Colorectal cancer is one of the most common malignant tumors of the digestive system worldwide, including 2 types of rectal cancer and colon cancer. In China, the mortality rate of colorectal cancer has been ranked between the 4th and 5th among malignant tumors, and is showing an increasing trend. A reasonable treatment plan is usually formulated according to the patient’s clinical stage, organism condition and patient’s family economic situation to improve the treatment effect and prolong the survival. At present, surgery is still the main treatment for colorectal cancer, but simple surgery is not enough to achieve complete cure for some patients, especially those in the middle and late stages, and necessary adjuvant treatment is needed. For how to choose the next treatment after surgery, I think you may have some confusion, and I will answer them briefly. Lv Huifang, Department of Internal Medicine, Henan Cancer Hospital 1.
Which patients need adjuvant chemotherapy? Which patients do not need adjuvant chemotherapy? Do you need adjuvant radiotherapy?
To know whether you need treatment after surgery, first of all, two points should be clarified: (1) clarify the TNM stage after surgery, which is divided into stage IV. The earlier the tumor stage, the better the treatment effect; (2) conduct comprehensive review after surgery, including chest orthopantomograph or chest CT, abdominopelvic ultrasound or CT for post-treatment assessment.
If you are a stage I patient, you do not need adjuvant treatment and regular review is sufficient. The benefit rate of postoperative adjuvant chemotherapy for stage II colorectal cancer patients is only 2% to 5%, so stage II patients also need to clarify whether there are high-risk factors: (1) T stage of T4; (2) poor histological grading (grade 3 or 4); (3) lymphovascular invasion; (4) preoperative intestinal obstruction and intestinal perforation; (5) positive surgical margins; (6) less than 12 lymph node biopsies. If you are a stage II high risk patient, adjuvant chemotherapy can be administered; conversely, adjuvant chemotherapy is not needed and regular review is sufficient. Recent studies have shown that stage II patients with high microsatellite instability do not benefit from fluorouracil chemotherapy, so for stage II patients, microsatellite instability screening is feasible, and if you have high microsatellite instability, you do not need chemotherapy; conversely, you can have adjuvant chemotherapy. If you are a stage III patient, there is no doubt that you need adjuvant chemotherapy. If you are a stage IV patient, then you do not need adjuvant chemotherapy, but palliative chemotherapy. The special thing is that rectal cancer is prone to local recurrence, so patients with rectal cancer need adjuvant radiotherapy, while patients with colon cancer do not need adjuvant radiotherapy. 2. When to start adjuvant chemotherapy after surgery? How long does it take?
Adjuvant chemotherapy after surgery for colon cancer is mainly for stage II high-risk or stage III patients, and adjuvant chemotherapy starts 4-6 weeks after the day of surgery, which takes half a year and is not related to the number of times of chemotherapy. 3. How to choose adjuvant chemotherapy regimen after surgery? In theory, both FOLFOX6 (oxaliplatin + fluorouracil) and Xelox (oxaliplatin + Xeloda) are possible, but each has its own advantages and disadvantages, depending on your specific situation. The former has a long infusion time and a short treatment cycle, with chemotherapy once every 2 weeks, basically spending the first half of the year in the hospital; the latter has a relatively long treatment cycle, with chemotherapy once every 3 weeks, and a relatively long time at home. The incidence of hand-foot syndrome and diarrhea is relatively high in the latter Hierroda, but it varies from person to person. 4. Do I need to combine targeted therapy with adjuvant chemotherapy after surgery? Targeted therapy drugs for the treatment of colon cancer mainly include cetuximab (Ebiximab) and bevacizumab (Avastin), which are mainly applicable to patients with recurrent metastasis or advanced colon cancer after surgery, and are not applicable to patients with adjuvant therapy after surgery. The most important point is that we must pay attention to moderate exercise and healthy diet, and we must eat more of the following things.