For those with colorectal cancer, liver metastasis — or the spread of cancerous cells from the colon to the liver — is a dangerous threat. In fact, almost 25 percent of patients with colon or rectal cancer present with liver metastases at the time of their initial diagnosis, and 50 percent of colorectal patients are likely to develop the issue down the line.
Fortunately, although the risk factor is high, the past fifteen years have seen significant improvement in methods for removing liver metastases. Ongoing research on effective treatment has led to safer, more efficient procedures with better survival rates, and doctors continue to progress in finding more reliable medical solutions. Here is a look at recent advances in treatment for colorectal liver metastases.
Resection: Removing the Liver Tumor
The best way to fight metastases, eliminate cancer from the liver and prevent future recurrence is to remove the tumor or tumors in a surgical procedure called resection. Partial hepatectomies are resections to remove a single, non-developed tumor, while more complicated, invasive hepatectomies are necessary to get rid of multiple tumors or those that have invaded larger liver sections. In cases where metastases growth is excessive and present on both lobes of the liver, surgeons may even perform two-stage hepatectomies.
Surgical removal is the only curative treatment for liver metastases, promising average survival rates of five years and beyond, but due to individual circumstances, only about 15 percent of patients are candidates for resection.
In order to be eligible for resection, colorectal patients must have the capacity to retain 20 percent of their healthy liver volume after the potential removal of their tumor. Even so, surgeons often prefer to leave a higher percentage of future liver remnant (FLR) for safety purposes. To determine surgical candidacy, doctors calculate patient body mass against liver volume, remnant liver volume and tumor volume. If the tumor makes up too large a percentage of the liver, the patient cannot safely undergo resection.
In order to increase patient candidacy for resection, doctors may treat liver metastases in a few ways. To decrease the size of the tumors and make removal in the realm of possibility, chemotherapy may be necessary. Incorporating risk factors, surgical compatibility, duration of treatment and potential outcome based on therapy type, doctors will plan an individualized chemo regimen for the patient.
The most current treatments for colorectal liver metastases are neoadjuvant chemotherapies with FOLFOX or FOLFIRI components. After two to four rounds of chemo, it should be apparent whether surgery is possible, and resection can take place after five weeks.
Portal vein embolization is another preoperative procedure that increases the FLR to make resection possible. By safely blocking blood flow one on side of the liver, this method encourages tissue regrowth on the other side. Several weeks of embolization will result in a liver volume large enough to allow tumor removal with a safe percentage of remaining liver.
Learn More About Colorectal Liver Metastases
For more information on colorectal liver metastases and the best treatment options for you, reach out to our compassionate, multidisciplinary liver specialists. We’ll be able to assess your situation and provide you with the best care possible. Contact Dr. Fraiman today to get started.