An overview of colorectal cancer that has spread to the liver

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The outlook of colorectal cancer liver metastases (CRLM) may depend on whether CRLM is resectable — which means surgeons can remove the tumor with surgery — or unresectable. Unresectable refers to tumors that a surgeon is unable to remove with surgery.

The development of more effective treatments, including chemotherapy and surgical procedures, has improved the outlook for CRLM. The outlook is likely to continue improving with the development of new treatment options.

According to a 2019 review, the 5-year survival rate for people who have chemotherapy to shrink a tumor before surgery may be 33%, with a 10-year survival rate of 23% after surgery.

People with resectable CRLM may have slightly higher survival rates, while people without surgery have lower survival rates.

A person with resectable CRLM may have a 5-year survival rate of 16–71%. For people with unresectable CRLM at diagnosis, treatments may be able to shrink the tumor so that surgery is possible. In these cases, the 5-year survival rate may be 33–50%.

Is it curable?

According to a 2018 study, surgery may be the only cure for colorectal cancer that has spread to the liver. Around 25 in 100 people with CRLM are suitable candidates for surgery.

The 2019 review notes that CRLM treatments and survival have greatly improved in recent years.

According to a 2017 article, 20–25% of people may have CRLM at the time of diagnosis. Around 40–50% of people with colorectal cancer may develop liver metastasis in the first 3 years after their initial diagnosis.

A 2019 article states that in around 18–25% of cases, colorectal cancer will spread to distant sites, such as the liver, within 5 years of the initial diagnosis.

Symptoms of liver metastasis include:

• fatigue
• appetite loss
• nausea
• unexplained weight loss
• fever
• jaundice, which is a yellowing of the skin and eyes
• dark urine
• itchy skin
• abdominal pain or discomfort
• swelling in the abdomen
• swollen ankles

The aim of treatment is to make it possible to remove CRLM with surgery, as this is the best chance for improved survival or to cure the cancer.

Treatments for CRLM include:

• Systematic chemotherapy: Chemotherapy can shrink a tumor so that people may have surgery to remove it. Systematic chemotherapy enters the bloodstream and affects the whole body.
• Hepatic arterial infusion (HAI) chemotherapy: HAI administers chemotherapy directly into the liver. Floxuridine is the most common type of HAI chemotherapy.
• Transarterial chemoembolization (TACE): TACE is another method that administers chemotherapy directly to the liver through a catheter. TACE also blocks blood supply to the tumor so that cancer cells cannot grow.
• Targeted therapy: This uses drugs that specifically target cancer cells to prevent or slow down their growth.
• Immunotherapy: This uses substances to support the immune system in destroying cancer cells.
• Surgery: People can have surgery to remove the cancerous section of the liver. A surgeon will make a cut in the abdomen to access the liver and remove the cancerous areas.
• Ablation therapy: This uses heat or an injection of ethanol to destroy cancer cells. People may have ablation therapy if surgery is not a suitable option.

To diagnose CRLM and to identify the stage, size, and exact location of the liver metastasis, doctors may carry out the following tests:

• Ultrasound: Contrast-enhanced ultrasound uses microbubbles to show blood flow to help detect small tumors.
• CT scan: A CT scan is an effective imaging test for detecting CRLM, although it may be more difficult to detect CRLM smaller than 10 millimeters (mm).
• MRI scan: MRI scans have higher sensitivity and can be more effective than CT scans to detect CRLM smaller than 10 mm.
• Fluoro-18-deoxyglucose (FDG) positron emission tomography (PET): FDG-PET is highly sensitive and accurate in detecting CRLM larger than 10 mm.

There are many organizations and support groups that people with advanced colorectal cancer may find helpful, including:

• Colorectal Cancer Alliance: Offers information, resources, a community hub, and support groups for people with all stages of colorectal cancer.
• Cancer Care: Provides a free, online Colorectal Cancer Patient Support Group for people currently receiving treatment.
• American Cancer Society (ACS): Offers a range of programs and services for people with cancer, including a 24/7 helpline, support with lodging and transport to treatment, and a network to connect people with cancer.
• Cancer Support Community: Connects people with cancer through a free online community.

The ACS suggests a list of questions people with colorectal cancer may want to ask their healthcare team, such as:

• What is the stage of cancer, and what does this mean?
• What are the treatment options?
• What treatments do you recommend and why?
• What are the potential side effects of treatment?
• What is the goal of treatment?
• What activities will I be able to do during treatment?
• How much experience do you have in treating CRLM?
• Who can help if I experience mental health issues?
• Who can help with concerns about finance and insurance?

If colorectal cancer spreads to the liver, it can cause symptoms such as jaundice, fatigue, and abdominal pain and swelling.

People may have chemotherapy to shrink the liver tumor, which may make it possible to remove the tumor with surgery.