By Jamie Blom, M.D.
My how things have changed….
Cancer in and of itself is a frightening word. Metastatic cancer, or cancer which had spread from where it started to other parts of the body, is downright devastating. Metastatic disease has meant the proverbial horse was out of the barn. It was a death sentence with a not-too-distant due date. Not too many years ago a patient who had been told that his or her cancer had metastasized had been taken out of the realm of “curative” and entered the realm of “palliative”. “Palliation” means attempts or interventions could be made to maintain or preserve quality of life and alleviate symptoms, but with few exceptions there was no significant extension of life.
Fast forward to today, and enter the concept of “oligometastatic “ disease. “Oligo” is Greek meaning “few or sparse”. Decades ago we had noticed that patients with colon or rectal cancer who had four or fewer metastases to their liver and underwent surgical resection of those lesions tended to live a lot longer than other patients with metastases to other body organs. We thought that phenomenon was limited to colorectal cancer; we are discovering now that it is not. In today’s world of cancer, people with small numbers of metastases are treated much more aggressively with local treatments, such as radiation therapy… even if they have no symptoms of their disease. What the data are showing is that by doing so, for many patients we are altering the course of the patient’s disease. We are finding that although we may not be able to “put the horse back in the barn” and render a “cure”, for many we ARE able to not only preserve and maintain quality of life, but extend life as well.
As oncologists we keep learning and the field keeps advancing; paradigms continue to shift. Once upon a time we thought metastatic disease meant certain and fairly swift death; now we can sometimes say “not so fast”…