Search

Only radical resection can cure patients with pancreatic cancer (PC); however, adjuvant gemcitabine (GEM) doubles the postoperative five-year-survival. The best treatment of locally advanced PC is not established, but radio-chemotherapy followed by surgery may be considered. Fit patients with metastatic PC benefit from GEM, which is standard. The addition of the epidermal growth factor-receptor-inhibitor erlotinib prolongs median survival significantly by two weeks and one-year survival by 7%. Very fit patients might benefit by combining GEM with platinum or capecitabine, but evidence is not firm. Participation in clinical trials is strongly encouraged in PC.

Isolated colorectal liver metastases should be referred for multispecialist management at a liver centre. Long-time survival is possible after resection and adjuvant therapy. If unresectable, newer chemotherapy with oxaliplatin, irinitecan, bevacizumab and cetuximab may result in a median survival > 20 months. Selected patients may be down-staged and resected with good long-time survival. Bilateral, multiple and large metastases can also be treated by complex combinations of portal vein embolization/ligature, staged resections and local (radiofrequency) ablation.

Metastases from colorectal cancer are most often confined to the liver or lungs, in which 20-25% may be resected with curative intent. Without treatment, no patients are alive after four years, whereas 30% are alive four years after radical resection. Early use of chemotherapy increases survival, and about 20% of patients may thus become suited for local therapy. After the primary operation, surveillance is recommended, with measurement of carcinoembryonal antigene every 3-6 months for 3 years, then every 6-12 months from years 3 to 5, plus ultrasound or CT scan every 6 months for 3 years, then yearly for up to 5 years.

In less than a decade, metastatic cancer in the colon or rectum has changed from being primarily a surgically palliated disease to one in which there have been increasing successes with combination chemotherapy and molecular targeted therapy. Without treatment, only half of the patients are alive after six months, and there are almost no survivors after two years. With modern therapy, about half of the patients are now alive after two years and the survival time continues to increase. Instead of being a more or less acute life-threatening disease, metastatic colorectal cancer may exist as a chronic condition for years.