When Colon Cancer Spreads: Advanced Treatments Help People Live Longer, Better

**By Flavio G. Rocha, MD**

Cancer that starts in the colon can sometimes spread to other parts of your body, including the liver. Another name for it is metastatic, or stage IV, colon cancer.

Colorectal cancer is the third most common cancer diagnosed in both men and women in the United States. The American Cancer Society estimated that in 2016 more than 95,000 new cases would be diagnosed, and it was expected to cause more than 49,000 deaths last year.

Symptoms

As with many malignancies, symptoms vary depending on tumor size and where it has spread in your body. Some people with colon cancer that has spread to the liver don’t 3D human male x-ray digestive system.have symptoms. In other cases, they can include:

  • Bloody stool
  • Abdominal pain
  • Belly swelling
  • Feeling sick and tired
  • Weight loss

Diagnosis

Your doctor might find that the disease has spread to your liver when he or she first diagnoses you. Or, after you’ve been treated, the colon cancer can come back and spread to your liver.

It is normal to worry when you have cancer that has spread. But treatment can make a real difference with symptoms, quality of life and longevity.

Your physician will help determine if you need surgery, chemotherapy, radiation or other liver-focused therapy. Doctors may be able to remove or shrink the tumor. Afterward, you’ll need to keep up with your doctor visits to stay symptom-free.

To determine location and size of the cancer, your doctor may order one or more imaging tests, including:

  • CT (computed tomography) – Powerful X-ray that makes detailed pictures of the inside of your body
  • MRI (magnetic resonance imaging) – Powerful magnets and radio waves that create pictures of organs and internal structures
  • PET (positron emission tomography) – Uses radioactive particles, or tracers, to find disease inside the body
  • Liver biopsy – Removing a tiny sample of the liver to test it
  • Colonoscopy – Visual inspection inside the colon using a camera-enabled scope

Being your own best health advocate

In today’s health care environment, most people understand that patients – along with their opinions and decisions – play an important role in the delivery of care. By advocating for themselves and getting involved in decision making, they can reap numerous benefits.

That is why I tell patients who are diagnosed with cancer that they should ask a lot of questions of their physician, such as:

  • What treatment or treatments will work best for me? What is involved with each?
  • How long will I need treatment?
  • What is my outlook?
  • What problems or side effects could I have? How will they be managed?
  • Should I consider participating in a clinical trial? If so, can you recommend one?
  • Could I benefit from a second opinion? If so, will you recommend another physician to get one from?
  • How often should I see you for follow-up appointments?

Treatment options

Even if the malignancy has spread to a person’s liver, the tumor is still made up of colon cancer cells. For that reason, your doctor will treat it like colon cancer, not liver cancer.

You may get one or more types of treatment. While the mainstay of treatment is chemotherapy, the only potential curative option for colon cancer that has spread to the liver is surgery, when possible.

Thanks to medical advances, there are numerous options for treating liver metastases either alone or in combination.

The innovative techniques described below allow surgeons to remove or “resect” multiple tumors in both lobes of the liver based on the liver’s ability to regenerate. The liver is a unique organ in that it can regrow after surgery, a property called “hypertrophy.” Surgeons can safely remove up to 80 percent of the liver and expect full regeneration in six to eight weeks as long as a patient doesn’t have substantial underlying liver disease, such as cirrhosis or chemotherapy-related liver injury. This is why it’s important to see both a surgical – and medical – oncologist prior to starting any therapy.

  • Parenchymal-sparing surgery – This surgical approach includes resection of individual liver segments (there are eight) performed alone or in combination with ablative therapies, where heat is used to destroy a tumor. Advantages of this strategy include removing less normal liver, which results in a quicker recovery and better chances for future resections, if necessary.
  • Portal vein embolization – This procedure induces regrowth on one side of the liver in advance of a planned resection on the other side. To be suitable, a patient must have enough functional liver remaining after the operation. However, the body requires that a minimum amount of liver remain (liver reserve) to support regrowth. If the liver reserve can’t support regrowth, surgeons may use portal vein embolization to jump start growth before surgery.
  • Two-stage hepatectomy – In this approach, tumors on one side of the liver are removed followed by tumors on the other side after a period of liver regeneration, which is usually on the heels of a portal vein embolization.
  • Microwave or radiofrequency ablation – In this approach, microwaves or an electric current are transmitted into the tumor through a thin needle or probe to heat and destroy liver tumors without removing them. It is used in patients with a few small tumors when surgery isn’t a good option.
  • Laparoscopic hepatectomy – This approach, which is a viable alternative to traditional resection, uses a laparoscope – a viewing tube with a small camera – to perform minimally invasive surgery through small incisions. Advantages can include less surgical stress, early discharge from the hospital, and rapid return to a normal diet and activity.

Other non-surgical treatments include:

  • Chemotherapy
  • Radiation (e.g., external beam radiation, radioembolization and brachytherapy)
  • Targeted therapies, also called “biologics”
  • Immunotherapy (prevention or treatment of disease with substances that stimulate immune response)

Perspective and promise

It is important to remember that every patient’s case is unique. Although these treatments may not cure your cancer, the goal is to help you live a longer, better life.

Researchers around the world are also involved in clinical trials looking for new, innovative ways to treat colon cancer that has spread. These trials test new drugs to see if they’re safe and effective. Clinical trials are often a good way for people to try new medicine that isn’t available to everyone. Your doctor can tell you if one of these research opportunities might be a good fit.

Taking care of yourself

Cancer patients go through a lot when battling a malignancy. During treatment, it’s especially important to rest, exercise, manage stress and eat well. During this trying time, it’s also important to get emotional support. Family, friends, social workers and therapists can be invaluable.

Hope

Treatments for colon cancer that has spread to the liver have greatly improved over the last quarter century. I encourage all my patients to take solace in the fact that people with this cancer are surviving longer than ever.


Dr. Flavio RochaA version of this article originally appeared in Seattle’s LocalHealthGuide. Flavio G. Rocha, MD, has advanced training in surgical oncology and specializes in liver, biliary tract and pancreatic cancer. He is director of research in the Digestive Disease Institute at Virginia Mason and an affiliate investigator at Benaroya Research Institute. Dr. Rocha practices at Virginia Mason Hospital and Seattle Medical Center (206-341-1904).

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

%d bloggers like this: