When colorectal cancer spreads to a distant site in the body, it is called metastatic disease. These tumors or lesions in the new site — most commonly the liver, lungs or abdominal cavity — are called metastases.
About one in every four patients with colorectal cancer will already have metastases to their liver at the time of their initial diagnosis. And among those who don’t have metastases at diagnosis, about half will eventually develop them.
Patients with liver metastases can still be cured of their disease. Successful treatment demands specialized skills by surgeons with advanced training and focus in liver surgery and experienced medical oncology and interventional radiology teams working together. At Roswell Park, we do this every day.Boris Kuvshinoff, MD, MBA, FACS, Chief Medical Officer and surgical oncologist
We take a comprehensive approach to metastatic colorectal cancer, bringing in other Roswell Park specialists, such as our liver and lung surgeons and interventional radiologists, to offer advanced treatments that can improve survival and quality of life — and result in a cure.
Your treatment will depend on where the disease has metastasized, and whether these metastases can be completely removed with an operation. Also, since the cancer has spread beyond the main tumor, systemic therapies — including chemotherapy, immunotherapy and targeted therapies — are often beneficial. Your team will look closely at your tumor tissue and its genetic mutational analysis to ensure you receive those treatments most likely to help.
Treatment for Liver Metastases
The liver is the most common site for colorectal metastases. However, unlike many other metastatic cancers for which surgery is typically not an option, metastatic colorectal cancer often grows slowly enough and tends to stay confined to the liver so that an operation to remove the metastases can be beneficial — extending survival and potentially curing the disease. In addition to systemic therapies, treatment for liver metastases may include one or more of the following approaches:
- Liver surgery to remove the metastatic liver tumors offers patients the best chance at cure as long as enough healthy liver tissue is spared to regenerate. Our specialty hepatic surgeons are uniquely experienced with:
- Surgical techniques that spare as much liver as possible to increase the number of patients we can help with operations.
- Minimally invasive laparoscopic or robotic surgery that, when feasible, is likely to speed patient recovery.
- Intraoperative ablation (local destruction of the tumor without removal) to increase the number of tumors we can effectively treat.
- Incorporating presurgical techniques such as portal vein embolization prior to the operation, which causes the healthy part of the liver to grow larger, allowing for a safer liver surgery to remove the tumors.
Ablation therapy such as microwave ablation or radiofrequency ablation. Ablation procedures use a small probe inserted into the tumor that emits microwaves or radio waves that heat the tissue, killing cancer cells. Ablation procedures can treat multiple sites and can be used in conjunction with an operation, or in cases in which surgery is not an option. These are minimally invasive techniques, frequently performed as outpatient procedures.
Radioembolization (also called Selective Internal Radiation Therapy) places tiny radioactive spheres or beads (using the isotope yttrium-90) into the artery that supplies blood to the liver tumor. The beads both block (embolize) the blood flow to the tumors and deliver radiation directly into them. Radioembolization is an additional option for patients whose liver metastases are inoperable. Use of drug-eluting beads in place of the radioactive beads may offer another embolization option.
The Roswell Park Advantage — Combined Surgery
Patients should ask what the stage of their colorectal cancer is because up to 25% of patients with colorectal cancer already have metastases to the liver when they are first diagnosed with cancer. In many of these cases, our expert group of colorectal and liver surgeons can work together to remove all the cancer — the primary tumor and liver metastases — in a single operation. This option offers patients the benefit of avoiding a second operation, reducing their risk for complications and making their treatment time shorter.
Treatment for Abdominal Metastases
Colorectal cancer may also spread to the space in the abdominal cavity, metastasizing to abdominal organs or the peritoneum, a membrane that lines the abdomen. Treatment for these metastases may involve both systemic chemotherapy, surgery and/or:
- Cytoreductive Surgery/Hyperthermic Intraperitoneal Chemotherapy (CS/HIPEC). This highly specialized approach for abdominal metastases involves surgery to remove all visible tumor, a process called debulking. Then, the abdominal cavity is bathed with heated chemotherapy drugs to kill any remaining microscopic cancer cells. This is a very complex treatment that requires careful planning. However, it may be possible to combine with liver-directed therapy for some patients who have both liver and peritoneal metastases
Treatment for Lung Metastases
Compared with other metastases, lung metastases may also grow slow enough where surgical removal can provide benefit and even cure. Your colorectal team closely collaborates with our thoracic surgeons to plan treatment which may include:
- Video-assisted thoracoscopic surgery (VATS). This is a minimally invasive surgical approach that is used to remove metastases to the lungs, operating through two to four small incisions with the assistance of three-dimensional video guidance.
Stereotactic body radiation therapy (SBRT) is a radiotherapy approach in which radiation treatment is delivered in fewer, higher-intensity doses. SBRT uses advanced imaging with tumor tracking to target radiation for effective cancer control.
Get a Second Opinion for Liver Metastases
Even if you were not treated at Roswell Park initially, we can arrange for a consultation with our specialized team for liver metastases. Our experienced surgeons are dedicated to making patients disease-free to extend survival and provide the best chance to successfully control and cure the disease. This special expertise, formally offered in a surgical opinion, is especially important for patients who have been told their liver metastases are unresectable or cannot be effectively removed. For patients who truly cannot have their cancer resected, we offer innovative treatments and therapies that can improve outcomes and potentially convert tumors from unresectable to resectable status.