Every March, we wear blue to recognize Colorectal Cancer Awareness Month. The rising incidence of colorectal cancer in younger patients has been highlighted in recent years by the loss of well-known public figures. The importance of screening colonoscopy beginning at age 45 — and paying attention to warning signs and symptoms at any age — cannot be overstated.
For patients who are newly diagnosed, standard treatment for early- or middle-stage disease often includes surgery to remove the affected portion of the colon and/or rectum, along with chemotherapy when appropriate. Patients with advanced disease, where the cancer has spread to distant organs, are often treated primarily with medical therapy. However, as we raise awareness of this common cancer, it is important to remember that surgical removal of metastatic tumors may be an option for otherwise healthy patients with limited spread of disease.
Decades of research have shown that liver surgery can help patients with stage 4 colorectal cancer and liver metastases live longer compared to medical therapy alone. Several factors must be considered when evaluating a patient for liver surgery. First, the patient must be healthy enough to tolerate a major operation. Second, the cancer should be stable or responding to treatment, allowing for a temporary pause in medical therapy during surgical recovery, and there should be little to no disease outside the liver. Third, the portion of liver that remains after surgery must be large enough and healthy enough to meet the body’s needs. Hepatobiliary surgeons carefully review imaging studies to ensure the remaining liver has adequate blood flow and functions properly.
Some patients with stage 4 colorectal cancer develop tumor deposits along the lining of the abdomen or on the surfaces of abdominal organs, known as peritoneal metastases. Studies suggest that selected patients with limited peritoneal disease may benefit from surgical removal of all visible tumor, combined with chemotherapy delivered directly into the abdomen. This approach is called cytoreductive surgery (tumor debulking) and hyperthermic intraperitoneal chemotherapy (HIPEC). Candidates for this procedure must also be healthy and have disease that is controlled on medical therapy. Surgical oncologists evaluate imaging and operative findings carefully to determine whether all visible disease can be safely removed before proceeding.
Evaluation for surgery in the stage 4 setting is best performed by surgeons trained in complex surgical oncology and hepatobiliary surgery. Some patients may be candidates for minimally invasive approaches, including laparoscopic or robotic surgery. Others may not be candidates for surgery but may benefit from alternative treatments such as liver-directed therapy, radiation, or individualized medical therapy.
At Northside Hospital Cancer Institute, our team works closely with medical and radiation oncologists, interventional gastroenterologists and radiologists, oncology dietitians, body imaging radiologists, pathologists, genetic counselors and patient navigators to develop a comprehensive treatment plan. Each plan is grounded in scientific evidence and tailored to the individual patient.
LEARN MORE ABOUT COLORECTAL CANCER CARE AT NORTHSIDE.
