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Bowel cancer that has spread only to the liver, and sometimes only to the lung, is one of the few forms of secondary cancer treated with the aim of cure. If the deposits can be removed or destroyed, with chemotherapy before and after, a substantial minority of people are alive five years later.
Why it is treated differently. The liver is the first place colorectal cancer spreads, through the portal vein, and disease confined to it is not biologically the same as disease scattered through several organs. NICE NG151 asks a multidisciplinary team with expertise in resecting disease at all involved sites to consider resection, either at the same operation as the primary or sequentially (1.5.15), to consider perioperative systemic anticancer therapy when resection is suitable (1.5.16), and to consider chemotherapy with local ablative techniques when resection is not (1.5.17). Selective internal radiation therapy is not offered first line for liver metastases unsuitable for local treatment (1.5.18). Lung metastases suitable for local treatment are handled the same way, with metastasectomy, ablation or stereotactic body radiotherapy after discussion by a team including a thoracic surgeon (1.5.19).
What the numbers are. In EORTC 40983, 364 patients with up to four resectable liver metastases were randomised to six cycles of FOLFOX4 before and six after surgery or to surgery alone; three-year progression-free survival rose by 7.3 percentage points in all randomised patients, 8.1 in eligible patients and 9.2 in those who actually had a resection (from 33.2 to 42.4 percent, hazard ratio 0.73), with more reversible postoperative complications after chemotherapy (25 against 16 percent) (Nordlinger 2008). In England, among people whose colorectal liver metastases could be operated on, around 45 percent survived five years or more after the operation, a figure that includes deaths from other causes (Morris 2010, quoted by Cancer Research UK).
What it means for a patient. The first question after a liver-only diagnosis is not which chemotherapy but whether a liver surgeon has seen the scan, because operability is a judgement made by a specialist team and can change after treatment. Where the disease is not removable at first, the aim becomes conversion, which has its own term.
Showing the technology this term belongs to: Thermal ablation (RFA, microwave, cryo).
Shares Peritoneal metastases from bowel cancer, CT (computed tomography), Colon cancer (adenocarcinoma of the colon), Rectal cancer and the tags gi, colorectal.
Shares Peritoneal metastases from bowel cancer, Colon cancer (adenocarcinoma of the colon), Rectal cancer, Colorectal cancer and the tags gi, colorectal.
Shares Sidedness (left vs right colon), Colon cancer (adenocarcinoma of the colon), Rectal cancer, Colorectal cancer and the tags gi, colorectal.
Shares Sidedness (left vs right colon), Colon cancer (adenocarcinoma of the colon), Rectal cancer, Colorectal cancer and the tags gi, colorectal.
Shares MRI, Colon cancer (adenocarcinoma of the colon), Rectal cancer, Colorectal cancer and the tags gi, colorectal.
Shares Sidedness (left vs right colon), Colon cancer (adenocarcinoma of the colon), Rectal cancer, Colorectal cancer and the tags gi, colorectal.
Shares Colon cancer (adenocarcinoma of the colon), Rectal cancer, Colorectal cancer and the tags gi, colorectal.
Shares Colon cancer (adenocarcinoma of the colon), Rectal cancer, Colorectal cancer and the tags gi, colorectal.