Developed countries offer more and more new effective methods of cancer treatment, which work well even for terminal oncology. What will be rectal cancer stage 4 treatment depends on the characteristics of the progression of this disease. Systemic therapy is considered the major one, but oncologists also prescribe local procedures to many patients to control the primary tumor or distant metastases.
Can surgery be performed for stage 4 cancer?
The answer is yes. Surgery is often performed even for stage 4 rectal cancer. It can be palliative or potentially curative (radical).
If the disease is detected at an earlier stage, the patient will likely undergo surgery to remove the rectal tumor. Unfortunately, some people will have their cancer come back. This most often happens in the first 2-3 years after surgery, sometimes later. Recurrence can occur in distant areas, which means that at the time of surgery, the patient had small foci of distant metastases. Now they have grown into large tumors. In such a situation, it is possible to perform a surgical procedure to remove metastatic foci, which can occur in various organs, such as the liver, lungs, or brain. Surgery is recommended when only one anatomical area is affected.
Some patients with rectal cancer develop peritoneal carcinomatosis: the spread of the tumor throughout the abdominal cavity. Multiple tumor foci develop. This is a prognostically unfavorable type of cancer, but doctors have learned to treat it with cytoreductive surgery. They perform an operation to remove all the tumor foci. This is often supplemented by intraperitoneal "hot" chemotherapy: the peritoneal cavity is rinsed for an hour and a half with a heated solution of cytostatic drugs, which destroys the remaining cancer cells and prevents recurrence.
In addition, palliative surgery for end-stage cancer may be aimed at eliminating complications, such as bleeding or bowel obstruction. In this case, the doctor may recommend rectal tumor resection or a colostomy even if it is not expected to significantly prolong life.
Regional procedures for stage 4 rectal cancer
Regional procedures are used to control individual tumors locally. They help destroy metastases in the liver or other parts of the body.
Chemoembolization: This is a common procedure for liver metastases. It is performed from inside the blood vessels through a small incision in the leg or arm. The doctor uses chemotherapy drug-loaded microspheres to block the arteries that supply blood to the metastatic tumors. A similar procedure can be used to block the rectal arteries. This helps control the growth of an inoperable primary tumor and prevents rectal bleeding.
Hepatic artery infusion: This is another treatment option for controlling liver metastases. In a minimally invasive procedure, a pump that delivers chemotherapy drugs is implanted in the hepatic artery.
Ablation: Radiofrequency or microwave ablation helps destroy small liver metastases.
Radiation therapy: This can be used to control the growth of metastases in the bones, brain and, less commonly, lungs or liver. Physicians in developed countries use both standard and advanced radiotherapy modalities, such as CyberKnife and proton therapy. The main advantage of these treatments is their safety.
Systemic therapy
After staging, patients are always given systemic therapy, regardless of whether they receive local treatments to control individual tumors. Systemic therapy includes the following modalities:
- Systemic chemotherapy
- Targeted therapy, which is individually selected based on diagnostic results
- Immunotherapy, which may be used in a small number of patients
Medicines can help to suppress tumor growth for a very long time, even in terminal rectal cancer. When they stop working, you can use innovative drugs by enrolling in clinical trials.
You are welcome to use the Booking Health service if you want to undergo diagnosis, have a biopsy, or receive treatment for rectal cancer abroad. The website presents the leading clinics in Europe. You can also find prices here, make an appointment for your preferred dates, and benefit from travel arrangements.
