Ask the doctor: surgery vs. chemotherapy treatment options

Deborah Nagle, M.D.

Cancer treatment options can be confusing, especially when initial treatments are not as successful as anticipated. This Ask The Doctor question comes from a reader who was diagnosed with colon cancer at a young age and is now in the process of gathering information about future treatment.

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Get Your Rear in Gear reader: At age 33, I was diagnosed in 2007 with colon cancer that had metastasized to my lungs; about nine very small bilateral spots.  After 12 rounds of Oxaliplatin, Evastin and 5FU they were gone.  I followed up with CT scans every three months.  The spots started growing again.  I did another round of chemo in June 2009 for about eight months.  This time I had allergic reaction to Oxaliplatin so I only had about three doses of that.  I just continued with Evastin and 5FU until January.  My last CT scan in June showed they are growing again.  My oncologist wants to start chemo again in August.  This time he wants to add Irinotican (which I have heard is horrible).  I went to my thoracic surgeon and he doesn’t want to do surgery because the spots are bilateral and too small and are responding to chemo. Do you have any new suggestions or treatment ideas that I could consider?

Dr. Nagle: Joan, surgery and chemotherapy are the mainstays of treatment for colon cancer.  Unfortunately, there are too many lung nodules for surgery.  Given the pattern of disease (both lungs and 9 small lesions), the only real option at this point is chemotherapy.  Most medical oncologists will utilize all standard regimens before trying something more experimental.  Irinotecan has been shown to be effective.  Everyone responds to chemo a bit differently, so it may be worth a try for you.

Dr. Deborah Nagle is the Chief of Colon and Rectal Surgery at Beth Israel Deaconess Medical Center, and member of ASCRS. She is also a member of the Harvard Medical Faculty Physicians and an instructor in surgery.