Managing Metastatic CRC: Coming to a Consensus

Managing Metastatic CRC: Coming to a Consensus

According to the National Cancer Institute, colorectal cancer (CRC) is the second leading cause of cancer death in the United States. However, modern chemotherapy and improved surgical techniques for resectable metastases have increased the average survival for patients with stage IV metastatic CRC from approximately 6 months about 20 years ago to between 2 and 3 years today. To further enhance clinicians’ ability to manage liver metastases from CRC and contraindications to initial liver resection, a group of experts convened and published a consensus statement in The Oncologist. Aggressive Surgical Approaches for CRC “With surgery, it’s expected that some patients with metastatic CRC will be cured,” explains Jean-Nicolas Vauthey, MD, lead author of the consensus statement. “That’s unique for a stage IV solid cancer. It’s also why we’re aggressive by performing surgery. The typical approach is to resect the primary CRC, administer chemotherapy, and then resect the liver metastases [Table]. Some patients, however, present with both primary colon cancer and liver metastases in place. In some of these patients, resection of the liver metastases is recommended, followed by resection of the primary CRC in a second surgery.” Dr. Vauthey notes that both of these surgeries can be performed at the same time if the primary colorectal tumor is easily resectable, and the number of liver metastases is low. “When patients have extensive metastatic disease with multiple metastases involving the right and the left lobe of the liver, two sequential liver resections can be performed. For example, one strategy could be to treat patients with chemotherapy, perform a first liver surgery to remove metastases in the left lobe, and then...

CRC & Follow-Up Screening

Patients with colorectal cancer (CRC) who undergo potentially curative surgery have been shown to have an increased risk of disease recurrence. To reduce this risk, several professional societies have issued guidelines that specify a combination of regularly scheduled office visits, colonoscopy, and the carcinoembryonic antigen (CEA) test to detect changes that could indicate a recurrence. The hope is that early detection of recurrence can enable clinicians to treat patients appropriately and prolong their lives. Unfortunately, studies show that some patients may not receive these services as recommended. In fact, others may be sent for CT or PET scans even though they...