Stage IV Colon Cancer That Has Spread to the Liver

Colon cancer stages and symptoms

Colon cancer has four stages, with stage IV as the most severe stage because
it means the cancer cells have spread (metastasized) to other organs like the
liver (or lungs, lymph nodes, stomach or other organs). Although some
individuals may show no symptoms when this spread occurs, other people may
develop the following symptoms in addition to the symptoms they had or have with
their colon cancer:

All of these symptoms may be caused by the spread of the colon cancer cells
into the liver, thereby disrupting liver functions and/or killing liver cells.
This information will focus on colon cancer that has metastasized to the liver.

If any of the above symptoms develop, you should contact a doctor
immediately. If any of the above symptoms were the result of your colon cancer,
and the symptoms have gone into remission and now recurred, you should still
contact your doctor immediately to determine if they are related directly to
your colon cancer or due to it spread to the liver. Your doctor is likely to
order liver function tests plus one or more imaging studies (CT, MRI, PET), and
possibly a liver biopsy to confirm metastases of your colon cancer into the
liver.

What is the treatment for stage IV colon cancer that has spread to the liver?

Stage IV colon cancer is difficult to treat. Stage IV cancers don’t have a good prognosis as their relative survival rate for 5 years is about
11%. However, survival rates are only estimates do not predict what can happen
in any individual. Consequently, the patient and their doctor(s) need to discuss
how to approach this new problem of metastasis to the liver. Some people may
even want to get a second opinion. However, there are still treatment options
that may allow symptom reduction and perhaps increase the 5-year survival rate
even with the spread of colon cancer to the liver, but there are no guarantees
that this will happen. In fact, some of the drugs utilized specifically to treat
metastatic colon cancer show that on the average, some lifespans were only
increased by a few months.

Basically, physicians attempt to treat metastatic colon cancer cells in the
liver like colon cancer and not like liver cancer. The main treatment options
are:

• Surgery removal of tumors from both the colon and the liver: Some surgery may be needed to take out part of the colon
  (partial colectomy) and can result in the patient requiring a diverting
  colostomy (collection of feces in a bag by routing part of the colon to empty
  outside the abdomen into a colostomy bag).
• Chemotherapy: Oral or IV therapy with
  drugs that are designed to kill or harm colon cancer cells wherever they occur.
  Most regimens involve multiple drugs such as fluorouracil (5-FU), leucovorin,
  oxalplatin, capecitabine, and irinotecan. Drugs are typically given as
  combinations, with regimens termed, for example, FOLLFIRI, FOLFOX, and CapeOX. In 2015 the US FDA approved another chemotherapy medication, Lonsurf (trifluridine
  and tipiracil).
• Radiation:
  High-energy radiation
  administered to kill colon cancer cells and/or shrink colon cancer tumors in the
  liver. (Colon or colon tumors pressing on the portal vein that carries blood to
  the liver.)
• Radioembolization implants: Puts radioactive beads into arteries that feed the colon tumors.
• Radiofrequency ablation uses heat generated by radio waves to destroy the cancer cells.
• Brachytherapy inserts radioactive
  implants directly into colon cancer tissue.

Targeted therapies

Targeted therapies are therapies designed
to damage and/or kill colon cancer cells wherever they occur by specifically
directing designed drugs that act on certain receptors or surface chemicals
present on the colon cancer cells. The drugs interact with the receptors or
regulating proteins like vascular endothelial growth factor (VEGF) or epidermal
growth factor receptor (EGFR), and cause changes in them that ultimately damage
or kill colon cancer cells. Some of the drugs used in targeted therapies no
matter where colon cancer cells are located are cetuximab, panitumumab and
Stivarga (regorafenib).

You and your doctors (the medical team) can decide what treatments, if any,
are best for you as an individual. In addition, you and your doctors may wish to
discuss the possibility of participating in a clinical study where the newest
anticancer drugs are being developed.

If you have further questions, especially if you would like to talk to a
support group with people who have had to face the same problems you have, you
and your family can contact the American Cancer Society, the Colon Cancer
Foundation or other groups that may be located at your treatment center near
your home.