Liver Metastasis, Cancer Spread to the Liver
For colorectal cancer patients with liver metastasis (cancer that has spread to the liver), it’s important to remember it is treatable — and may even be potentially curable. There are many more treatment options available than even five years ago. If you’ve been told chemotherapy is your only treatment option, you should seek a second opinion.
Chemotherapy plays an important role in treating liver metastasis, but depending on your condition, surgery or interventional radiology may be more successful treatment options. It is also becoming standard for patients with advanced stage cancer to receive multi-modality therapy — combinations of systemic chemotherapy and interventional radiology techniques. Physicians in the Colorectal Cancer Program participate in clinical research related to this approach.
With the Colorectal Cancer Program at the Froedtert & the Medical College of Wisconsin Clinical Cancer Center, all the specialists you need are under one roof.
Treatment options for liver metastasis include the following.
The best, first option for treating liver metastasis is surgery, and that can be done either laparoscopically or through a traditional open method, depending on the location and extent of the tumor(s). The Colorectal Cancer Program includes highly skilled surgeons with specialized experience in liver surgery. Our interdisciplinary setting is key, because doctors from several specialties work together to determine the best treatment plan for each patient.
Each patient is considered on an individual basis and many factors determine whether surgery is a viable option. A patient’s overall health, other medical conditions, the extent of the tumors, and the general health of the liver are among factors taken into account. For certain patients who need bowel and liver surgery, we have experienced surgeons to perform those operations at the same time, eliminating multiple surgeries for those eligible patients.
Surgical Procedure for Liver Metastasis
Common surgical procedures include:
- Segmentectomy — removal of a defined segment of the liver
- Lobectomy — removal of a lobe of the liver
- Trisegmentectomy — an extensive surgery that can remove up to 80 percent of liver tissue
Isolated liver perfusion is another, less common surgical technique available at Froedtert & the Medical College of Wisconsin. In the operating room, the liver’s blood supply is isolated from the rest of the body and high doses of chemotherapy are delivered directly into the liver for a period of time.
Vascular and Interventional Radiology Treatments
If the cancer cannot be removed surgically, vascular and interventional radiology offers several treatment options. Our physicians work together to determine the best course of treatment, including a consideration of a patient’s quality of life goals. Ablation techniques can be done through open or laparoscopic approaches, or they can be performed percutaneously (through the skin). They can also be done in an effort to shrink tumors before surgery or in combination with other surgical therapies.
While every patient does not need every one of these treatment options, having them all here in one program gives us the ability to personalize each patient’s treatment based on individual needs.
- Radiofrequency Ablation — a procedure that uses heat to destroy a tumor. A needle electrode is placed in the tumor under the guidance of imaging such as ultrasound or computed tomography (CT). A radiofrequency current is passed through the electrode to heat the tumor tissue near the needle tip and ablate or destroy it.
- Microwave Ablation — a procedure similar to radiofrequency ablation, except that the energy deposited has the ability to reach higher temperatures. This procedure is still being studied but it can be used in more challenging cases where bigger ablation zones are needed.
- Cryoablation — a procedure that kills a tumor by freezing it. A metal tube is placed into the tumor while the physician watches the process with ultrasound. The tube is cooled to -190° C (-360° F) and an ice ball engulfs the tumor, resulting in the death of the tumor cells.
- Chemoembolization — a method of delivering chemotherapy directly into a tumor. A catheter is placed in a groin artery and guided into the artery that supplies blood to the tumor. A potent dose of a chemotherapy drug is infused through the catheter to the tumor, and the artery section is plugged to stop further blood flow to the area.
- TheraSphere® embolization — a procedure commonly used to treat primary liver cancer in which microscopic glass beads containing radioactive material are delivered via catheter directly into the blood that supplies the tumor. This allows delivery of a much higher dose of radiation in a single administration, with minimal effect to the healthy tissue surrounding the tumor. Froedtert & the Medical College are one of only about 30 hospitals in the United States using TheraSphere therapy.
- SIR-Spheres® embolization — a procedure approved for treating colorectal cancer that has spread to the liver. Microspheres, or tiny polymer beads that are loaded with a radioisotope, are injected into the liver tumors, and do not affect other organs in the body. These microspheres continuously deliver radiation for approximately two weeks.
Very focused radiation can be used to treat liver metastases in select patients with colorectal cancer. This is sometimes an option for patients with a small number of lesions near the central blood vessels in the liver. It can also be used for patients who are not candidates for or who have failed surgery or interventional radiology procedures. Image guidance is needed to accurately define and deliver radiation on a daily basis.
Accounting for movement of the liver due to breathing is also an important part of this approach and requires special techniques called gaiting where radiation is only delivered during certain parts of the respiratory cycle.
In addition to chemoembolization, described above, chemotherapy may be given as a follow up treatment in certain circumstances to be sure any microscopic disease has been treated. Targeted agents are also available that target a specific growth factor or receptor in the tumor cells. These agents are usually used in combination with chemotherapy to help stop the cancer cells from growing or spreading.
Angiogenesis inhibitors, which block the formation of new blood vessels, have been approved to use against colorectal cancer that has spread to other parts of the body.
Anti-EGFR agents (epidermal growth factor receptor) help stop the tumor cells from growing. Physicians also must test for a specific gene mutation called KRAS in the cancer before using an anti-EGFR agent. If the patient has the KRAS gene mutation, he or she is not likely to respond to the anti-EGFR agent. And if doctors know in advance that a patient won’t respond, they can avoid using an ineffective therapy that may cause toxicity. That means we can further personalize a patient’s treatment to get the best possible outcome.