If your large intestinal cancer has spread to the Liver

Spread of large intestinal cancer, medically known as "colorectal cancer" to the liver was once considered incurable disease. I still remember the tumour board meetings and my own early experience with the disease, that most of these patients were given only palliative treatments.16 years later, we have a better understanding of the disease and we now know that patients with liver metastases can be potentially cured.

The spread of cancer to the liver would require a specialist surgical gastroenterologist to examine the two different treatment pathways that you should be offered. Today, I am discussing the options available after you have been treated for the large intestinal cancer and the doctor has discovered that you have a liver tumour during the follow up.

Colorectal liver metastases being exposed during the surgical operation.
The most important message from the last decade is that cure is a possibility.

This type of cancer spread after the primary cancer in the intestine is removed is called a "metachronous lesion". 

Once a lesion has been discovered, we aim to subgroup the patients into "patients who will have surgical treatment first" or "patients who will have cancer medical treatment first". This is done by studying the CT scan images of the patient. We have adopted the San Francisco consensus guidelines in our unit for treating such patients. 

On the CT scan, we look for involvement of the blood supply to the liver, the number of the liver parts (segments) involved and the percentage of liver involved by the cancer. Using this information, we segregate the patients who should be treated by medicine first before the surgery and those who can have the surgery first. 

The most important understanding one should have is that most of the patients could be offered some form of treatment. The patients who cannot have the treatment are mostly in poor general health (cannot even take care of their own needs), patients with disease in the lining of the abdominal cavity (peritoneal disease) and spread of the cancer to other parts of the body.

If you have the opportunity to have your disease surgically removed, you can have the entire cancer removed even by multiple surgeries. Cancers that come back after resection can be removed by surgery again and still have the same hope of survival. This is the best treatment you can receive for your cancer. Your doctor will help you in making this decision. It would be your decision to keep pushing the boundaries so that the option of surgical removal always remains open.

If you have the misfortune of having a lesion that is inoperable, do not lose hope. We give 3 cycles of very effective cancer medicines called FOLFOX of FOLFIRI or FOLFOXIRI with or without adding bevacizumab. These medicines can reduce the size of the tumour to the extent that surgical removal of the cancer is possible. It is true that these medicines have side effects, but remember that side effects indicate that the medicine is having an effect too. The side effects can be managed by good supportive care. So there is little for you to worry.

When we planned our HOPE protocols (HOPE stands for Hepatic Oncology ProgrammE), we aimed to provide the needed services under one point of contact, so that the patients do not have to go from place to place. What would make us very happy is to see each one of you, who have been robbed of hope, smiling and hopeful on your way home, successfully treated and "cured" from your liver metastases.

This is happiness for us, indeed.