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Colorectal cancer spread to your liver? Surgery holds potential cure

Colorectal cancer is the most common cancer in Singapore (Thinkstock photo)
Colorectal cancer is the most common cancer in Singapore (Thinkstock photo)

Colorectal cancer, or cancer of the colon and the rectum, is the most common cancer in Singapore. It affects about one in every 20 men and one in every 30 women here.

While this deadly cancer develops from the cells of the large intestine, it can spread to other parts of the body, particularly the liver. This happens when the cancerous cells in the colon enter the bloodstream, circulating to the lymph nodes in the region and subsequently to vital organs like the liver.

When colorectal cancer spreads in this way, it is known as colorectal liver metastasis and is considered late stage cancer. However, the good news is that in 20 per cent of patients, the colorectal liver metastasis can be treated by a liver surgeon who will remove the cancerous cells in the liver to effect a potential cure of the cancer.

Below, Dr Chan Chung Yip, Consultant Surgeon, Department of General Surgery, Singapore General Hospital, answers some of your questions on the treatment of colorectal liver metastasis.

1. If the cancer has spread to my liver, how about the rest of my body?

You will already have undergone or will be undergoing investigations to determine whether this is the case. This is often done with specialised imaging such as a CT scan or a PET scan. In most cases, liver surgery is undertaken only if the cancer has not spread to other parts of the body.

Related article: 7 tips to lower your risk of colorectal cancer

2. What if I don't do anything?

Modern chemotherapy for the liver is highly effective in prolonging the life of patients with advanced colorectal cancer. However, chemotherapy is not curative. With chemotherapy alone, very few patients with stage 4 colorectal cancer survive beyond three years from their diagnosis of metastatic cancer. With surgery, about 40-50 per cent of patients can live beyond five years, and about a third of patients can make it to the 10-year mark. If a person is cancer-free for 10 years after liver surgery, it is very likely that he or she is cured of the cancer. Chemotherapy in combination with surgery provides the best chance for cure of the cancer.

3. If the spread of cancer to the liver is too extensive to allow surgery now, does it mean that I will never be able to undergo surgery for removal of the cancer in the liver?

There are many instances where chemotherapy can shrink the tumour to the point where surgery can be considered. The management of patients with colorectal liver metastasis can be complex, and involves a multi-disciplinary team of doctors (including medical oncologists, liver surgeons, colorectal surgeons, radiologists and radiation oncologists). The best care is provided when such cases are discussed in an open forum with the attendance of the multi-disciplinary team. It involves planning for the complete removal of the tumour whilst leaving enough liver to sustain life, and assessing the patient's fitness for surgery.

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4. When is the surgery done?

Depending on the chemotherapy regime designed for you, surgery can be performed before the start of chemotherapy, in between rounds of chemotherapy or at the completion of the chemotherapy regime. In the latter two situations, it is usual to wait 4 to 6 weeks for the chemotherapy effects on the liver to "wash out" before surgery is undertaken. The timing of the surgery will be discussed on an individualised basis between your medical oncologist and your liver surgeon.

Related article: Colorectal liver metastasis: Surgery FAQs

5. Any other alternatives?

Surgery provides the best chance for lasting survival and cure of the cancer. In some cases, local ablation of the cancer may be undertaken to kill off the cancer cells. Local ablation involves delivering heat energy to kill tumour cells by inserting a needle probe into the liver. This is most commonly performed under local anaesthesia by radiologists with image guidance, or in certain situations under general anaesthesia by laparoscopy or open surgery by surgeons. The effectiveness of this treatment is still inferior to surgery, and is only suitable in limited circumstances. However, this treatment can be combined together with surgery in those situations where surgery alone to remove all cancer-bearing areas would leave too little of the liver for the person's needs.

This article was written by Dr Chan Chung Yip, Consultant, Department of General Surgery, Singapore General Hospital (SGH), for Health Xchange.

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Health Xchange's articles are meant for informational purposes only and cannot replace professional surgical, medical or health advice, examination, diagnosis, or treatment.