Preparing for Colon Cancer Surgery
- Mavericks frontman Raul Malo, 59, is preparing for colon surgery despite not slowing down with his on-stage performances, showing remarkable strength as he battles stage 4 metastatic colon cancer.
- Experts stress that while surgery is essential for early-stage colon cancer, those with advanced cases often require personalized approaches, which may prioritize chemotherapy or experimental therapies.
- Colon cancer experts say a colonoscopy is among the most effective colon cancer screening methods. It involves a long, thin tube attached to a camera used to examine the colon and rectum for polyps (small growths in the colon that aren’t yet cancerous). If found, doctors can remove them during the procedure.
- Colorectal screenings are recommended to begin around age 45. However, people at increased risk – such as having a family history of the disease – may want to screen sooner. Discussing your screening options with your doctor is recommended.
“I want those who are going through this to know that challenges will arise. You will have your own. The fact that I can go onstage helps keep me focused on the end game,” Malo shared in a heartfelt Instagram post.
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“My colon surgery has been scheduled for August…I’m not out of the woods yet, but I’m on my way,” he added.
This next step follows multiple rounds of chemotherapy, which Malo has already endured with grit. Stage 4 colon cancer indicates that the disease has spread beyond the colon, often reaching the liver, lungs, or peritoneum—the tissue lining the abdomen.
Each case of metastatic colon cancer presents a unique treatment path. According to Dr. Daniel Labow, Chief of the Surgical Oncology Division at Mount Sinai Health System:
“Most patients, when they come in the door—as I am a surgeon as well as an oncologist—want to go right to the operating room, because they just feel getting it out is a critical thing.”
WATCH: Not all stage 4 colon cancer patients are the same; thus, different treatment options are necessary.
But Dr. Labow emphasizes that thoughtful strategy, not urgency, drives success:
“In actuality, effective chemotherapy and effective surgery are both important for the best possible outcome, and part of the job is to figure out which one we should do first. There are very diverse options.”
While surgery is a vital weapon against colon cancer, it’s not always the first—or the right—step for everyone. For those diagnosed with stage 1, 2, or 3 colon cancer, surgery is typically part of the treatment plan, though stages 2 and 3 often require chemotherapy as well.
WATCH: When to operate on colon cancer.
Stage 4 patients like Malo face more complex options, based on how far and where the cancer has spread. Surgery may be recommended when metastases are limited to a single area, but extensive disease often leads to a primary treatment of chemotherapy.
“The overall view of treating metastatic colon cancer is that most of those patients cannot proceed to surgery, and so their cancer can never be removed entirely,” said Dr. Paul Oberstein, a medical oncologist at NYU Langone’s Perlmutter Cancer Center.
In such cases, patients often live with their cancer while undergoing continual therapy or experimental treatments designed to keep the disease in check and preserve quality of life.
Expert Resources on Colorectal Cancer
How Malo Has Navigated His Stage 4 Cancer Journey
While undergoing a colonoscopy, which screens for colon cancer, doctors discovered Malo had “two cancerous spots,” which prompted further testing. The singer then learned he had colon cancer.
“One of the reasons I’m telling you all this is that some of the shows may be affected this year as we navigate this situation and see how the therapy goes,” Malo previously explained.
The cancer starts when abnormal lumps called polyps grow in the colon or rectum. If you don’t have these polyps removed, they can sometimes change into cancer. It takes up to 10 years for a colon polyp to become a full-blown cancer, according to SurvivorNet experts.
“When we see a polyp, we actually physically take the polyp out through the colonoscope,” Dr. Zuri Murrell, a colorectal cancer surgeon and Director of the Cedars-Sinai Colorectal Cancer Center, explained.
WATCH: When to get a colonoscopy
Most colon cancers can be prevented if people are regularly screened. The screening usually involves a colonoscopy, in which a long, thin tube attached to a camera examines the colon and rectum. If no polyps are discovered, the following screening won’t be needed for about ten years.
What Treatment Options Exist for Colon Cancer?
“There are a lot of advances being made in colorectal cancer,” Dr. Heather Yeo, a colorectal surgeon at Weill Cornell Medicine, previously told SurvivorNet.
Colon cancer treatment is more targeted, meaning doctors often test for specific changes or genetic mutations that cause cancer growth.
Biomarkers are key to tailoring specific treatments. Biomarkers are molecular patterns becoming more commonly used in colon cancer diagnosis, prognosis, and management. According to the National Cancer Institute, a biomarker is “a biological molecule found in blood, other body fluids, or tissues that is a sign of a normal or abnormal process, or a condition or disease,” such as cancer.
“In colon cancer, we’re starting to look more and more at people’s biomarkers, so we’re starting to take the cancers, sequence them, understand where the different mutations are to figure out whether or not someone has a normal gene here or an abnormal gene,” Dr. Yeo explained.
“Those are the areas that people want to be able to target a little bit more. We’re getting close to more of what we would call precision medicine, meaning we can start looking at people’s genetic mutations and think about how they might respond to different drugs.”
There are different types of biomarkers, including DNA, proteins, and genetic mutations found in blood, tumor tissue, or other body fluids. The biomarkers most commonly used in colon cancer management are:
Genetic mutations within the tumor, such as MMR/MSI, KRAS, BRAF, and HER2
Bloodstream carcinoembryonic antigen (CEA)
CEA is a protein produced by most tumor cells (but not all) and can be picked up in the bloodstream. High CEA levels do not establish a colon cancer diagnosis. However, higher CEA levels correlate with a worse prognosis and potential metastasis. Carcinoembryonic antigen is important for post-treatment follow-up to ensure the cancer hasn’t returned. Be sure to check with your doctor before treatment starts to ensure a CEA blood sample has been obtained.
More on Treating Colon Cancer
Surgery and chemotherapy are common approaches to colorectal cancer.
Some examples of Food and Drug Administration (FDA) approved chemotherapy drug treatments include:
- FOLFOX: leucovorin, 5-FU, and oxaliplatin (Eloxatin)
- FOLFIRI: leucovorin, 5-FU, and irinotecan (Camptosar)
- CAPEOX or CAPOX: capecitabine (Xeloda) and oxaliplatin
- FOLFOXIRI: leucovorin, 5-FU, oxaliplatin, and irinotecan
- Trifluridine and tipiracil (Lonsurf)
WATCH: Understanding Your Options with Metastatic Colon Cancer
Among metastatic colon cancer patients, multiple treatment options exist, including surgical and non-surgical options.
One treatment option includes an oral treatment called Fruquintinib, which is a targeted therapy for adults who have metastatic colorectal cancer and have tried other treatments. Results from a trial published last year showed the drug improved overall survival and progression-free survival, which measures the amount of time before the cancer returns or spreads. It works by blocking the growth of blood vessels, which increases tumor growth.
Once you get to the metastatic setting, many patients “just run out of options,” Jennifer Elliott, head of solid tumors at Takeda, explained to SurvivorNet at the ASCO Annual Meeting. So it was critically important for Takeda to do this deal to in-license fruquintinib. We hope to give patients another option.”
Fruquintinib has been approved in China since 2018 and was originally developed by the Chinese biopharmaceutical company HUTCHMED. Takeda Oncology acquired the exclusive worldwide license for the drug outside of mainland China, Hong Kong, and Macau in January 2023.
Understanding Colon Cancer
Colon cancer is very treatable and curable if caught early. Colon cancer screenings can involve at-home tests such as Cologuard, but a colonoscopy is more effective, according to SurvivorNet experts.
The cancer starts when abnormal lumps called polyps grow in the colon or rectum. It takes up to 10 years for a colon polyp to become full-blown cancer, according to SurvivorNet experts.
The American Gastrointestinal Association lowered the recommended initial age for colorectal screening from 50 to 45. However, experts recommend screening earlier for some people who may be at an increased risk of developing colon cancer, such as those with a family history of the disease.
WATCH: Debunking misconceptions about colon cancer.
The most poignant symptom of colon cancer includes a change in bowel habits. This may include constipation or diarrhea due to changes in the size or shape of bowel movements. A change in stool color, particularly black or tarry stools, can indicate bleeding from a tumor that lies deep in the colon.
Other symptoms can be harder to pinpoint, such as abdominal pain and unintentional weight loss. Finally, some tumors bleed a small amount over a long period of time, resulting in anemia (low red blood cell count) that is picked up on blood work.
Questions to Ask Your Doctor
If you are facing a colon cancer diagnosis, here are some questions you may ask your doctor.
- What are my treatment options based on my diagnosis?
- If I’m worried about managing the costs of cancer care, who can help me?
- What support services are available to me? To my family?
- Could this treatment affect my sex life? If so, how and for how long?
- What are the risks and possible side effects of treatment?
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