Cancer that starts in your colon can sometimes spread to other parts of your body, including the liver. Another name for it is metastatic, or stage IV, colon cancer.
Your doctor might find that the disease has spread to your liver when he first diagnoses you. Or after you've been treated, the colon cancer can come back and spread to the liver.
It’s normal to feel worried when you have cancer that has spread. But treatment can make a real difference in your symptoms and quality of life, and help you live longer, too.
Your doctor will help you find out if you need surgery, chemotherapy, radiation, or medicines given right into the liver. Doctors may be able to remove or shrink the tumor. Afterward, you'll need to keep up with your doctor visits to stay free of symptoms.
The types of symptoms depend on the size of the cancer and where in your body it has spread. Some people with colon cancer that has spread to the liver don't have any symptoms.
Or you might have symptoms like:
- Blood in the stool
- Pain in the right side of your belly
- Swelling in your belly
- A tired, sick feeling
- Weight loss
Getting a Diagnosis
To find out whether you have colon cancer that has spread to your liver, your doctor may ask questions like:
- When were you diagnosed with colon cancer?
- What treatments have you had?
- What are your symptoms?
You may also get blood tests to check how well your liver is working.
To see where the cancer is and how big it has grown, your doctor may order one or more of these scans:
- CT, or computed tomography. It's a powerful X-ray that makes detailed pictures of the inside of your body.
- MRI, or magnetic resonance imaging. It uses powerful magnets and radio waves to make pictures of organs and structures inside your body.
- PET, or positron emission tomography. It uses radioactive particles called tracers to find disease inside your body.
- Liver biopsy. Your doctor will take a tiny sample of your liver to test it.
Some people find out that the cancer has spread to their liver when they're first diagnosed with colon cancer. Others learn about it after they have surgery to remove their colon.
Questions for Your Doctor
When you're diagnosed with any kind of cancer, you're bound to have a lot of questions for your doctor, such as:
- What treatments will work best for me? What’s involved?
- For how long will I need treatment?
- What's my outlook?
- What problems or side effects could I have? How will we manage them?
- Should I consider a clinical trial?
- Should I get a second opinion? Will you recommend someone?
- How often should I see you for follow-ups?
Even though the cancer has spread to your liver, the tumor is still made up of colon cancer cells. Your doctor will treat it like colon cancer, not liver cancer. You may get one or more types of treatment.
The main treatment for colon cancer that has spread to the liver is surgery when possible.
The surgeon will take out as much of the cancer as possible from both the liver and colon. People who have just one cancer tumor in the liver have the highest survival rates.
Sometimes, the tumor can block the intestine. If this happens, your doctor can do surgery to put in a tube called a stent to open up the blockage.
Before surgery, you may get a type of medicine called chemotherapy, or "chemo," to kill cancer cells. There are different kinds of chemo drugs, and your doctor will pick those that are right for your type of cancer. Chemo shrinks the tumor so it's easier to remove.
You may get chemotherapy after surgery, too, to kill any cancer cells that are left behind.
Radiation uses high-energy X-rays to kill cancer cells. You may get this treatment if your tumor can't be removed with surgery or to relieve your symptoms.
External beam radiation is high-dose radiation that comes from a machine outside your body to target the tumor. These treatments are often only used in people with a small number of tumors in the liver. The radiation beam focuses treatment on the cancer cells to destroy them while limiting damage to nearby normal tissue.
Radioembolization is a type of radiation that happens inside you. Your doctor sends tiny radioactive beads through the bloodstream to the arteries that feed liver tumors. Once these beads get to those arteries, they stay there and release a dose of radiation only to the area where the tumors are. They leave the rest of your liver alone.
Brachytherapy is a different type of internal radiation. Your doctor uses a tube to send radioactive pellets directly into the cancer for several minutes.
Radiofrequency ablation uses heat from radio waves to destroy cancer cells if your liver tumors are small.
You may hear these called "biologics" or "immunotherapy." Monoclonal antibodies, or targeted therapies, are lab-made versions of proteins that can be targeted to the cancer. You get some of these drugs through an IV. One drug comes in a pill form. They attach to certain other proteins in your body and change the way they work.
Cetuximab (Erbitux) and panitumumab (Vectibix) target a protein called EGFR (epidermal growth factor receptor), which helps colon cancer cells grow. Before you get an EGFR drug, a test will be done to find out whether you have a gene change that will affect how your cancer will respond to the drug.
Bevacizumab (Avastin), ramucirumab (Cyramza), and ziv-aflibercept (Zaltrap) target a protein called VEGF (vascular endothelial growth factor), which grows the blood vessels the tumor needs to live.
Regorafenib (Stivarga), known as a kinase inhibitor, blocks some kinase proteins and helps stop cancer cells from growing.
Your doctor may also suggest you try immunotherapy. These are medicines that help your immune system more easily spot and attack cancers:
Immune checkpoint inhibitors. Nivolumab (Opdivo) and pembrolizumab (Keytruda) block PD-1 protein on immune cells called T cells. They help shrink and stop the growth of tumors.
Remember, every case is different. Although these treatments may not cure your cancer, the goal is to help you live longer and make your life better.
Scientists also are doing clinical trials to look for new ways to treat colon cancer that has spread. These trials test new drugs to see if they're safe and if they work. They often are a way for people to try new medicine that isn't available to everyone. Your doctor can tell you if one of these trials might be a good fit.
Taking Care of Yourself
You go through a lot when you have cancer. Rest, exercise, and managing stress can help. It's also important to eat well during your treatment. It may be harder now for your body to absorb nutrients from food. Work with a dietitian to make sure you get enough calories and nutrition. Ask your doctor for a referral.
Make sure you get the emotional support you need during this time, too. Friends, family members, social workers, and therapists can all be a big help. They may not be sure what to offer, so let them know what would be helpful. Ask them to listen when you’ve had a tough day or to do something fun with you when you have the energy for it.
What to Expect
Treatments for colon cancer that has spread to the liver have improved a lot over the last 25 years. People are surviving longer than ever with this cancer.
Ask your doctor how the size and the location of your tumor affect your case.
To learn more about colon cancer that has spread to the liver, or to find a support group in your area, visit the websites of the American Cancer Society, CancerCare, the Colon Cancer Alliance, and the Colon Cancer Foundation.