Referring Physicians >> Newsletters >> September 2012 Liver Newsletter >> Metastatic Colon Cancer to the Liver: What to Look for and What's on the Horizon
Colorectal cancer is the third most commonly diagnosed cancer. There are one million new cases of colorectal cancer annually in both males and females worldwide.1 Approximately 50% of patients diagnosed with colorectal cancer will develop liver metastases over the course of their disease.2 Colorectal liver metastasis is Stage IV cancer that did not start in the liver, but instead spread over time from the colon or rectum.
Symptoms of Colon Cancer
In the early stages, there are no symptoms for colorectal cancer which can lead to colorectal liver metastases. It is typical in patients with colorectal liver metastases to exhibit no symptoms at all. This is why regular screening with colonoscopy is so important. However, symptoms of colon cancer can appear over time and may include:
Diagnosis of Liver Metastases
Screening during routine examination following previous surgery for colorectal cancer is often how colorectal liver metastases are found. A typical work-up can include:
New Advances and Treatment Techniques
The management of colorectal liver metastases has evolved over the past few years. Various forms of liver-directed therapy ranging from operative resection to ablation to trans-arterial therapies are applied depending on the extent of liver involvement and the underlying condition of the liver.
Traditional resection is often performed; however, new surgical techniques and innovative treatments for liver tumors, such as radiofrequency or microwave ablation, portal vein embolization, chemoembolization and endoscopic retrograde cholangiopancreatography are on the rise.
Portal vein embolization (PVE)
PVE works by blocking or embolizing the portal venous flow to the diseased segment of the liver and redirecting flow to the part of the liver that is expected to remain after surgery. This blockage stimulates hypertrophy (growth) of the non-embolized healthy liver segment and causes the embolized diseased portion of the liver to shrink. This aids in removal of the maximum amount of disease from the liver during surgery by improving the size and function of the remnant liver.
This procedure can increase a patient’s chances of being candidates for surgical removal of liver cancer and is usually done as an overnight admission.
A liver tumor ablation attempts to eliminate the liver tumor by killing the tumor cells without removing any of the liver. This can be done with a variety of techniques, most of which involve heat.
Descriptions of this technique are called:
This procedure can be performed percutaneously (using guidance from imaging alone, typically CT), laparoscopically, or open depending on the specifics of the case.
Newer transarterial therapies such as chemoembolization, transarterial embolization and radioembolization are also available for patients with colorectal liver metastases that are not resectable.
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1. Parkin D M, Bray F, Ferlay J, Pisani P. Global cancer statistics, 2002. CA Cancer J Clin. 2005;55(2):74–108.