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Approximately 20% of patients with colorectal cancer (CRC) present with Stage IV metastatic disease. Patients and caregivers are often very distressed when informed of the diagnosis. While the diagnosis can be devastating, there can be various treatment options possible.
Chemotherapy has become the mainstay of treatment for Stage IV CRC and there have been many advances in care. There is also a wide range of disease severity in Stage IV disease. For example, a single liver metastasis or solitary lung metastasis is also classified as a Stage IV disease, and potential "curative" options are possible for removal of all cancer.
Dr Chew has managed many Stage IV colon cancer and rectal cancer patients, and works with various specialists to determine the best care for these patients. He has similarly performed several important research studies in this area of expertise and has gained a better understanding of the strategies needed to tackle this difficult and complex disease.
There are several misconceptions that Stage IV disease is terminal with no curative options. And while chemotherapy is an important treatment option for these patients, there are several considerations to determine if surgery may be required:
  • Symptoms of the colon cancer and rectal cancer, as well as the ability to remove all tumour during surgery
  • The site and severity of disease burden of metastasis, and if there is a possibility of resection
  • Surgical fitness of the patient
  • In some circumstances, the patient may present with emergency or severe symptoms such as obstruction, perforation or infection whereby emergency surgery is required
Surgery may be recommended after a careful assessment, detailed discussion of the risks and benefits, as well as an establishment of goals and outcomes. Surgery may be performed with other surgical specialties upfront if deemed possible, or the patient may be recommended for chemotherapy or other treatment options first.


  • In curable Stage IV disease, it is to ensure a complete tumour clearance for good survival.
  • In incurable Stage IV disease, it is to improve the quality of life for patients.


Our team will coordinate and organise the following:
  • Multi-disciplinary team discussion and evaluation. This will be dependent on the site of metastasis as well as any chronic medical conditions that the patient has.
  • Close follow ups and monitoring of symptoms in order to determine recovery.
  • Chew MH; Teo JY; K Tousif; Koh PK; Eu KW; Tang CL
    Stage IV colorectal cancers: an analysis of factors predicting outcome and survival in 728 cases.
    Journal of gastrointestinal surgery 2012; 16(3):603-612
  • Tan WJ, Chew MH, Tan BH I, Law J, Zhao R, Acharyya S, Mao YL, Fernandez LG, Loi CT, Tang CL2) Tan WJ, Chew MH, Tan BH I, Law J, Zhao R, Acharyya S, Mao YL, Fernandez LG, Loi CT, Tang CL
    Palliative surgical intervention in metastatic colorectal carcinoma; a prospective analysis of quality of life.Palliative surgical intervention in metastatic colorectal carcinoma; a prospective analysis of quality of life.
    Colorectal Dis 2016 Apr;18(4):357-63Colorectal Dis 2016 Apr;18(4):357-63
  • Dorajoo SR, Tan WJ, Koo SX, Tan WS, Chew MH, Tang CL, Wee HL, Yap CW.
    A scoring model for predicting survival following primary tumour resection in stage IV colorectal cancer patients with unresectable metastasis.
    Int J Colorectal Dis. 2015 Oct 21.
  • Tan WJ, Dorajoo SR, Chee MYM, Tan WS, Foo FJ, Tang CL, Chew MH
    A Novel Derivation Predicting Survival After Primary Tumor Resection in Stage IV Colorectal Cancer: Validation of a Prognostic Scoring Model and an Online Calculator to Provide Individualized Survival Estimation.
    Dis Colon Rectum. 2017 Sep;60(9): 895-904. doi: 10.1097/DCR.0000000000000821.
    PMID: 28796727
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