Stage 4 Colon Cancer

By Kathryn E. Vinson, MS, CCRC

The other day, as I was scrolling through my Facebook feed, an article popped up stating that Queen Elizabeth II’s late mother, the Queen Mother (Queen Elizabeth in her own right), had dealt with colon cancer in 1966.  (How these things pop on my feed is mysterious, all I can guess is that I may be addicted to The Crown, and let’s face it – Facebook is psychic and reads my thoughts).  In the case of Her Majesty’s disease, it appears that it was caught early, as she only needed a tumor excision and lived for another 36 years. Sadly, many patients aren’t lucky enough to catch the disease that early (or have a fleet of private physicians), and the disease progresses to late stage before it is caught.  Let’s take some time today to talk about stage IV colon cancer, its symptoms, outlook, and treatment options.

What are the symptoms of stage 4 colon cancer?

Colon cancer is another one of those types of cancer that can be silent in its early stages – which is why routine screening according to your physician’s recommendations are so vital.  No, a colonoscopy isn’t the most pleasant of procedures, nor is the bowel prep the day before, but you are usually under twilight sedation for the procedure and seldomly remember it. And remember – it can catch pre-cancerous polyps and – (everyone say it with me, you’ve heard it from me enough) – IT CAN SAVE YOUR LIFE!  The American Cancer Society recommends that people of average risk begin regular screenings for colon cancer at 45 years of age and continue through age 75.  From 75-85, the decision to screen for colon cancer depends upon the patient’s past medical history.  They do not recommend screening beyond the age of 85.

As the disease progresses, this is when symptoms generally start to develop.  According to the American Cancer Society, symptoms of late stage colon cancer may include:

  • A persistent (more than a few days) change in the frequency or consistency of your bowel movements.
  • Feeling like you still need to have a bowel movement, despite having just gone to the bathroom; a feeling that isn’t relieved by going to the bathroom.
  • Bright red blood with bowel movements
  • Bloody stools – which may look like coffee grounds
  • Abdominal pain and cramping
  • Unexplained fatigue
  • Unexplained weight loss

What is the prognosis for stage 4 colon cancer?

As we touched on briefly above with the case of the Queen Mother, colon cancer that is caught early has a remarkably high five-year survival rate – 90% for localized disease, and even 71% for disease with regional spread.  These number drop rapidly with distant spread of the disease (read as metastatic disease) – only 14% of these patients tend to survive 5 years beyond their diagnosis.

How is stage 4 colon cancer treated?

Treating stage 4 colon cancer is often aimed at symptom control, and measures to improve the patient’s quality of life.  Surgery is utilized at this stage to relieve symptoms and is seldom curative.  Chemotherapy may be given to the patient prior to surgery in order to shrink tumors so that they are more easily removed.  Chemo would be given again after surgery to target those tumors that were unable to be removed during surgery.  Immunotherapy drugs, such as Keytruda, have also been utilized in stage 4 colon cancer, as well as targeted therapies and radiation.

Regardless of the treatment plan, the American Cancer Society suggests that you discuss the aim of your treatment.  Whether the aim is palliative or curative, it is vital that patients and care givers understand this from the beginning.

New findings on colon cancer

Recently, a group from the Institut Pasteur in France have found that an imbalance in the gut microflora (the bacteria that live in our intestines and help keep us healthy), may be responsible for the development of sporadic colon cancers, or colon cancers that seem to appear for no reason in patients without risk factors.  Even more exciting that this causative discovery, is their belief that they have found a fairly non-invasive screening method (although it still needs to go through clinical trials).  They found that when the microflora in the intestine is out of balance, it causes a change to the DNA in those tissues, that can be picked up on in a blood test!  How amazing its that?!

As always, much love, many prayers, and abundant blessings to all of the warriors out there!!

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