Hi Stage IV colon cancers have spread from the colon to distant organs and tissues. Colon cancer most often spreads to the liver, but it can also spread to other places such as the lungs, brain, peritoneum (the lining of the abdominal cavity), or to distant lymph nodes. In most cases surgery is unlikely to cure these cancers. However, if there are only a few small areas of cancer spread (metastases) in the liver or lungs and they can be removed along with the colon cancer, surgery may help you live longer and may even cure you. This would mean having surgery to remove the section of the colon containing the cancer along with nearby lymph nodes, plus surgery to remove the areas of cancer spread. Chemo is typically given as well, before and/or after surgery. In some cases, hepatic artery infusion may be used if the cancer has spread to the liver. If the metastases cannot be removed because they are too large or there are too many of them, chemo may be given before any surgery (neoadjuvant chemo). Then, if the tumors shrink, surgery to remove them may be tried. Chemo would then be given again after surgery. For tumors in the liver, another option may be to destroy them with ablation or embolization. If the cancer has spread too much to try to cure it with surgery, chemo is the main treatment. Surgery might still be needed if the cancer is blocking the colon (or is likely to do so). Sometimes, such surgery can be avoided by inserting a stent (a hollow metal or plastic tube) into the colon during a colonoscopy to keep it open. Otherwise, operations such as a colectomy or diverting colostomy (cutting the colon above the level of the cancer and attaching the end to an opening in the skin on the abdomen to allow waste out) may be used. If you have stage IV cancer and your doctor recommends surgery, it’s very important to understand the goal of the surgery ─ whether it is to try to cure the cancer or to prevent or relieve symptoms of the disease. Most patients with stage IV cancer will get chemo and/or targeted therapies to control the cancer. Some of the most commonly used regimens include: FOLFOX: leucovorin, 5-FU, and oxaliplatin (Eloxatin) FOLFIRI: leucovorin, 5-FU, and irinotecan (Camptosar) CapeOX: capecitabine (Xeloda) and oxaliplatin FOLFOXIRI: leucovorin, 5-FU, oxaliplatin, and irinotecan One of the above combinations plus either a drug that targets VEGF (bevacizumab [Avastin], ziv-aflibercept [Zaltrap], or ramucirumab [Cyramza]), or a drug that targets EGFR (cetuximab [Erbitux] or panitumumab [Vectibix]) 5-FU and leucovorin, with or without a targeted drug Capecitabine, with or without a targeted drug Irinotecan, with or without a targeted drug Cetuximab alone Panitumumab alone Regorafenib (Stivarga) alone Trifluridine and tipiracil (Lonsurf) The choice of regimens depends on several factors, including any previous treatments you’ve had and your overall health. If one of these regimens is no longer effective, another may be tried. For people with certain gene changes in their cancer cells, another option after initial chemotherapy might be treatment with an immunotherapy drug such as pembrolizumab (Keytruda). For advanced cancers, radiation therapy can also be used to help prevent or relieve symptoms such as pain. It may shrink tumors for a time, but it is very unlikely to result in a cure. If your doctor recommends radiation therapy, it’s important that you understand the goal of treatment.