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Advances in Treating Colorectal Cancer With Liver Metastases

Giving new hope to potentially thousands of patients, surgeons at UC San Francisco are now providing lifesaving procedures for many colorectal cancer patients whose cancer has spread to the liver.

A finding of colorectal cancer with liver metastases (CRLM) – once considered incurable – is no longer cause for automatic pessimism. When surgery is included with modern chemotherapy regimens, the combined treatment gives patients about a 65 percent chance of surviving five years or more, and about one-third of patients can even realize a 10-year survival. 

“A metastasis to the liver from colorectal cancer used to offer very little chance of long-term survival,” said Adnan Alseidi, MD, EdM, professor of surgery in UCSF’s Division of General Surgery and vice chair for education in the Department of Surgery. “Even after more than a decade of improving results, we find that many patients are treated only with chemotherapy. While chemotherapy alone does extend life, many options now exist to further enhance outcomes and in fact offer some the chance of a cure.”

Alseidi points to one advance in particular, namely, the success of minimally invasive (laparoscopic) surgery in removing malignant tumors in the liver – even when there are many of them. “We are still working to dispel the mistaken impression that surgery is not possible if there are more than a few tumors,” he noted. “The number of tumors isn’t necessarily the deciding factor. What matters is how much of the liver remains free of tumor, not how much needs to be removed.” 

The chance for more success with CRLM than with, say, pancreatic or gallbladder cancer lies in part with the particular efficacy of chemotherapy treatment for colorectal cancer. This fact, along with the success of minimally invasive surgery in resecting liver tumors, enables UCSF surgeons to remove many cancerous lesions within the liver with a very low chance of complications, a high chance for an expedited recovery, less pain and a faster return to treatment.

“Colorectal cancer is the second-leading cause of cancer death in the U.S., and in half of all cases the cancer has spread to the liver,” said Alseidi, who chairs the Education and Training Committee for the Americas Hepato-Pancreato-Biliary Association. “There’s a tremendous opportunity to extend lives – even more critical now as we’re seeing this disease present in younger people.” 

Other Options Possible When Resection Is Not; Patients Benefit From Comprehensive Cancer Team 

For those tumors that cannot be removed with minimally invasive or open surgery, treatment with other modalities – such as ablation, pump placement for hepatic arterial infusion of chemotherapy and even radiation treatment – remains an option. UCSF’s multidisciplinary cancer team includes a full complement of specialists who convene to determine the best approach for each patient. In addition to dedicated HPB surgeons, the team includes a medical oncologist, a radiation oncologist, a colorectal surgeon and interventional radiologists, as well as genetic counselors and supportive care specialists to assist patients with symptom management. 

“We are providing a one-stop destination for patients dealing with CRLM and related issues, so that they have the benefit of a coordinated and robust effort to find the optimal course for their particular circumstance,” said Alseidi. “I want physicians and their patients to know that now, more than ever, there is cause for hope.”

To learn more:

UCSF Gastrointestinal Surgical Oncology Clinic

Phone: (415) 514-1964 | Fax: (415) 502-2236

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