Colorectal Cancer That Has Spread to the Liver: What You Should Know

• If you or a loved one is dealing with colorectal cancer that has spread to the liver (colorectal liver metastasis), here’s some hopeful news: although the condition has long been difficult to treat, recent advances are making a big impact.

  Unlike primary liver cancer, which begins inside the liver, colorectal liver metastases are cancers that have spread to the liver from the colon or rectum. It’s most common in cases of late-stage colorectal cancer or colorectal cancer that recurs.

  Regardless of stage, stopping colorectal liver metastasis is challenging.

  “A surgical evaluation is important early on in treatment,” said Jason A. Castellanos, MD, MS, a surgical oncologist at Fox Chase Cancer Center. “While chemotherapy plays an important role, surgery is also an essential treatment to consider when evaluating patients with these types of tumors.”

  But not every patient is a candidate for surgery when they’re first diagnosed with colorectal liver metastasis. And surgery, according to Castellanos, can pose significant risks.

  That’s why experts at cancer centers like Fox Chase are leading the way in finding new approaches to treating cancers that have spread to the liver from the colon or rectum and making them more amenable to surgery.

  “Anywhere from 25 to 40 percent of cancer patients with colorectal liver metastases that can be removed have the potential to live at least 10 more years, depending on multiple factors,” Castellanos said. “And, there have been a lot of technical innovations in the last 20 years that have made treatment for these metastases much safer.”

  These innovations include:

  • Multistage Surgeries: According to Castellanos, this technique involves performing a two-stage surgery where one side of the tumor is cleared in the first part, and the second side is removed later on. This gives the patient’s liver function time to recover.
  • Portal Vein Embolization: This procedure cuts off blood flow to the cancerous part of the liver, encouraging the healthy section that isn’t undergoing surgery to grow larger.
  • Microwave Ablation:This alternative to surgery uses a probe to direct microwave heat into the liver to kill cancer cells. According to Castellanos, it can offer as good of a response as surgical intervention for patients with tumors less than two or three centimeters in size.

  In cases where a tumor is too large to be safely removed right away, treatments like hepatic arterial infusion chemotherapy can shrink the tumor enough to make a patient eligible for surgery.

  “We place a catheter into the artery and attach a subcutaneous pump in the abdomen so patients can get chemotherapy continuously to try to shrink the tumor,” Castellanos said. “It can help us get to a point where less liver needs to be removed during surgery.”

  External beam or other radiation techniques may also be used to treat tumors that can’t be removed surgically.

  Expertise Matters

  To gain access to the latest techniques and treatment options, it’s important to be seen at a designated cancer center with experienced cancer specialists.

  “We know that patients treated at centers not specialized in treating colorectal liver metastases aren’t always able to have surgery,” Castellanos said. “Coming to a center like Fox Chase allows for multidisciplinary opinions, making it more likely that patients will receive optimal treatment.”