Colorectal Cancer: Treatment for Metastases

Pictured: Charbel Ishak, Constantinos Sofocleous & Jana Auguste An expert in interventional radiology, Constantinos Sofocleous (center) uses sophisticated and minimally invasive image-guided therapies to target tumors that have spread (metastasized). Looking on: Surgery fellow Charbel Ishak (left) and angiography technician Jana Auguste.

Metastasis — the spread of cancer cells to other organs — is common in patients with advanced colon and rectal cancer. Although colon cancer usually spreads to the liver and rectal cancer more often to the lungs, either type of cancer can spread to either (or even both) organs. Liver metastasis is far more common. Approximately 60 to 70 percent of people who experience a recurrence after surgery for primary colorectal cancer develop a tumor in the liver. The liver is the only site of metastasis in up to 35 percent of patients with metastatic colorectal cancer.1

To treat metastases, Memorial Sloan Kettering physicians use a variety of treatment approaches, including surgery, image-guided therapies, chemotherapy, biologic therapies, and radiation therapy.

Learn more about Memorial Sloan Kettering’s approach to treatment for liver metastases.

Surgery

Surgery — often in combination with chemotherapy — is the most effective treatment for patients with colorectal cancer liver metastases that are limited in size and number. Our doctors have developed and refined several techniques to improve the safety and effectiveness of surgery to remove such metastases.

When possible, our surgeons remove primary colorectal tumors and liver metastases during the same operation, rather than during two separate procedures. In addition, Memorial Sloan Kettering surgeons often use minimally invasive laparoscopic surgery to remove liver tumors. Minimally invasive surgery can significantly reduce the risk of complications and the time it takes you to recover.

Image-Guided Therapies

Surgical removal of metastases is not possible for all patients, particularly if your cancer is more advanced. When this is the case, specially trained doctors called interventional radiologists can perform image-guided, minimally invasive procedures to treat metastases.

Image-guided therapies involve the use of advanced imaging technologies to guide the delivery of treatments directly to the tumor site. Although these techniques cannot cure cancer, they offer an effective way to control it. In addition, image-guided therapies can be used to enhance the effectiveness of other treatments, such as surgery.

Chemotherapy

In recent years, more-effective chemotherapy drugs such as oxaliplatin and irinotecan have contributed to significant improvements in survival for patients with liver metastases.

Medical oncologists at Memorial Sloan Kettering use chemotherapy to reduce the risk of tumor recurrence following surgery for metastases (adjuvant therapy) and also to help shrink tumors prior to surgery (neoadjuvant therapy). Chemotherapy can be delivered systemically (throughout the entire body) through intravenous infusion or directly to the affected region with a procedure called hepatic arterial infusion.

Doctors at Memorial Sloan Kettering routinely use chemotherapy before surgery in patients with colorectal liver metastases. As a result, many patients with tumors that were once considered inoperable may safely undergo surgery — increasing the chance of a cure. Studies have shown that nearly one-third of patients with “initially unresectable” colorectal liver metastases who undergo surgery following chemotherapy survive beyond five years.

Hepatic Arterial Infusion (HAI) Chemotherapy

Memorial Sloan Kettering has significant experience with the use of HAI chemotherapy. This chemotherapy technique delivers a high dose of chemotherapy drugs into the hepatic artery — the main source of blood and nutrients for liver tumors — through a tiny pump implanted under the skin in the lower abdomen. Additional chemotherapy medicine is injected into the pump, as needed, on an outpatient basis.

HAI chemotherapy may be given alone or in combination with systemic chemotherapy as adjuvant therapy or neoadjuvant therapy. Our doctors have found that HAI chemotherapy prolongs survival for some patients following surgery. In addition, because HAI chemotherapy is delivered regionally (only to the tumor site), it causes fewer toxic side effects and has been associated with better physical functioning than systemic chemotherapy.

In a number of patients who cannot have liver metastases removed because of their number, size, or location, HAI plus systemic therapy can reduce tumors so that resection can become possible.

Biologic Therapies

Unlike chemotherapy drugs, which kill both cancer cells and healthy cells, biologic therapy offers a targeted approach to fighting cancer. Biologic therapy may include antiangiogenesis drugs, which stop the growth of blood vessels that nourish tumors, and EGFR drugs, which block a protein that may contribute to the progression of colorectal cancer. These drugs are now used in combination with many chemotherapy drugs to improve the effectiveness of treatment.

1Actual 10-year survival after resection of colorectal liver metastases defines cure. Tomlinson JS, Jarnagin WR,  DeMatteo RP, Fong Y, Kornprat P, Gomen M, Kemeny N, Brennan MF, Blumgart LH, D'Angelica M. J Clin Oncol. 2007 Oct 10;25(29):4575-80. PMID: 17925551