1 in 5 colorectal cancer patients has metastases in the liver at the time of diagnosis. This may cause patients to think that it is "too late" and that there is no chance of treatment. However, with personalised and disease-specific methods, full recovery can be achieved in about half of the patients.
The key to successful treatment is to treat both liver metastases and bowel cancer with the most appropriate methods. This increases the chances of long-term survival.
Factors affecting the choice of treatment:
Patient age and other health problems
Bowel cancer in the colon or rectum
Stage of bowel cancer (spread outside the bowel)
Number and size of liver metastases
Before starting treatment, imaging methods are used to assess whether liver metastases are suitable for surgery.
Surgical Treatment Options in Liver Metastases
Surgery plays an important role in the treatment of metastases in the liver. In the surgical method called metastezectomy, only metastatic masses are removed, provided that tumour-free tissue borders are preserved. This method is usually suitable for metastases on the surface of the liver, which are easy to remove.
In some cases, it may be necessary to remove a lobe or the entire liver. Right hepatectomy involves the removal of the right lobe of the liver and left hepatectomy involves the removal of the left lobe.
These surgical methods can be applied in the following cases:
Multiple metastases in one lobe
Metastases located deep in one lobe of the liver and close to the vessels
Presence of large metastases in one lobe of the liver
After liver resection to remove all metastases, 30% of the remaining liver tissue is acceptable for a healthy adult. These surgical methods are called extended right or left hepatectomy.
In the selection of surgical treatment:
Such factors are taken into consideration;
General health status of the patient
Functions of the liver
Number, size and location of metastases
Patient age
In the postoperative period:
Necessary follow-up and treatments are applied for the patient to recover.
Additional treatments such as chemotherapy and radiotherapy may also be required.
The success rate of surgical treatment in liver metastases:
Depends on factors such as;
General health status of the patient
Number, size and location of metastases
Applied treatment methods
Treatment of Colon Cancer and Resectable Liver Metastases
The most appropriate treatment for patients with colon cancer and resectable liver metastases is determined by the individual characteristics of the patient and the stage of the disease.
Optimal treatment methods for the most common conditions:
If the colon tumour is obstructive:
Firstly, colon cancer surgery is performed.
In patients without intestinal obstruction and with large and multiple metastases in the liver:
Treatment starts with chemotherapy.
After the metastases are reduced with chemotherapy, simultaneous liver and colon surgery can be performed.
Patients with single and small metastases in the liver:
Simultaneous colon and liver surgery can be performed.
Patients with serious co-morbidities:
Colon surgery can be performed first and liver surgery can be performed 4 weeks later to reduce the risk of surgical complications.
Surgical methods used in the treatment of resectable metastases in the liver:
Metastezectomy: Removal of metastatic masses only
Hepatectomy: Removal of one lobe or all of the liver
In the postoperative period:
Necessary follow-up and treatments are applied for the patient to recover.
Additional treatments such as chemotherapy and radiotherapy may also be required.
The success rate of surgical treatment in liver metastases:
Depends on factors such as:
General health status of the patient
Number, size and location of metastases
Applied treatment methods
Treatment of Rectal Cancer and Resectable Liver Metastases
The most appropriate treatment method for patients with rectal cancer and resectable liver metastases is determined by the individual characteristics of the patient and the stage of the disease. The treatment of rectal cancer differs from colon cancer and the treatment of metastasised rectal cancer is even more complex.
To reduce the risk of regional recurrence in rectal cancer patients:
Radiotherapy and chemotherapy (neoadjuvant treatment) are applied before surgery.
In rectal cancer that has metastasised to the liver:
The actual treatment plan is made according to the metastases in the liver.
It is the metastasis in the liver that determines the survival of patients, not the tumour in the rectum.
Although different treatment methods are appropriate for each patient, the general treatment approaches are as follows:
1. Chemotherapy and Radiotherapy:
Treatment starts with chemotherapy.
Pelvic radiotherapy is applied after the last cycle.
If the targeted stage regression is achieved;
2. Surgery:
If a large liver resection is required, liver metastasis surgery is performed first.
After 4-6 weeks, rectum surgery is performed.
In young patients with good general condition, simultaneous rectum and liver surgery can be performed.
Small metastases in the liver may disappear under chemotherapy.
In this case, they are removed before chemotherapy because of the risk of not being found during surgery.
Then, when the patient's chemotherapy and radiotherapy treatments are completed, rectal surgery is performed.
3. Controlling Rectal Cancer:
In patients with resectable but large or multiple liver metastases, short-term radiotherapy is started first to control rectal cancer.
In this way, systemic chemotherapy is rapidly started.
When chemotherapy treatment is completed, simultaneous or staged rectal and liver surgery is performed depending on the condition of the patient and the tumour.
To summarise:
Each patient's condition and tumour characteristics are different.
Therefore, successful results can be obtained with a personalised treatment plan specific to each patient.
Patient Example in Colorectal Cancers Metastasised to the Liver
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