Surgery not neccessary for most late-stage colorectal cancers

Saturday May 30,2009 (foodconsumer.org) -- A new study presented today at the American Society of Clinical Oncology Annual Meeting has found that surgery to remove most late-stage colorectal cancers may not be neccessary.

  Researchers from Memorial Sloan-Kettering Cancer Center (MSKCC) suggest instead that chemotherapy should be immediately started after diagnosis of the stage IV disease.

  "For this population with metastatic disease that cannot be cured by surgery, undergoing colon surgery is not always necessary," said Philip Paty, a surgical oncologist at MSKCC and one of the study's lead authors.

  "If the colon tumor is not causing obstruction, perforation, or bleeding we've found these patients are best treated with chemotherapy," said Paty. "By moving straight to chemotherapy, patients can avoid the risk of surgical complications and can start treatment for all sites of disease without delay."

  Previously, patients with advanced colorectal cancer underwent colon surgery immediately following their diagnosis and would start chemotherapy treatment three to six weeks later. Doctors believed that immediate colon resection could prevent future symptoms and complications from the primary tumor and the majority of colorectal cancers would have little response to the treatment.

  Doctors at MSKCC started using chemotherapy as initial treatment for patients with late-stage colorectal cancers as the those treatments in the past decade have advanced. A press release by the organization states that the new approach seems to be reliable in shrinking both colon tumors and the metastases.

  The retrospective study involved 233 patients with metastatic colorectal cancer treated at MSKCC between 2000 and 2006. The researchers found 217 out of the 233 patients, or 93 percent, did not have complications that justified resection of the primary tumor. Only 16 required colon surgery for symptom control.

  "We now know that the routine use of surgery for these patients is based on old thinking, and we're beyond that," said Paty. "There will always be the need for individual exceptions based on the clinical situation, but our default position should be not to operate."

  The findings suggest that patients with advanced colorectal cancer may start chemotherapy treatment immediately after diagnosis.

  According to Medpage, Paty did not disclose any relationship with drug companies while co-workers Leonard Saltz and Nancy Kemeny reported relationships with Pfizer and other drug makers.

  In the United States, about 150,000 men and women are diagnosed with colorectal cancer each year and 50,000 die from the disease. The disease is the fourth most common cancer and the second leading cause of cancer-related death in the country.

(By David Liu, and edited by Sheilah Downey)