ANNOUNCER: Colorectal cancer, or cancer of the colon and rectum, can be especially dangerous if it has spread. Doctors rate the extent of the disease in a process called staging.
ROBERT WHITEHEAD, MD: In colorectal cancer there are four stages, stage I, II, III and IV. These are determined based on the tumor itself, whether or not it has spread to lymph nodes, and whether or not there is a distant metastases present.
ANNOUNCER: Stages three and four are considered advanced cancer. When disease spreads to lymph nodes, it is stage three.
RICHARD GOLDBERG, MD: You can think of lymph nodes as one of the body's regional areas of defense. So if a cancer or an infection develops in the colon, the lymph nodes will try and filter out the germs or the cancer cells as a way of trying to keep that from spreading to other parts of the body.
ANNOUNCER: In stage three, surgery is usually performed to remove the tumor and surrounding lymph nodes. Chemotherapy is prescribed to destroy cancer cells that may have already spread further.
RICHARD GOLDBERG, MD: In the setting of patients with disease that has been removed surgically, the stage 3 patients you use oxaliplatin plus 5-FU in a program that we abbreviate as FOLFOX just because it's easier to say it and remember it.
FOLFOX is actually two chemotherapy drugs and a vitamin. So the FOL in FOLFOX is folinic acid or vitamin B12. It makes 5-FU work better. The second "F" in FOLFOX is the 5-FU and then the "OX" in FOLFOX is the oxaliplatin. And that is quite effective in terms of eradicating disease in about half of the people who would otherwise be destined to relapse.
ANNOUNCER: Even after treatment with surgery and chemotherapy, cancer can reoccur in the colon.
EDWARD CHU, MD: If, in fact, recurrent colon cancer is determined, if one can surgically remove that recurrence, that probably is the ideal situation. Unfortunately, in the vast majority of patients, usually the recurrence occurs at multiple sites.
ANNOUNCER: If cancer re-occurs in multiple organs, surgery is not the first option. Instead, many patients are treated with a combination of chemotherapy and a medication known as a monoclonal antibody or biologic.
RICHARD GOLDBERG, MD: The biologic that is approved for use in first-line colon cancer in the United States and many other places in the world is a drug called Avastin or bevacizumab. It works by attacking blood vessel growth in the tumors.
EDWARD CHU, MD: We now know that this process of angiogenesis, the process of new blood vessel growth formation, is absolutely critical for the growth not only of the primary colon cancer tumors but also critically important for the growth and proliferation of metastatic tumors. So if one is able to choke off the formation of new blood vessels, then hopefully one can actually choke off the growth of the tumors.
ANNOUNCER: In cases when just a few cancerous lesions are found on other organs like the liver or lungs, stage four can be treated with surgery.
RICHARD GOLDBERG, MD: So stage 4 cancer is treated principally with medicines, not with surgery. But it's very important to understand that some patients with colorectal cancer who have stage 4 disease will only have one or two or three spots where the cancer has spread. And one of the realizations and improvements that we've made in the last 15 years is to be able to do liver and lung surgery better, and to show that we can cure some patients with stage 4 disease by removing tumors that have spread to the liver and lung as long as there are just a few of them.
ANNOUNCER: Although there are now more effective medications for treating advanced colorectal cancer, few patients are cured. But new drugs are proving helpful in some circumstances.
EDWARD CHU, MD: I think it's important whenever I see a patient with stage 4 metastatic colon cancer to emphasize, yes, the overall prognosis is not so great, but that we have a number of very effective, very active treatment regimens that are available. So on the one hand, we don't want to raise false hopes, but when I was fellow in training the overall survival was in the order of maybe six to eight months. And now we're talking overall survivals approaching 30-35, maybe even 36 months.