Metastasis means that the cancer has spread beyond the rectum to other parts of the body. This is often referred to as advanced rectal cancer.
Your treatment options will depend on several factors, including the extent of the cancer and where it has spread. Colorectal cancer usually spreads to the liver. It can also spread to the lungs, the lining of the abdomen, the ovaries, the brain, and other organs.
Recent advances in treatment have improved the outlook for people with metastatic rectal cancer, including stage IV cancer.
Treatment Options for Metastatic Rectal Cancer
Rectal cancer that has spread to other organs often requires a combination of treatments. These may include:
- image-guided therapies, such as MRI and CT
- radiation therapy
- targeted therapies and immunotherapy
- clinical trials
Treatment Options for Rectal Cancer That Has Spread to the Liver
Rectal cancer most often spreads to the liver. This happens in part because the blood supply from the large intestine, which includes the rectum, is connected to the liver through a large blood vessel.
To treat rectal cancer that has spread to the liver, MSK specialists may use several options, often in combination. These include:
MSK surgeons can often remove tumors in both the rectum and the liver during the same procedure. This can reduce pain and shorten recovery time. Chemotherapy and radiation therapy are sometimes used to shrink tumors before surgery. MSK surgeons operate on several hundred people with liver metastasis each year.
Some people will need a colostomy. For this procedure, a surgeon cuts the rectum above the level of the cancer and attaches the end to a surgical opening in the belly. Waste is collected from this opening and stored in a bag attached to the skin.
Chemotherapy is often combined with surgery and other treatments. It can be done at various times during treatment:
- Neoadjuvant therapy is done before surgery to shrink tumors or stop their growth.
- Adjuvant therapy is done after surgery. It can help wipe out remaining cancer cells, lowering the risk of tumors coming back later.
- Hepatic arterial infusion (HAI) is a kind of chemotherapy that is given through an IV. HAI delivers chemotherapy drugs directly to the liver through a tiny pump that is implanted under the skin in the lower abdomen. HAI delivers treatment directly where a tumor is located.
Interventional radiology treatments, such as ablation, use several forms of highly focused energy to shrink or destroy tumors. This can be done before or after surgery, or in place of surgery if it’s not an option. These techniques are extremely precise. Sophisticated imaging tools, such as CT and PET/CT, allow specialists to see what is happening inside the body during treatment.
These techniques are sometimes combined with a procedure called embolization. This involves injecting tiny particles to block or reduce blood flow to cancer cells, cutting off their nourishment.
Targeted therapies attack specific genes and proteins in cancer cells.
- Some drugs target a protein called VEGF. This protein helps tumors form new blood vessels to get the nutrients they need to grow.;
- Other drugs target EGFR. This protein helps fuel the growth of cancer cells.
- A third drug type is known as a kinase inhibitor. It targets a protein that carries important signals to the cancer cell’s control center. Blocking this protein can help stop the growth of cancer cells.
Targeted therapies work for a relatively small number of people with colorectal cancer, depending on a variety of genetic factors.
Immunotherapy uses the body’s own immune system to attack cancer cells.
Checkpoint inhibitors are drugs that unleash the immune system’s powerful T cells to strike at the cancer. Some cancer cells make themselves invisible to the immune system by signaling that they are not harmful. Checkpoint inhibitors prevent this deception. These drugs allow T cells to see and attack a tumor.
Immunotherapy is an exciting new advance, but it helps only a small number of people with colorectal cancer with a specific genetic makeup.
As one of the premier cancer research institutions in the world, MSK may give you access to clinical trials testing new treatments that may not be found elsewhere. Talk to your care team to see if a clinical trial may be an option for you.