How to prevent and treat relapsed colorectal cancer?

How to prevent relapse of colorectal cancer, how to treat relapse of  colorectal cancer after surgery?

Colorectal cancer is a common malignant tumor, including colon cancer and rectal cancer. The incidence of colorectal cancer from high to low is rectum, sigmoid colon, ascending colon, descending colon and transverse colon. In recent years, there is a trend toward the proximal end (right colon).

If colorectal cancer is detected early, it can usually be cured.

5-year survival rate of colorectal cancer

According to the US ASCO official website data, the 5-year survival rate of colorectal cancer patients is 65%. However, the survival rate of colorectal cancer may vary depending on many factors, especially the stage.

For colon cancer, the overall 5-year survival rate is 64%. The 5-year survival rate for limited-stage colon cancer is 90%; the 5-year survival rate is 71% for metastasis to surrounding tissues or organs and / or regional lymph nodes; the 5-year survival rate is 14% if colon cancer has metastasized distant .

For rectal cancer, the overall 5-year survival rate is 67%. The 5-year survival rate of limited-stage rectal cancer is 89%; the 5-year survival rate of metastasis to surrounding tissues or organs and / or regional lymph nodes is 70%. If there is distant metastasis of rectal cancer, the 5-year survival rate is 15%.

Currently, treatments for colorectal cancer include surgery, chemotherapy, radiotherapy, targeted therapy, and immunotherapy. Surgery is the preferred method of eradicating colorectal cancer. But Vicki, the editor of a cancer-free home, learned that about 60% to 80% of patients with rectal cancer will relapse within 2 years after surgery.

How to effectively prevent recurrence of colorectal cancer?

Improve lifestyle

To quit drinking, quit drinking, quit drinking, say important things three times, you must quit drinking. In addition, do not smoke, do not overwork, and maintain a happy mood.

Appropriate exercise, 2-3 months after surgery, you can do gentle exercises, such as walking, gradually increase from 15 minutes to 40 minutes; you can also practice qigong, Tai Chi, radio gymnastics and other gentle exercises.

Pay special attention to diet, do not eat moldy food, barbecue, bacon, tofu, nitrite-containing food, and do not eat Chinese medicine and health products.

The postoperative diet is mainly light, and the intake of high-quality protein, such as egg white and lean meat, is appropriately increased. The postoperative diet generally transitions from water, porridge, milk, steamed eggs, fish, lean meat to the ordinary diet.

Eat digestible foods as much as possible, avoid greasy, spicy, irritating, too hard, sticky and other foods, eat a balanced diet, eat fewer meals and not eat too much at each meal.

Regular consumption of nuts such as cashews, hazelnuts, walnuts, almonds, and walnuts can reduce the recurrence rate of intestinal cancer.

Postoperative nursing advice for colorectal cancer

The suture removal was completed 7-10 days after bowel cancer surgery. Older patients or patients with certain complications can properly extend the time for removing the thread. After removing the thread, pay attention to the cleanliness of the wound to avoid infection.

After the stitches are removed, it is necessary to continue covering the dressing and tightening the abdominal band during wound healing until the surgical incision is completely healed, which takes about half a month.

At least 10 days after the operation, the skin lifter can be removed, and the wound should be kept clean and dry as much as possible to reduce sweating. You can take a shower, but not rub the wound.

It is normal to feel numbness around the wound after the operation, and it will disappear after a while.

It is normal for the wound to seep, and a small amount can be partially disinfected, and the dressing on the surface can be changed. However, if the amount of exudate is large and severe redness and swelling occur, the doctor should be contacted in time for wound treatment.

When the surgical incision is about to grow, it will feel itchy, commonly known as “long meat”. At this time, avoid scratching, water, and infection.

The wound has not healed beyond the healing period. You need to find a professional surgeon to deal with it, change the dressing in time, clean the wound, and treat the infection, and pay attention to controlling blood sugar and strengthening nutrition.

Anal wounds usually take one month to heal. After healing, you can slowly practice the squat movement, 3-5 minutes each time, once in the morning and afternoon.

If the wound heals well, you can take a bath 7-14 days after the stitches are removed. You can use a shower gel or soap, but avoid the wound.

Regular review

According to statistics, the rate of recurrence and metastasis of colorectal cancer in China is as high as 50%, and more than 90% of recurrence and metastasis occur in 2-3 years after surgery, and the recurrence rate is lower after 5 years. Therefore, the operation is not once and for all, and we must insist on regular review after the operation.

Intestinal cancer patients are most likely to relapse within 3 years after surgery. During this period, the number of patient re-examinations should be relatively frequent; after 3 years, the re-examination interval can be extended appropriately.

In general, recheck every 3 months within 1 year after operation; recheck every half a year in the second 2-3 years; check it once a year in the 4-5 years. The specific review time also needs to find your own doctor to determine.During the review, the items to be checked include,

Blood tests: blood routine, liver and kidney function, tumor markers (CEA, etc.);

Imaging examination: abdominal pelvic ultrasound, chest radiograph

Colonoscopy: 3 months after surgery to determine the healing of the anastomosis and observe polyps in other parts

How to treat bowel cancer recurrence after operation?

Secondary surgery

The most ideal way for patients with colorectal cancer to relapse is to remove the recurring lesions to achieve the goal of radical cure. First of all, it depends on whether a second surgical resection can be performed. If it meets the surgical criteria, the tumor can be surgically removed.

If there are multiple lesions, the invasion area is relatively large, or the metastasis is far away, if reoperation is prone to danger, other treatment methods can be selected when the benefit of surgery is not guaranteed.

Medication

Colon cancer chemotherapy

Common chemotherapeutic drugs are 5-fluorouracil, irinotecan, oxaliplatin, calcium folinate, capecitabine, tigeol (S-1), TAS-102 (trifluridine / tipiracil).

However, colon cancer chemotherapy is usually a combination of several chemotherapeutic drugs. Common combinations are:

1.FOLFOX (fluorouracil, calcium folinate, oxaliplatin)

2. FOLFIRI (fluorouracil, calcium folinate, irinotecan)

3.CAPEOX (Capecitabine, Oxaliplatin)

4. FOLFOXIRI (fluorouracil, calcium folinate, irinotecan, oxaliplatin)

Colon cancer targeted drugs and immune drugs

1. KRAS / NRAS / BRAF wild-type targeted drugs: cetuximab or panitumumab (commonly used for left colon cancer)

2. Anti-angiogenesis inhibitors: bevacizumab or ramucirumab or ziv abercept

3. BRAF V600E targeted drugs: dabrafenib + trametinib; connetinib + bimetinib

4. NTRK fusion targeted drug: Larotinib; Entratinib

5.MSI-H (dMMR) PD-1: pembrolizumab; nivolumab ± ipilimumab

6. HER2-positive targeted drug: trastuzumab + (pertuzumab or lapatinib)

In addition to surgery and  radiotherapy, advanced colon cancer is an indispensable stage of treatment. First-line treatment refers to the first stage of treatment with anticancer drugs, also called initial treatment. There are many options for the first-line treatment of advanced colon cancer, usually based on chemotherapy.

However, it is necessary to distinguish the patient’s condition and physical condition. After a series of examinations, patients can be divided into two types of patients suitable for high-intensity treatment and unsuitable for high-intensity treatment.

Choice of medication suitable for patients with high-intensity treatment

Divided into three categories:

First-line solution with oxaliplatin

First-line solution with irinotecan

(1) First-line solution containing oxaliplatin

FOLFOX ± bevacizumab

CAPEOX ± bevacizumab

FOLFOX + (cetuximab or panitumumab) (only for KRAS / NRAS / BRAF wild-type left colon cancer)

(2) First-line plan with irinotecan

FOLFIRI ± bevacizumab or

FOLFIRI + (cetuximab or panitumumab) (only for KRAS / NRAS / BRAF wild-type left colon cancer)

(3) First-line solution containing oxaliplatin + irinotecan

FOLFOXIRI ± bevacizumab

Choice of medications not suitable for high-intensity treatment

First-line medication options

1. Infusion of 5-fluorouracil + calcium folinate ± bevacizumab or

2. Capecitabine + Bevacizumab

3. Cetuximab or panitumumab (Class 2B evidence, only applicable to KRAS / NRAS / BRAF wild-type left colon cancer)

4. Nivolumab or pembrolizumab (only for dMMR / MSI-H)

5. Nivolumab + Ipilimumab (Class 2B evidence, only applicable to dMMR / MSI-H)

6. Trastuzumab + (Pertuzumab or Lapatinib) (Applicable to HER2 amplified and RAS wild-type tumors)

1) After the above treatment, there is no improvement in functional status, choose the best supportive treatment (palliative care);

2) After the above treatment, the functional status improves, and a high-intensity initial plan may be considered.

Final medication choice

Regefini

Trifluorothymidine + tipiracil

Best supportive treatment (palliative care)

Reference materials:

https://www.cancer.net/cancer-types/colorectal-cancer/statistics

https://zhuanlan.zhihu.com/p/42575420

https://www.nccn.org/professionals/physician_gls/default.aspx

 

For details on colorectal cancer treatment and second opinion, do call us at +91 96 1588 1588 or write to cancerfax@gmail.com.

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