Sunday, March 3, 2024

Colon Cancer Spreads To Liver

Treating Colon Cancer That Has Spread To The Liver: A Team Approach

Mayo Clinic Minute: When colon cancer spreads to the liver

Reviewed By:

Adrian Gerard Murphy, M.B. B.C.H. B.A.O., M.B.B.Ch., Ph.D.

If you or a loved one has a colon cancer diagnosis, there is also the chance that the cancer will spread to other organs, most commonly the liver. However, according to Dr. Richard Burkhart, a Johns Hopkins cancer surgeon and researcher, advancements in the treatment of liver tumors caused by colon cancer have improved survival rates drastically. In fact, 40-60 percent of patients treated for isolated colon cancer liver metastasis are still alive five years after treatment.

At Johns Hopkins, researchers such as Dr. Burkhart are conducting clinical trials to find ways to slow or prevent the spread of colon cancer. These trials, coupled with a multidisciplinary, or team, approach using molecular testing, surgical techniques, chemotherapy and radiation, have greatly improved life expectancy for patients in the last 10 years.

What Happens When Colon Cancer Goes To The Liver

There are several ways in which colon cancer can spread to other parts of the body, including the liver. These secondary cases are called secondary liver cancer and affect as many as 70 percent of people with colorectal cancer. In this article, experts explain how to spot this condition and discuss treatments.

The primary test for diagnosis is a colonoscopy with biopsy, where a sample of tissue from the colon is taken and sent for laboratory analysis. This is important to confirm the diagnosis of cancer. Surgery may also be an option if the colon cancer has spread to the liver. In some cases, chemotherapy will also be used.

Depending on the size of the tumor, surgeons may decide on the best treatment for the patient. In some cases, patients may undergo a surgery as their first treatment. Other times, however, they may be required to have another type of treatment before surgery.

Treatment Of Liver Metastases

A total of 102 patients were referred to a liver MDT conference and 69 of the 272 patients were treated with curative intent. No patients treated outside of a liver MDT conference had a liver resection. Recurrence of liver metastases was diagnosed in 29 patients, corresponding to a recurrence rate of 42%. Of these, 11 patients were re-resected. Patients with metachronous detection of liver metastases were more likely to undergo an intervention with curative intent than patients with synchronously detected metastases and major resections were less likely to be performed in the latter group . Patients with liver metastatic left-sided cancer were more often resected, compared to patients with liver metastatic right-sided cancer . In a multivariate logistic regression, the probability of undergoing a liver resection was associated with age68 years , primary tumour-stage T-stage and number of liver metastases , while gender , nodal stage of the primary , synchronous versus metachronous detection and primary tumour origin were not. Thirty-nine patients in whom liver metastases were resected received pre-operative chemotherapy. There was no statistically significant difference in administration of palliative chemotherapy or best supportive care between synchronous or metachronous detected liver metastases . Of the 251 patients with extra-hepatic metastases, 30 were treated with curative intent .

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Colon Cancer Spread To Liver And Lungs Prognosis

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Where Does Colon Cancer Spread

Imaging and clinical features of colorectal liver metastases with ...

When you are diagnosed with colon cancer it means that you had abnormal cells invade your colon. The abnormal cells grow into colon polyps. Not all colon polyps are cancerous. Sometimes the polyps turn cancerous and can spread to surrounding tissues.

Colon cancer symptoms are often mild and can be missed early on in the disease. This means you may not notice any symptoms until the disease has progressed into advanced stages and spread beyond the colon. This is why it is important to get screened for colon cancer at each yearly physical after the age of 50. Once the disease has spread it may be harder to treat.

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Does Liver Cancer Progress Quickly

If colon cancer spreads to the liver, treatment options depend on the type of cancer and the location of the metastasis. Treatment may include surgery, chemotherapy, or radiation therapy. The aim of chemotherapy is to shrink the tumor before surgery and control the cancers growth. This method also decreases the risk of the cancer returning. It may be given intravenously or orally through a needle or pill. The dosage and frequency of chemotherapy will depend on the type of cancer.

In the case of colon cancer that spreads to the liver, the cancer cells are not liver cells, but instead come from another part of the body. Therefore, these cancers are classified as stage four cancer. Unlike colon cancer, liver cancer metastases are rare, but the condition is associated with risk factors. Early stages of liver metastases do not cause any symptoms, but as the tumor advances, liver swelling may occur.

It’s A Mystery Why Colon Cancer Cases Are Increasing For People Under 50

Dr. Nelson reveals, “We don’t know exactly why colorectal cancer is increasing in people under 50, but the usual suspects are typically blamed . This is why screening is now recommended at age 45 for those at average risk. It should be noted that left sided and rectal cancers are especially prominent in this group.” Dr. Wilkinson adds, “Although the jury is still out as to why exactly colon cancer rates are climbing in individuals under 50, many physicians point to the increase in the prevalence of unhealthy lifestyles as a major cause. Smoking, alcohol consumption, obesity, and highly processed diets are all contributing factors for increased colon cancer rates.”

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Biological Markers For Crlm

Based on current standard of care, KRAS and BRAF mutations are probably the most well studied in the context of CRC. KRAS mutant status has been associated with lower likelihood of having resectable CRLM. There is also higher risk of extrahepatic disease, adverse response to targeted anti-EGFR therapy as well as to oxaliplatin or irinotecan-based peri-operative chemotherapy . RAS mutation status has also been found to confer poorer survival for patients who underwent CRLM metastatectomy . Therefore, RAS mutation status is important in guiding decision-making before embarking on aggressive surgical therapies, e.g., 2-stage liver resections and those who are planning for liver resection after second-line chemotherapy . On the same note, BRAF mutation in CRC has been found to confer poorer survival and poorer response to biological therapies . The outcomes of patients with BRAF mutation status who underwent CRLM metastatectomy has also been shown to be poor .

Sufficient Future Liver Remnant & Quality Of The Liver Parenchyma

Treating Advanced Colon Cancer that has Spread to the Liver

It is imperative for the liver surgeon to study the images the liver scan to determine the location and size of the lesion with crucial surrounding structures. The relationship of the lesion to critical inflow pedicular structures such as bile duct, portal vein and hepatic artery as well as outflow structures such as hepatic veins has significant influence on how the surgery will be conducted.

Peripherally located tumours can be easily resected if the quality of the liver parenchyma allows so. In most circumstances, the liver parenchyma of patients with CRLM should be able to withstand liver resection, provided it is not exposed to excessive amount of systemic chemotherapy which may cause CALI liver as discussed above. Small wedge resection should be reasonably safe in most patients. If the tumours are located deep within the parenchyma of the liver and near to major hepatic veins, portal veins or biliary pedicles, major liver resection will be necessary in order to achieve R0 resection. In this circumstance, careful consideration must be given to the size of the FLR and the adequacy of liver function post resection. In most circumstances, up to 70% to 75% of non-cirrhotic liver could be resected as long as the remnant liver volume contributing to 25% to 30% of the total liver volume . The safety margin increases significantly in these patients with non-cirrhotic liver if a smaller resection is required.

Figure 4

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Tame Your Upset Stomach

A number of medicines can help with an upset stomach. Antiemetic drugs can ease nausea.

You may also want to:

  • Ask other people to make food for you, if cooking makes you queasy.
  • Avoid drinking a lot right before you eat.
  • Go with warm or cold foods, if smell is a trigger .
  • Eat small amounts, and chew your food well.
  • Stick with bland foods, like crackers or plain toast, when your symptoms are at their worst.
  • Take small sips of drinks, not big gulps.
  • Try foods and drinks with peppermint or ginger.

Treatment Of Unresectable Metastases

Isolated hepatic perfusion is an optional regional treatment that offers a highdose of chemotherapy, biological agents, and hyperthermia by means of a recirculationcircuit of vascular perfusion as treatment of hepatic metastasis. A study was conducted ofIHP with tumor necrosis factor plus Melphalan, or IHP with Melphalan alone, Floxuridine ininfusion, and Leucovorin in patients with advanced hepatic metas-tases from colorectalcancer that were unresectable or recurrent. It was concluded that IHP can be performedwith low morbidity and that it possesses great antitumor activity with clinical relevancein patients with hepatic metastasis from colorectal cancer that are unresectable orrecurrent.56 About 10 to 25% ofpatients with isolated metastases in the liver are candidates for resection due toanatomical limitations , inadequatefunctional-liver reserve, or comorbidities. The hepatic metastases of colorectal cancerare defined as resectable when it is anticipated that these can be completely resected,when there is adequate vascular flow , preserved bile drainage, andadequate hepatic volume. For cases that are unresectable, local therapy is the bestchoice due to that it increases the survival rate.57

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Role Of Circulating Tumor Cells In Crlm

Patient-derived CTCs has been shown to bear all the functional attributes of CSCs. The markers expressed by CTCs are similar to the cancer niche, which are conducive to liver metastasis., CD133+CD44+CD54+cellular subpopulation of CTCs has a prognostic value in CRLM, especially in the survival of CRLM who did not receive surgical treatment for metastasis. Patient-derived CTCs lines are tumorigenic in subcutaneous xenografts and are also able to colonize the liver after intrasplenic injection. Drug test by in vitro culture of CTCs may facilitate access to personalized medicine. TAMs regulated JAK2/STAT3 signaling pathway by secreting IL6, thereby inhibiting miR-506-3p expression and promoting FoxQ1 expression. CTC cells then produced CCL2 to recruit more TAMs. TAMs and CTC both interacted to promote the occurrence of metastasis. These findings suggest targeting strategies against CTC clusters may be effective in the treatment of liver metastases.

Why The Physical Exam Matters

Colorectal Cancer Metastasis Associated With Liver Metabolic Processes

It may not be high-tech, but a physical exam has a lot of value. Your doctor will feel for pain or bulges, check your skin, and ask about your symptoms.

That last part is important. Tell your doctor about any changes or new problems you’re seeing, even if they seem minor. It’s useful insight, but that’s not all. Certain issues could be emergencies, such as:

  • Severe jaundice, where your skin turns yellowish and itchy
  • Shortness of breath

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Get A Second Opinion For Liver Metastases

Even if you were not treated at Roswell Park initially, we can arrange for a consultation with our specialized team for liver metastases. Our experienced surgeons are dedicated to making patients disease-free to extend survival and provide the best chance to successfully control and cure the disease. This special expertise, formally offered in a surgical opinion, is especially important for patients who have been told their liver metastases are unresectable or cannot be effectively removed. For patients who truly cannot have their cancer resected, we offer innovative treatments and therapies that can improve outcomes and potentially convert tumors from unresectable to resectable status.

Treatments To Help If It Spreads

If colon cancer spreads, you and your doctor will come up with an aggressive treatment plan to try and stop cancer from spreading. The treatments go by Stage and include:

Stage 1 and 2 Treatments

If the cancer is still confined to just the colon, surgical intervention can usually prevent the spread of colon cancer.

Stage 3 Treatments

If the cancer begins to spread to the lymph nodes, any lymph nodes near the start of the cancer will be removed. If the cancer is found in distant lymph nodes near the liver or lungs, they will also be removed.

Stage 4 Treatments

Once colon cancer has invaded the liver, lungs, bones, and/or brain, the treatment plan will be to give both chemotherapy and radiation in cycles to kill off cancer cells. Radiation may also be given early in Stage 1 or 2 to prevent the spread.

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Your Liver Can Usually Keep Doing Its Job

The liver is a key organ in your body with functions like storing nutrients, filtering waste from the blood, and more. But thankfully, cancer may not prevent your liver from keeping up its duties: The liver is a large organ, and it can function with a lot of disease, says Dr. Abrams. That said, if the cancer gets bad enough in the liver, it can affect functionbut this isnt the case for most people, says Dr. Polite. Amazingly, the liver cells that arent involved tumor can do a remarkable job, he says.

Metabolic Factors In Crlm

Colon Cancer Liver Metastasis

Tumors are also a metabolic disease, and metabolic changes are closely related to every process of tumor metastasis. The process of transfer requires a large amount of energy supply, and some enzymes and molecules that affect energy metabolism also act as gas stations in the process of transfer. In the extracellular space, creatine kinase brain used ATP-catalyzed phosphorylation of the metabolite creatine to form phosphocreatine, which can produce large amounts of ATP into CRC cells as an energy reserve to maintain the energy requirements of CRC cells during anoxia during metastasis. CKB promoted the development of liver metastasis, and targeted inhibition of its activity was also the direction of future treatment of CRLM. In addition to phosphocreatine generating energy for cancer cells, the fatty acid oxidation pathway is also an important energy source within cancer cells. In detached CRC cells, under the action of carnitine palmitoyl transferase 1, FAO was greatly activated, thus increasing the ability of cells to metastasize. CRC cells implanted in the liver promoted the metabolism of fructose by upregulating enzyme aldolase B , which provided energy for cell growth in liver metastases. This particular metabolic pathway change was found only in liver metastases and not in other sites of metastasis or primary tumors. All in all, the metabolic pathways of tumors adapt to the environment during metastasis, and there are still many problems to be studied.

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Treating Stage Iii Colon Cancer

Stage III colon cancers have spread to nearby lymph nodes, but they have not yet spread to other parts of the body.

Surgery to remove the section of the colon with the cancer along with nearby lymph nodes, followed by adjuvant chemo is the standard treatment for this stage.

For chemo, either the FOLFOX or CapeOx regimens are used most often, but some patients may get 5-FU with leucovorin or capecitabine alone based on their age and health needs.

For some advanced colon cancers that cannot be removed completely by surgery, neoadjuvant chemotherapy given along with radiation might be recommended to shrink the cancer so it can be removed later with surgery. For some advanced cancers that have been removed by surgery, but were found to be attached to a nearby organ or have positive margins , adjuvant radiation might be recommended. Radiation therapy and/or chemo may be options for people who arent healthy enough for surgery.

Study Population And Data Collection

Ethical approval for the study was obtained from the Regional Ethical Review Board in Stockholm who also deemed the need for informed consent unnecessary according to national regulations. All patients diagnosed with CRC in the counties of Stockholm and Gotland, Sweden from January 1st 2008 to December 31st 2008 were identified using the Swedish National Quality Registry for Colorectal Cancer Treatment . The register has a validated coverage of over 99% . In the region, CRC is treated at 9 hospitals. Data on pre-therapy CRC staging, time and type of surgery and histopathology staging were retrieved from the registry. Patients that during the course of follow-up developed any metastases were identified by reviewing the clinical records of all patients for at least five years after time of diagnosis of the primary tumour, or until time of death. Date of diagnosis and distribution of metastases were recorded in detail. It was also noted whether patients with CRCLM were assessed by a liver multidisciplinary team , and surgical and oncological treatment were documented in detail.

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How Imaging Comes Into Play

Your doctors use images taken at different times to look for changes in the size, shape, and other features of tumors. They also want to see if any new ones have shown up.

CT scans tend to be used most often because you can get images of the belly, chest, and pelvis all in one shot. Typically, you’ll take a contrast dye, either by mouth or IV, to get clearer results.

Your doctor might use an MRI to plan surgery or to find out for sure if a growth is cancer or not.

Doctors sometimes use PET scans as well. In some cases, they can show more clearly how treatment affects a tumor.

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