What is the Most Important Part of a Colon Cancer Prognosis?

colon cancer prognosisMany patients of course are concerned about their colon cancer prognosis.  There are different ways to evaluate the prognosis of patients, the most important of course is the staging of disease.

Dr. Heinz-Josef Lenz of The Wunder Project explains that over the last ten years, overall survival has surpassed 30 months, two-and-a-half-years which is unheard of in a colon cancer prognosis.  Researchers are learning more and more with access to clinical pathological criteria, so when a doctor looks in the microscope, they understand potentially what tumors are more aggressive, they are usually poorly differentiated.  All of this will help in determining a colon cancer prognosis.

In the future, doctors will have more and more predictive markers to select the right treatments and prognostic markers to really understand better tailoring of chemotherapy using targets particular specifically developed for this mutation. Doctors will also be able to monitor these patients more carefully because it will be known certain patients may metastasize early or to unusual places such as the brain. With more and more technology entering clinical practices, doctors will develop a very individual personalized treatment plan as well as surveillance plan.

Heinz-Josef Lenz MD:  So, many of the patients of course are concerned what their prognosis is.  Now, there are different ways to evaluate the prognosis of patients, the most important of course is the staging of disease.

Obviously, if we have stage 1 disease, a very small tumor removed, your prognosis is excellent and all patients basically are cured, but if the tumors get bigger or involve lymph nodes, the prognosis decreases.  We are now using different treatment options to improve the outcome with adjuvant chemotherapy.  For patients with metastatic disease, we are here facing a life threatening cancer because we have active disease and choosing chemotherapy to prolong overall survival.

Now over the last 10 years, the overall survival has now surpassed 30 months, two and a half years which is unheard of.  When we would not treat, it would be may be six or eight months and this goes along not only with extent of overall survival, but also with better quality of life.  Now, we are learning more and more, we know some clinical pathological criteria, so when we look in the microscope, we understand potentially what tumors are more aggressive, they are usually poorly differentiated.  The more sites the tumor travelled to is associated with poorer outcome.

If you have travelled cancers to liver, lung, bone or brain, obviously, this is more challenging to treat and the prognosis is not as good as when you have only liver or lung lesions, but we also now learn more and more about molecular markers, so we have a test which shows that when you test for a mutation in BRAF, this is associated with poor prognosis.  So, it is always difficult to talk about, okay you have this mutation and the outcome is not good, but the good news is we have now drugs developed to really target this particular prognostic marker.

So, I think in the future, we will have more and more predictive markers to select the right treatments and prognostic markers to really understand better tailoring of chemotherapy using targets particular specifically developed for this mutation, but also monitor these patients more carefully because we know these patients may metastasize early or to unusual places such as the brain.  So I think with more and more technology entering our clinical practices, we will develop a very individual personalized treatment plan as well as surveillance plan.  So, I think this will help all our patients, the more we know, the better we can help you.

For an interactive tool to learn more about your colon cancer and your personalized treatment options, go to MyColonCancerCoach.org.

Heinz-Josef Lenz
Heinz-Josef Lenz, M.D., FACP, is the Associate Director for Clinical Research and Co-Leader of the Gastrointestinal Cancers Program at the USC Norris Comprehensive Cancer Center. Dr. Lenz is Professor of Medicine and Preventive Medicine, Section Head of GI Oncology in the Division of Medical Oncology and Co-Director of the Colorectal Center at the Keck School of Medicine of the University of Southern California.


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