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Chemotherapy
Adjuvant therapy is additional of treatment after the primary or
initial therapy has been completed. For both colon and rectal cancer,
there are specific situations where adjuvant therapy has proven
value. For colon cancer, if the tumor has spread to regional lymph
nodes, it is clear that chemotherapy will decrease recurrence rates
and improve survival. In particular, 5-Fluorourasil and Leucovorin
have been shown to be effective. Increasingly, however, there are
new agents available that may prove to be even more effective. For
tumors that do not involve lymph nodes but penetrate through the
bowel wall, there is a small but real risk of recurrent disease.
Physicians are currently trying to identify sub-groups of patients
in this category who may be at increased risk. There are molecular
biological markers that you may hear about. Such terms as P-53,
P-27, DCC Gene, and flow cytometry are measurements that can be
used to determine the aggressiveness of tumors. Based on this, your
physician may counsel that additional radiation or chemotherapy
is appropriate.
For rectal cancer, some physicians will recommend pre-operative
radiation and chemotherapy for all patients. Again, this will generally
be a dose of radiation therapy in the range of 4500 centigrade,
and chemotherapy to include 5-Fluorourasil and Leucovorin. Other
physicians will only recommend this pre-operatively and on a selected
basis.
Finally, some physicians will recommend it only post-operatively
for those patients where the tumor goes through the bowel wall or
there are positive lymph nodes. Increasingly, however, it is recognized
that surgical technique is the most important factor in decreasing
local recurrences. This is another situation where the choice of
the surgeon is critically important.
If a physician recommends adjuvant therapy, then I would suggest
you follow that recommendation. First of all, chemotherapy used
to treat colon and rectal cancer is generally well tolerated. It
is unusual for one to lose their hair or to have other such profound
effects that they cannot continue their life. Most patients are
able to continue working and tolerate the treatments very well.
There are side effects, but they are not incapacitating.
In addition, if the side effects are unacceptable, the treatments
can always be stopped. Therefore, there would seem to be little
reason to not start the treatment and, if the patient finds it unacceptable,
to terminate the treatment at that time. The proof that chemotherapy
is effective is very clear. There should not be a question whether
or not the chemotherapy is of benefit when lymph nodes are involved
or for rectal cancer when the tumor goes through the bowel wall.
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