Possible metastases (presence of cancer cells at a distance from the initial tumor) can be found on different organs depending on the stage of cancer evolution: ganglions, peritoneum, liver, lungs ... Treatments vary according to stage of evolution .
As long as the lymph nodes are not affected, the surgical operation is sufficient. Complementary chemotherapy is prescribed when there is metastasis or lymph node involvement.
- In stage 1: the cancerous lesions must be removed either by colonoscopy or by surgery according to the depth of the attack.
- Stage 2: Partial colectomy should be considered by laparotomy (opening of the abdomen) or laparoscopy, depending on the surgeon's practice. Chemotherapy may be prescribed if the tumor is aggressive.
- Stage 3 : adjuvant chemotherapy is needed. Cancer and lymph nodes have been removed through surgery, so there is no more cancer, but at this stage chemotherapy decreases the risk of recurrence and improves the chances of healing.
In this case, a chemotherapy is proposed, most of the time, in day hospital. This means that you have to go to the hospital to receive treatment for only a few hours and that you can go home at night. The duration of chemotherapy varies from one patient to another.
There are 9 different drugs today used in colon cancer treatments, used alone or in combination. The reference chemotherapy, FOLFOX, combines 3 drugs (5 Fluoro-Uracil (5 FU), folinic acid and oxaliplatin), infused intravenously for 2 days, every 14 days for six months (12 courses) . Another reference chemotherapy is the FOLFIRI protocol: 5FU, irinotecan, folinic acid.
Nevertheless, the idea now is to personalize as much as possible the care, and therefore to adapt the chemotherapy protocols for each person. In the case of metastases, the therapeutic protocols differ according to many parameters, such as the patient's state of health, his age, the extent of the cancer ... but also according to certain biomarkers, especially when chemotherapy is added. targeted drugs.
With regard to colon cancer, no radiotherapy is necessary before surgery (this is often the case, however, for rectal cancers).
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