of stage 4 colorectal cancer is ascites, a condition in which fluid accumulates in the abdominal cavity. They resort to laparocentesis – a procedure during which a puncture is made in the wall of the abdominal cavity and excess fluid is removed. Various surgical interventions are performed to help prevent the recurrence of ascites. A modern method of treatment (but it is very complex and can not be used in all patients) is HIPEC, hyperthermic intraperitoneal chemotherapy. First, an operation is performed, during which all visible foci are removed in the abdominal cavity, then the abdominal cavity is washed with a heated solution of a chemotherapy drug, this helps to destroy the remaining cancer cells. HIPEC is only effective when the cancer is within the abdomen.

Survival prognosis for stage 4 bowel cancer

Five-year survival depends on the type and stage of the tumor. For stage 4 colon cancer, this figure is 12%, for small bowel cancer – 4-5%. Stage 4 rectal cancer is characterized by a five-year survival rate of 13%. It is difficult to say in advance which of the patients will fall into this small percentage and remain alive for five years or more from the moment of diagnosis.