There are more and more interactions between surgeons and oncologists for patients with metastatic colon cancer.

Colon cancer is very special since we can cure metastatic disease which is not usually possible for cancer. In colon cancer we talk about cure and not only survival. Because we can cure, we need to make sure we don’t miss any opportunity to do so.

Over the last five years our approach in patients with metastatic disease with liver-limited lesions has changed. We know that with more successful chemotherapies, we are able to convert more and more patients to a situation which allows a surgical resection with the intention to cure. Not all surgeries will cure, but it gives us a chance to cure. Read the rest of this entry »

Most of us love cocktails. . .Manhattan, gin and tonic etc. We know, depending on what we use and how they are mixed, they may taste different.

Well, for the treatment of colon cancer patients we have different cocktails to choose from such as FOLFOX and FOLFIRI. Both are combinations of 5-FU and leucovorin and either irinotecan or oxaliplatin. Both regimens have similar efficacy and similar extent of side effects, with oxaliplatin having more neurotoxicity and irinotecan more diarrhea.

However, depending how you mix and deliver the three drugs you may have significant differences in toxicity. It is amazing what differences exist among oncologists in how they mix up their chemotherapeutic cocktails. Not only the doses but also the timing of administration can differ dramatically, which can result in differences in toxicities for patients.

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Many patients with metastatic disease ask how long we should do chemotherapy. This is astonishing since when we are diagnosed with diabetes or hypertension we usually would not ask the same question. Of course, for patients with metastatic disease we continue as long the chemotherapy works.

A lot of patients ask whether you can take a break from chemotherapy, particularly around the holidays or vacation times. Do you take a break from insulin or your high blood pressure medication? In the last two years, clinical trials have been conducted to answer exactly this question.
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Last week I had a consultation with an older gentleman who is 84 years old. Interestingly, the role of age in the treatment of colon cancer has changed. During my training in Germany in the nineteen eighties when someone came in with metastatic cancer and was older than 65, we rarely gave chemotherapy because we were afraid to make those patients sicker than cancer did.

We have a perception that when someone is old we should be much more gentle and we should adapt treatment not only using less aggressive chemotherapy cocktails but also lower doses.. These perceptions go back to the history of chemotherapy when chemotherapy drugs made most patients very sick and weak. With less toxic chemotherapeutic therapies and much better drugs against nausea and vomiting, our perception needs to be reevaluated. Read the rest of this entry »

When we go to a surgeon, we often don’t ask them how many surgery he has done for the same disease but may be we should.

For colon cancer, there is in fact a specialization fellowship to become a colorectal surgeon. A recent analysis of 17 studies from nine countries has shown that the quality of the surgeon and the surgery is associated with better outcome.

How can you evaluate the surgeon? Read the rest of this entry »