A study from Memorial Sloan Kettering recently showed that patients who have stage IV disease, which means spread to other organs, don’t need to undergo surgery immediately. If the tumor does not cause problems such as obstruction or bleeding, patients appear to do better to start with chemotherapy right away without delay because of the surgery.
Over 230 patients were studied with metastatic colon cancer. and the data showed that patients did very well when started with chemotherapy without surgery for the primary tumor. Only 7 percent required surgery for symptoms during chemotherapy.
Usually, in the conventional approach to treating stage IV disease, patients underwent colon surgery immediately following their diagnosis and would typically start chemotherapy treatments three to six weeks later. The rationale for immediate colon resection was to prevent future symptoms and complications from the primary tumor. It was assumed that the majority of colorectal cancers would have little response to chemotherapy.
However we have now more effective and less toxic chemotherapy which can shrink both colon tumors and the metastases. We need to caution that of course there are individual exceptions and each of these decisions needs to discuss with the surgeons and medical oncologists.