Patients with advanced cancer of the colon, rectum, or ovaries may now have hope for long-term survival with the Regional Cancer Centre here preparing to offer peritonectomy or cytoreductive surgery, an intensive, multi-disciplinary, and radical procedure currently done only in a few centres across the world.
Surgical oncologists at the RCC dealing with gastrointestinal cancers will soon be trained in the procedure at the National Cancer Centre, Singapore, the only centre in south-east Asia doing the procedure.
The RCC has had a long and fruitful collaboration with the NCC, Singapore, for six years in research and clinical practice, and exchange of data and medical faculty in certain key areas. The medical faculty from the RCC have been regularly trained in Singapore while doctors from the NCC have been visiting the RCC for more exposure to head-and-neck cancers
Peritonectomy
“Peritonectomy, followed by intraperitoneal chemotherapy, is a procedure that we offer patients with advanced (Stage IV) cancers of the colon and rectum, ovaries, primary peritoneal cancer, and a rare kind of cancer, pseudomyxoma peritonei. In this procedure, we remove all visible tumour from the abdomen and the peritoneum itself, and apply chemotherapy directly to the abdomen. The NCC has been doing this for the past 12 years. In the case of pseudomyxoma peritonei, we have reported a 10-year survival rate of 80 per cent, which is quite spectacular,” says Melissa Teo Ching Ching, Consultant Surgical Oncologist, NCC.
Colorectal cancer is the commonest cancer in Singapore among men and among women, the second commonest, after breast cancer. In most cases, the cancer is detected very late.
“We get plenty of referrals from other countries too and a lot of these patients have Stage IV cancers originating from the colon, rectum or ovaries which have spread into the peritoneum. They are not given many treatment options at this stage and without treatment they will die in six months. With chemotherapy, they may live for a year or two. But with the procedure at NCC, we are giving them a chance of a 30-40 per cent cure,” Dr. Teo Ching Ching says
The procedure is not for everyone. Some patients are considered a ‘good’ Stage IV while some are ‘bad’ Stage IV. If the metastasis (spread of cancer) is only in the peritoneum and the patient is fit enough, they are good candidates for the procedure. But if the Stage IV has spread to the lung, liver, or bone, then peritonectomy will not help them survive, she says.
Detection
Colorectal cancer is mostly detected very late because by the time the patient begins to feel the symptoms like difficulty in passing stools or blood in the stools, the cancer would have been fairly advanced. While colorectal cancer does not figure among the high prevalent cancers in Kerala, this is one of the lifestyle-related cancers which seem to be on the rise here, doctors at the RCC say.
The treatment options now available here for rectal cancers can be quite morbid. In most cases of rectal cancers, the quality of life of the patient is severely compromised after treatment. The collaboration with the NCC could help the RCC give better options to rectal cancer patients.
The NCC has now started a screening programme to detect colorectal cancers early. A stool test is the primary screening tool and if this test reveals the presence of blood, then the person has to go to a doctor and get CT colon or a colonoscopy done to check for growth.
Dr. Teo Ching Ching says that colorectal cancer is essentially a lifestyle cancer but with a big hereditary component.
The rates of colorectal cancers are certainly high when people pursue a Western lifestyle and diet, high in protein and fat, low in fibre and vegetables.
“We have done peritonectomies in about 130 patients till date and the long-term survival for the whole group has been about 50 per cent. While early detection and treatment give the best results, the message is that for colorectal and ovarian cancers, the prognosis is quite good even in Stage IV if through peritonectomy we can remove the entire tumour,” she says.
