Treating colon cancer that has spread to the liver

May 7, 2017 | By | Reply More

Peter Vredenburgh and his son, Joshua, were both diagnosed with colon cancer the same year.

Multiple Treatments Now Available for Colon Cancer that Spreads to the Liver

By Flavio G. Rocha, MD
Virginia Mason Hospital & Seattle Medical Center

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.

Colon cancer can spread to the lymph nodes and other tissues and organs, including the liver. (Cancer Research UK)

If caught early, this cancer can often be easily cured with surgery. However, when the cancer has spread–or metastasized–to other other tissues it becomes much more difficult to treat. That is why being screened for colon cancer is so important.

One of the organs that colon cancer commonly metastasizes to is the liver. In recent years, researchers have developed new ways to treat metastatic colon cancer in the liver, taking advantage of this organs unusual property — the ability to regenerate.

An Alaska family’s story

Despite having had a screening colonoscopy at age 50 that showed nothing suspicious, Fairbanks, Alaska resident Peter Vredenburgh had a bowel obstruction in 2014 at age 58. The condition was diagnosed as colon cancer, which required urgent surgery. In September of that year, he was referred to Virginia Mason in Seattle after being told it had spread to his liver.

A team of specialists at Virginia Mason felt Vredenburgh’s best chance was to have surgery to remove a large part of his liver containing the cancer. But in order for this strategy to work, a large enough portion of liver would have remain for the organ to regenerate after surgery.

To ensure Vredenburgh would have sufficient liver tissue remaining after surgery, the Virginia Mason team used a technique called portal vein embolization that stimulates liver growth.

When his physicians were sure the procedure had created sufficient liver reserve to allow for the surgery, they removed the right lobe of liver that contained the cancer.

Despite the operation, Vredenburgh’s cancer recurred so he continues to receive chemotherapy periodically. But three years later, there are no signs his cancer is progressing.

Unfortunately, colon cancer may run in the family. Josh Vredenburgh, Peter’s 29-year-old son, was also diagnosed with colon cancer that had spread to his liver the same year Peter was diagnosed. Josh has also undergone treatment and is, fortunately, cancer-free.

Although genetic testing found no connection between their two cases, Vrendenburgh’s 29-year-old daughter is likely to be at higher risk and plans to have a screening colonoscopy every five years.

Due to his and his son’s experiences, Vredenburgh has worked to make people more aware of colon cancer and the importance of getting screened.

Symptoms of colon cancer

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 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 try and learn if colon cancer has spread to your liver, your doctor may ask:

  • When were you diagnosed with colon cancer?
  • What treatments have you had?
  • What are your symptoms?

Your doctor may also order blood tests to check liver function.

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 that were traditionally thought to be unmovable by relying on the fact that the liver can 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 from surgery 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 remaining liver reserve (liver remnant) can’t support liver regeneration, surgeons may use portal vein embolization to jump start regrowth of the liver remnant 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.

Flavio G. Rocha, MD, has advanced training in surgical oncology and specializes in liver, biliary tract and pancreatic cancer. His medical interests include liver, pancreatic and biliary tract disease, gastrointestinal cancer and minimally invasive surgery. 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).

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Category: Cancer, Colon Cancer, Surgery, Uncategorized, Veterans Affairs

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