Colon Cancer, Liver and You

You may well wonder “What has the liver got to do with colon cancer?”. The simple answer is - quite a bit! It is estimated that 50% of patients who have colon cancer will develop colon cancer in their liver. This happens because the colon cancer cells have migrated from their original site to the liver. In order for the blood within the colon to return to the heart for re-circulation, the blood has to go through the liver to reach the heart. Therefore, any colon cancer cells in the blood will get trapped in the liver first. With time, these cancer cells can grow into visible cancers in the liver.

These colon cancers in the liver are called metastases. Some patients with colon cancer can have liver metastases at the same time as when they are diagnosed with colon cancer. In others, the liver metastases can develop months or years after the initial colon surgery.

Symptoms

Liver metastases in general do not give rise to any specific symptoms. Quite often the liver metastases are only diagnosed when the tumour marker level in your blood is found to be abnormally raised or a follow up scan of your abdomen shows tumour(s) in the liver. Some of the symptoms include weight loss, tiredness, feeling of fullness in the stomach, discomfort in the upper abdomen, palpable lump in the upper abdomen and increasing size of the abdomen.

Diagnosis

The diagnosis is made by the detection of an abnormally raised level of the tumour marker, carcino-embryonic antigen (CEA). It is important to remember that not all patients with colon cancer and /or colon liver metastases will have an abnormally elevated CEA level. About 20% of patients can have a normal CEA level despite the presence of colon cancer. A CT scan of the abdomen will show the presence of tumour(s) in the liver. Normally, when liver metastases are detected, the doctor will also scan other parts of the body, such as the lungs, to make sure that the cancer has not spread beyond the liver.

Treatment

The best treatment for patients with colon liver metastases requires a team approach involving a medical oncologist and a liver surgeon. Depending on the number and position of the cancerous deposits in the liver, immediate liver operation to completely remove the cancer may be the best treatment. A complete removal of the liver metastases is the best chance to cure. Although a liver operation is a very major operation, it can be safely performed by an appropriately trained liver surgeon. The average hospital stay for a patient who is undergoing a liver operation is 7 days.

If immediate liver surgery cannot be performed, then chemotherapy will be the main form of treatment. The chemotherapy is given to control the cancer. If the cancer responds well and reduces in size and /or number, it may be possible to perform a liver operation to remove the visible metastases in the liver. Sometimes the liver surgeon may recommend local destruction of the liver metastases by ‘cooking’ it with a special needle. This heating treatment is sometimes performed under X-ray guidance and sometimes is performed in the operating room.

Comments

Patients with colon liver metastases are said to have stage IV disease. Having stage IV disease does not mean that there is no chance to cure. Over the last 10 years, the ways of treating patients with stage IV disease have changed a lot. Consequently, the outlook for these patients has improved. To achieve a very good clinical outcome requires the medical oncologist and the liver surgeon to work closely together. As a successful operation has the potential to prolong life and possibly cure, the liver surgeon can advise when is the optimal time to perform the liver operation. If a liver operation is not possible, the liver surgeon can also advise on the optimal time to perform the local destruction treatment in order to give the best control.