What to Expect When Colon Cancer Spreads to the Liver
If you have colon cancer, you may worry about the possibility of your cancer spreading to other parts of your body. And the most common place for colon cancer to spread is the liver (called secondary liver cancer). In fact, up to 70% of people diagnosed with colorectal cancer eventually develop secondary liver cancer, according to Memorial Sloan Kettering Cancer Center. We spoke to the experts to get the facts you need to know about this possibility, including symptoms, treatment options, and more.
The Liver Is a Common Site of Spread
While colon cancer can also spread to other parts of the body, it most often goes to the liver. “It’s extremely common because the liver is an incredibly blood-rich organ,” explains Tom A. Abrams, M.D., a gastrointestinal oncologist at Dana-Farber Cancer Institute in Boston, MA. “It’s the blood filtration system of the body, and because colon cancer will travel through the bloodstream, the liver is the first visceral organ typically involved with metastatic colon cancer.” The liver is also a common site of recurrence after colon cancer is treated, he says.
There May Not Be Noticeable Symptoms
Most people whose colon cancer spreads to their liver won’t have obvious symptoms, says Blase Polite, M.D., a gastrointestinal oncologist at UChicago Medicine in Chicago. “Cancer inside the liver actually doesn’t tend to cause much pain because there are no pain receptors there,” he explains. “But some patients, if the tumors are pressing on the outside of the liver, can develop a lot of pain in the right upper quadrant and sometimes all the way up to the shoulder blade.” Some people may also experience tiredness or weight loss, adds Dr. Abrams.
Liver Metastasis Can Happen Fast
Unlike some cancers, colon cancer can spread very quickly after the original tumor develops, according to the National Cancer Institute (NCI). In fact, metastasis can start extremely early on, when the original colon tumor is smaller than the tip of a pencil, the NCI says. About 20% to 25% of people are first diagnosed with colon cancer after the cancer has already spread to the liver, according to a study in Euroasian Journal of Hepato-Gastroenterology, and 40% to 50% see spread to the liver within three years of the original colon cancer diagnosis.
Diagnosis Can Involve a Range of Tests
“When you’re diagnosed with colon cancer, you get a CT scan to stage the cancer to see if its localized to colon, which we’re hoping for, or if it has spread,” explains Dr. Abrams. “Then a biopsy usually needs to be done to confirm that.” In the case of a colon cancer recurrence in the liver, the cancer is usually found during routine follow-up testing, he says. That follow-up involves a blood test for the tumor marker carcinoembryonic antigen (CEA). If your CEA rises, that may trigger a CT scan that could discover a cancer recurrence in the liver, he says.
Your Liver Can Usually Keep Doing Its Job
The liver is a key organ in your body with functions like storing nutrients, filtering waste from the blood, and more. But thankfully, cancer may not prevent your liver from keeping up its duties: “The liver is a large organ, and it can function with a lot of disease,” says Dr. Abrams. That said, if the cancer gets bad enough in the liver, it can affect function—but this isn’t the case for most people, says Dr. Polite. “Amazingly, the liver cells that aren’t involved [with the] tumor can do a remarkable job,” he says.
You’ll Need a Strong Treatment Team
Should colon cancer spread to your liver, get the advice of a multidisciplinary team of surgeons and oncologists ASAP, Dr. Polite says. “Colon cancer is one of the few cancers where even in patients with metastatic disease, we can sometimes cut out that disease and still achieve a long-term cure for patients,” he says. “So early consultation with a team that specializes in colon cancer and has surgeons dedicated to liver surgery is an important first step.” They can determine if surgery could remove your tumors, which means fewer damaging effects of chemotherapy on the still-healthy parts of your liver, he explains.
Treatment Can Combine a Number of Approaches
The treatment plan for colon cancer that has spread to the liver depends on your specific disease, but can include a combination of surgery, chemotherapy, targeted drugs, radiation, and ablation (using techniques like heat or freezing to destroy the tumor), says the American Cancer Society. For example, in some cases where there is just one lesion in the liver, surgery and chemotherapy are generally used, says Dr. Abrams. Another procedure called hepatic artery infusion (HAI), in which chemo is pumped directly into the liver via surgical implant, may be used in some cases that are beyond surgical cure, he adds.
Treatment Outcomes Vary Based on Your Specific Disease
According to Hopkins Medicine, 40% to 60% of people treated for isolated colon cancer liver metastasis are still alive five years after treatment. “If there are multiple organs involved, outcomes are generally worse,” Dr. Abrams says. “If the liver has one solitary small lesion, it’s much better than if the whole liver is engulfed with cancer.” For example, if you just have one liver lesion, your doctors may be able to remove it and in some cases cure you, says Dr. Abrams. In other cases with more extensive cancer in the liver, it can be considered incurable, although chemotherapy may help control the disease to some extent, he says.
Genetic Testing May Be Encouraged
If your colon cancer spreads to the liver, your doctors may also suggest you undergo genetic testing, says Dr. Polite. “As we learn more about the genetics of cancer, especially for our younger patients, we think about testing the blood to see if there are any hereditary causes of their cancer,” he explains. Genetic testing results can help your health care team make decisions about your treatment, according to Memorial Sloan Kettering Cancer Center. In addition, your results may hold important implications for other members of your family, Dr. Polite says and potentially prevent them from getting cancer as well.
The Bottom Line
If you’ve been diagnosed with liver cancer, understanding the risk that your cancer may spread to your liver is important considering how commonly this occurs. But knowing what to expect can help prepare you in case this does happen. And remember, don’t be afraid to get second opinion, says Dr. Polite. “It’s always a good idea for somebody with metastatic colon cancer to get a second opinion at a high-volume cancer center,” he says. A care team with expertise in this type of metastatic disease can help confirm you’re getting the best treatment possible, he says.
2017 Study on Colon Cancer That Has Spread to the Liver: Euroasian Journal of Hepato-Gastroenterology. (2017.) “Hepatic Metastasis from Colorectal Cancer.” ncbi.nlm.nih.gov/pmc/articles/PMC5670263/
Colon Cancer Treatments By Stage: American Cancer Society. (2019). “Treatment of Colon Cancer, by Stage.” cancer.org/cancer/colon-rectal-cancer/treating/by-stage-colon.html
Liver Facts: Centers for Disease Control and Prevention. (2015.) “The Liver.” cdc.gov/hepatitis/theliver.htm
Study on Fast Spread of Colon Cancer: National Cancer Institute. (2019.) “Metastatic Colorectal Cancer May Spread Early in the Disease, Study Finds.” cancer.gov/news-events/cancer-currents-blog/2019/early-metastasis-colorectal-cancer
Treatment for Colon Cancer That Has Spread to the Liver: Hopkins Medicine. (2020.) “Treating Colon Cancer That Has Spread to the Liver: A Team Approach.” hopkinsmedicine.org/health/conditions-and-diseases/colon-cancer/treating-colon-cancer-that-has-spread-to-the-liver-a-team-approach