HJNO Mar/Apr 2021

HEALTHCARE JOURNAL OF NEW ORLEANS I  MAR / APR 2021 51 Janeiro Goffin, MD Medical Oncologist Mary Bird Perkins TGMC Cancer Center 1. Whether there are signs of cancer spread on a physical examination, computed tomography (CT) scan or magnetic resonance imaging (MRI) of the chest, abdomen and pelvis, chest X-ray or other imaging tests; 2. The appearance of the cancer specimen when viewed under the microscope af- ter it has been removed with surgery. Colon cancer stages range from stage I (cancer has invaded into, but not through, the entire wall of the intestine) to stage IV (cancer has spread or “metastasized” to distant organs, such as the liver or lungs). Treatment depends on the disease stage. Earlier stages of disease (stages I through III) are curable. They are referred to as local- ized colon cancer and are generally treated with surgery, with or without chemotherapy. Stage IV is incurable. It is generally treated with chemotherapy, targeted therapy or im- munotherapy. Some patients may benefit from surgery of the primary tumor prior to treatment of metastatic disease, especially if the primary tumor is causing symptoms. COLON CANCER TREATMENT The treatment of colon cancer usu- ally involves surgery, and it may also in- volve chemotherapy, targeted therapy and immunotherapy. Surgery: During surgery, the cancerous part of the colon and surrounding tissues are removed. The lymph nodes within this surrounding tissue are examined under a microscope to determine if cancer has spread beyond the colon. Inmost people, the two ends of the colon can be reconnected immediately after the cancerous part has been removed. If this can be done, it means that the patient will continue to have bowel movements normally, through the rectum and anus. In other cases, the colon cannot be re- connected during the initial surgery. This can happen if the surgeon feels there is a high chance that the reconnection will fail or if the tissues are inflamed and need time to heal. If this occurs, the surgeon will sew the colon to an opening in the skin on the abdomen. The opening is called an ostomy. The patient will wear a bag over the ostomy to collect bowel movements. The ostomy is usually temporary, and the two ends of the colon can often be reconnected after a few months, sometimes after chemotherapy is completed. In other cases, the patient will need the colostomy permanently. Chemotherapy: Chemotherapy is a treat- ment given to slow or stop the growth of cancer cells. Even after a colon cancer has been completely removed with surgery, can- cer cells can remain in the body, increasing the risk of cancer coming back (called a re- lapse or recurrence). In some people, che- motherapy can eliminate these cancer cells and increase the chance of cure. This type of chemotherapy is called “adjuvant,”which means that it is given after curative surgery (at which time all the tumor was removed). Most treatments involve a combination of several chemotherapy drugs, which are given in a specific order on specific days. Most of the drugs, for example FOLFOX, are given intravenously (IV); but sometimes a single drug will be recommended, which can be given in pill form (e.g., capecitabine or trifluridine/tipiracil). Chemotherapy is given for either three months or six months, depending on the stage of cancer. Chemo- therapy is recommended for most people with stage III colon cancer (spread to the lymph nodes) and Stage IV colon cancer (spread to other organs like the liver). Targeted therapy: There are antibodies (a type of protein) that work to inhibit specific proteins that are important for the growth and/or survival of colon cancer cells. Be- cause targeted therapy agents do not directly interfere with rapidly dividing cells, they do not have the usual side effects of conven- tional chemotherapy. Examples of targeted therapy used in Stage IV colon cancer are trastuzumab (for Her2neu+), cetuximab, bevacizumab, regorafenib and larotrectinib. Immunotherapy: It stimulates or un- leashes your immune system to attack and kill the cancer cells. There are several dif- ferent types of immunotherapy. For Stage IV colon cancer, we use nivolumab (Opdivo), pembrolizumab (Keytruda) and ipilimumab (Yervoy). They have important benefits for a small number of patients, notably the ap- proximately 5%whose tumors have specific genetic alterations (MSI-H). SURVEILLANCE At Mary Bird Perkins TGMC Cancer Cen- ter, we make sure to do surveillance on every colon cancer patient who has been cured. This will be done for at least five years. Sur- veillance involves a doctor visit every 6-12 months with blood work including tests for tumor marker CEA (carcinoembryonic anti- gen) and annual CT scans of the chest, abdo- men and pelvis. Patients also need to follow up with their gastroenterologist or colorec- tal surgeon for routine colonoscopies. n Janeiro Goffin,MD,earned hismedical degree at the American University of Medical School in Nicaragua, and he completed his internal medicine residency at the Miller School of Medicine at the University of Miami. Goffin was a hematology/oncology fellow at Tulane University School of Medicine in NewOrleans. He is board-certified in internal medicine, hematol- ogy and medical oncology by the American Board of Internal Medicine. Goffin underwent clinical and research rotations at MD Anderson Cancer Center in Houston, TX, the University of Miami Hospital/ Jackson Memorial Hospital and Tulane, where he published numerous articles on breast, lung and kidney cancer research.