关于晚期结肠癌治疗的10个问题

“The way that I approach thinking about staging is if you see cancer outside of the colon, that's metastatic disease, and that’s stage four,” says Leah Biller, M.D., an oncologist at Dana-Farber’s Gastrointestinal Cancer Treatment Center in Boston. Doctors arrive at the number by doing imaging tests (CT scans or, sometimes, MRIs or PET scans) as well as surgically removing the tumor. If the scans show that there’s cancer in other parts of your body—your lungs, your liver—or in the lymph nodes outside the colon, that’s stage 4.

Stage 4 colon cancer is sometimes curable, but, sadly, for most patients it’s not. The 5-year survival rate (the percentage of those who live five years past diagnosis) is a daunting 14%. But that doesn’t mean your cancer isn’t treatable, says Rishi Jain, M.D., an oncologist specializing in gastrointestinal tract cancers at the Fox Chase Cancer Center in Philadelphia. “The goal is to keep someone around longer and maintain a reasonable quality of life during that process.” Treatment will help reduce symptoms, too.

是的，很可能。Jain博士说，每个患者的案例都不同，但最可能会用药物组合治疗药物和手术和辐射。在手术前有时使用化疗来缩小肿瘤，使其更容易移除。它也使用手术后使用，特别是与其他类型的疗法组合使用，杀死手术后可能留下的癌细胞并缓解症状。

再次，可能是。但为了了解什么类型的药物为您工作，重要的是，病理学家对肿瘤进行遗传检测，以检查某些突变，说博勒塞博士。这是所有阶段4例患者所做的事情，无论你的肿瘤是否有所使用的治疗的确切突变。“也可能有临床试验选择和药物，用于不同类型的癌症，”她说。

这些是攻击癌细胞中特定基因和蛋白质的药物。它们通常与化疗组合使用（杀死癌细胞，而且致命，不幸的是，健康的）。Miller博士说，有两种类型的靶向治疗。一个“适用于血管生长。那些可以在4阶段使用的患者一般。大多数其他靶向疗法涉及特定的突变或对肿瘤本身病理学的一些特定的东西。“意思是，如果测试显示您的肿瘤具有其中一种标记，这些药物是您的另一种治疗选择。

您通过IV输注获得两种类型。让我们从抗血管生成治疗 - 血管生成意味着新血管的发育，这些药物会阻碍发生这种情况。(In fact, if you’re going to have surgery or have just had it, you won’t get anti-angiogenesis therapy because your wound wouldn’t heal as quickly.) Stopping blood vessel growth is important for cancer treatment because tumors need more blood vessel growth than other parts of the body, says Dr. Biller.

这些是阻止各种蛋白质，帮助癌细胞生长的各种蛋白质。您获得哪一个（如果有的话）取决于遗传突变医生在测试肿瘤时发现 - 或者他们是否找到任何东西。如果您是候选人，您可能会听到此类药物的名称作为Erbitux（Cetuximab），Braftovi（EncorafeNib）和Stivarga（RegoraFenib）。

“免疫疗法基本上有助于调节自己的免疫系统，以便它可以针对癌症，”博勒博士说。它可以有效，但有一个捕获：“免疫疗法仅用于具有一定的分子特征的结肠癌，称为微卫星不稳定性。”因此，只有5％的阶段4阶段结肠癌患者的益处（通常是患有林奇综合征的遗传遗传突变）。Jain博士说，目前有临床试验，是否有不同的免疫治疗药物的组合将适用于其他95％。

不论你正在服用什么药物,他们sometimes just stop working. “Somehow the cancer becomes resistant to either the chemotherapy or the targeted therapy, but there's still a lot that we don't know about why,” says Dr. Biller. In that case, there are many other types of drugs or combinations of drugs that doctors will try, and if those are exhausted, that’s where clinical trials can come in: You can volunteer to receive newer, not-yet-approved treatments that may work better.

The biggest change in the last five years has been the number of drugs approved to treat colon cancer—and the wider use of targeted therapies, says Dr. Biller. Talk to your doctor about the entire range of treatment available to you (and make sure your tumor gets genetically tested). Dr. Biller also recommends that her patients get palliative care early to help manage the symptoms and side effects (both physical and emotional) of treatment. One study found that palliative care decreased such symptoms as fatigue and pain.