Palliative care of colorectal cancer

Abstract

Colorectal cancer (CRC) is the third most common cancer in the world. The symptoms and syndromes that are most commonly observed in CRC patients are pain, nausea/vomiting, weight loss, fatigue, constipation/diarrhoea, gastrointestinal bleeding, ascites, bowel obstruction and confusion. Both locally advanced tumors and its distant metastasis can lead to extreme discomfort. Palliative care (PC) in oncology focuses on prevention and the relief of suffering in order to to optimize quality of life (QoL) for patients with advanced cancers. It is intended to address medical problems as a whole (physical, psychosocial and spiritual necessit).PC may be provided at any time during a patient's illness, even from the time of diagnosis. Moreover, it may also be given concurrent with treatments designed to prolong life. Palliative chemotherapy significantly reduces mortality in patients with stage IV CRC. Without any treatment, advanced CRC patients lives for approximately 6 months. Treating patients with a fluoropyrimidine compound can prolong overall survival for up to a median of ~12 months. Adding oxaliplatin and/or irinotecan to a fluoropyrimidine-based regimen enhances survival for up to 20 months and even more (>20-24 months) when using novel monoclonal antibodies like bevacizumab and cetuximab. Sometimes, addition of months of life does not justify excessive treatment toxicity. Studies addressing QoL issues are of upmost interest in this context. When symptoms are well-managed, CRC patients can be more likely to sustain a full anti-cancer therapy with a longer and more fulfilling life. PC becomes the main focus of care in the case that curative treatments fail or patients are unable to tolerate it. This chapter presents general approaches of some specific symptoms and syndromes commonly diagnosed in advanced CRC, including: malignant bowel obstruction, anorexia/cachexia, malignant ascites and cancer pain. The pathophysiology, underlying causes, assessment and management will be updated by the authors. General basis of palliative anti-cancer therapy will be presented by the authors. The last hours of life will also be discussed in this chapter, as well its associated management dilemmas, especially regarding feeding and hydration, changes in consciousness, delirium, breathlessness and respiratory secretions.© 2011 Nova Science Publishers,Inc. All rights reserved.