VALENCE. Research into colorectal cancer patient survival has led to an increase in recent years. In this sense, the importance of clinical trials stands out, as demonstrated by Dr. Marcos Melián, medical assistant of IVO Medical Oncology, the discovery of new drugs is essential to change the natural history of the disease, when it allows. research and development of new treatments, improve existing treatments and provide patients with access to promising experimental treatments before conventional treatments are available. Over the years, various therapies have been developed for colon and rectal cancer. Among them, the most outstanding therapy is with Dostarlimab, which is used for a subtype of rectal cancer patients with high microsatellite instability. In short, clinical trials are a vital tool in the fight against colon cancer.”
In relation to medicine, research focuses on the medical precision that is known: knowing the molecular disease, to individualize the treatment of each patient. “The individual treatment of each patient is very important. This is due to multidisciplinary commissions where different experts (physicians, medical oncologists, radiation oncologists, radiologists, nuclear medicine doctors, digestive doctors, pathologists and molecular biologists) participate, in which the cases are presented and we decide in one way to establish individual treatment plans”. Dr. Melián says, who points out, however, “the best weapon to increase health is early detection of the disease, since it increases a lot in the rudiments of the remedy. Here all. The population makes screening or early diagnosis through a fecal occult blood test vitally important from the age of 50.
What are the warning signs? Sometimes major colon cancer does not produce definite symptoms until the stages are very advanced. “However, the main symptoms for which they consult a doctor are abdominal pain, changes in bowel habits (constipation, diarrhoea), insufficient sensation of bowel emptying, blood with or in the stool and unknown weight loss for other reasons.
and the genetic factor? Dr. Melián states that the incidence of colon cancer is low, although there are some genetic mutations that affect the early types of colorectal cancer. The two most common are Lynch Syndrome and Familial Adenomatous Polyposis. “They are now very rare and it is estimated that they cause less than 5% of colorectal cancer.”
What influences its aspects are four risk factors “very established in our society”, as demonstrated by the assistant physician of the Oncology Medical Service IVO: alcohol, smoking, sedentary lifestyle and consumption of red meat and ultra-processed products. “Therefore, it is important to promote healthy eating habits, to reduce the intake of fruits, vegetables, legumes, grains and fiber, and to reduce the consumption of red meat and other processed items. In addition, consumption of dairy products could also protect against colon cancer. Finally, it is necessary to promote the implementation of sports and to remove the intake of alcohol and tobacco.
Another risk is age, although a gradual increase in this disease has been observed under the age of 50. In fact, a study recently published in Cancer Epidemiology, Biomarkers & Prevention suggests that colorectal cancers are increasingly being diagnosed in younger populations and at more advanced stages. “It is considered that the main problem can be lifestyle (diet, alcohol and tobacco). The most important thing is that the population should be aware that in the face of alarming symptoms they should consult a doctor early. There is no extemporaneous recommendation regarding the reduction of age in the schedules (they have been completed since 50 years) but it is a situation that is being studied and can change in the future.
Surgery, the main option
Regarding the approach to colon cancer, surgery remains the main option, combined, at times, with radiotherapy. “Purification is key in the management of patients with colon cancer and must maintain established oncological quality standards, regardless of the surgical technique used or the approach route,” says Dr. and Digestive Surgery service of the IVO.
Surgery has evolved in recent decades, from traditional open surgery “which is still used in some cases”, to minimally invasive surgery such as laparoscopic and robotic surgery, which already means a more agile postoperative recovery, with less postoperative pain and faster. to return to common life. “But, in addition, robotic surgery offers us a higher technical quality, with much more precise surgery, a greater range of movements than the doctor can perform, which translates into fewer postoperative sequelae for patients,” said Dr. García Fadrique In addition, IVO has had the Da Vinci robot since 2019, “the results obtained with this approach have been largely positive from the clinical point of view for our patients, with all the benefits already described, as well as the undoubted technical utility. surgeons performing the type of intervention. The undoubted fact today is that the tool of robotic surgery it is of great added value in the treatment of colorectal cancer and should be offered without any hesitation to our patients.”
These are followed by advances in the treatment of metastatic colon cancer, that is, cancer that has spread to other organs. “Surgery metastases, together with new chemotherapy treatments, targeted radiotherapy and interventional radiology, have allowed us to treat patients who were considered terminal before,” says the chief clinical officer of the IVO General and Digestive Surgery Service. “Explanation of surgery for liver, lung and peritoneal metastases, through cytoreduction and intraperitoneal hyperthermic chemotherapy, which is 10 years in IVO, greater knowledge when committing these treatments and multidisciplinary roles, are the things in the day-to-day treatment of colon cancer in our center.
And how is the postoperative period? Doctor García Fadrique points out that it is important to have a patient who is exposed and understands the whole process and is also a participant in his health. They generally arrive on the same day, they already give themselves a drink and in some cases they can already sit down. In the following 2-3 days he progresses to an oral diet, if possible, and the patient is already walking around the room for most of the day. If there is no doubt, they are usually discharged 3-5 days after the intervention, with the recommendation of cleanliness for the following weeks. “Obviously, the postoperative period is adjusted to each patient and the presence of any deviation from the normal postoperative course.”
Can there be sequelae after surgery? “If everything happened regularly, the sequelae after this type of surgery are mild and contracted during the time. The main ones are those derived from the resection of the intestines itself, since at first the bowels can be altered in their vicissitudes, consistency and composition. But in the course of time they return to normal. it can be done in incisions, but the increasing use of minimally invasive surgery and with smaller more scars means that this problem is less and less”, Dr. García Fadrique says.
The function of radios there
Along with surgery, radiotherapy is part of the comprehensive multimodal treatment of digestive cancer, especially rectal cancer. “Thanks to the effect of the combination of three treatments, systemic treatment, radiotherapy achieved through surgery, it is possible to achieve the cure of many tumors or to optimize the local control of the disease which makes it possible to improve the quality of life. , the number of conservative treatments of the anal sphincter can increase, explains Dr. Leoncio Arribas, head of Radiation Oncology at IVO.
In this sense, two techniques improve the health and control of this disease. On the other hand, intraoperative radiotherapy, the use of radiotherapy in the actual treatment of surgery. “It is necessary to have an accelerator that is located inside the operating room and after the surgery is completed, it is possible to administer, with said accelerator, high doses of radiation in areas in which, of course, the surgeon could not remove everything.” This tumor increases the chance of treating certain tumors, especially the resources, Dr. Arribas, who showed that through “improvement and technological development of linear accelerators, it is possible to carry out treatments in many clinical conditions of colorectal cancer. which have not been used before.” In addition, the head of Radiation Oncology at IVO emphasizes the importance of image management in all stages of the radiation treatment process, using guided imaging (IGRT) in both simulation, planning, verification and treatment.
The second technique is stereotactic radiotherapy in the treatment of metastases (both colon and rectal tumors) at any level (liver, lung, soft tissue, etc.) better survival and control of this disease”.
Thus, “it is possible to carry out organ-preserving treatments (in this case, the anus) every day, as well as metastasis treatments in a reduced number, raising the quality of life and prolonging the survival of these patients”, he affirms. Dr. You will arrive