Liver metastases in Stage 4 colorectal cancer. Surgical treatment. 1

Liver metastases in Stage 4 colorectal cancer. Surgical treatment. 1

Liver metastases in Stage 4 colorectal cancer. Surgical treatment. 1

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How good is survival of stage 4 colorectal cancer patients today? What are important factors in cure of patients with stage 4 metastatic colon cancer? “The whole philosophy of treating stage 4 metastatic colorectal cancer to the liver changed overnight about 15 years ago. Up to 40% of stage 4 colon cancer patients could be candidates for surgery to remove liver metastases.” Liver metastases in stage 4 colorectal cancer. Dr. Anton Titov, MD. Surgical treatment advances. Dr. Graeme Poston, MD. Liver metastases develop in stage 4 colorectal cancer patients, survival prognosis was perviously grim. 25-30% of patients who had liver cancer surgery were alive five years later without colon cancer recurrence. approach to treating stage 4 metastatic colorectal cancer to the liver changed overnight about 15 years ago. response rate of metastatic stage 4 colon cancer almost doubles. Up to 40% of stage 4 colon cancer patients could be candidates for surgery to remove liver metastases from colon cancer. Dr. Anton Titov, MD. Colorectal cancer liver metastases treatment. Dr. Graeme Poston, MD. Video interview with leading British liver cancer surgeon specializing in colorectal cancer metastases resectionAdvanced stage 4 colon cancer surgery for liver metastases. Medical second opinion confirms that stage 4 colorectal cancer diagnosis is correct and complete. Medical second opinion also confirms that liver metastases surgery is possible in stage 4 colon cancer. Best treatment for advanced stage 4 colon cancer with liver metastatic lesions. Medical second opinion helps to choose the best treatment for stage 4 colorectal cancer with liver metastases. Dr. Graeme Poston, MD. Get medical second opinion on advanced colorectal cancer and be confident that your treatment is the best. Best colorectal cancer treatment center for liver metastases. Video interview with leading expert in colorectal cancer liver metastases treatment surgery. Liver metastases in stage 4 colorectal cancer. surgical treatment advances. Why liver metastatic disease in colorectal cancer is important? Dr. Anton Titov, MD. Because 25% of patients at the time of colorectal cancer diagnosis have already developed liver metastatic disease. In total about 50% of patients with colorectal cancer develop liver metastatic disease. Dr. Graeme Poston, MD. Metastases often happen at some point during colon cancer disease course. Right. You have over 40 years of experience doing surgical treatment for liver metastatic disease in colorectal cancer. Dr. Anton Titov, MD. How situation improved for patients with liver metastases from colorectal cancer? How do you treat metastatic colon cancer in the liver? Dr. Graeme Poston, MD. Leading liver cancer surgeon. Yes, you have got to look at this in the context of colorectal cancer as a public health problem. It is the second commonest cancer now in Western society after lung cancer. Breast cancer in women is more common. But obviously the men and women counted together. Colorectal cancer is second most common cancer. Colorectal cancer is increasing in its incidence at 5% per year. In China and India, colon cancer is increasing amongst the middle classes. Colorectal cancer is a major public health problem. Dr. Graeme Poston, MD. Sometimes colorectal cancer spreads to the liver. If nothing is done, the prognosis is grim. Sometimes liver metastases develop in stage 4 colorectal cancer patients. Survival prognosis is probably six to nine months, if no treatment's offered at all. As we know, 25% of the patients already have colorectal cancer spread to the liver at the time of diagnosis. We operate on stage 4 colorectal cancer patients and we think that their colon cancer is confined to the bowel, the colon, the rectum. 50% of these patients will progress to the liver metastases after removal of primary colorectal cancer tumor. Historically, we go back 30 years ago, 35 years ago. Stage 4 metastatic colon cancer prognosis was probably six months, if you were lucky. After cancer spread to the liver. Dr. Graeme Poston, MD. At that time, there was no effective treatment for stage 4 metastatic colon cancer. There were no effective colon cancer treatment medications. Dr. Anton Titov, MD. Nobody was offering surgery for the liver metastases in colon cancer. We started to do liver surgery in the 1970s. Physicians thought we were mad. The liver is a very vascular organ. At any moment in time 25% of your blood is in the liver. There's a lot of bleeding. Dr. Graeme Poston, MD. We were lucky if patients didn't bleed to death during the operation. Surgeons said operating on stage 4 metastatic colon cancer in the liver was insane. We had no survival data to show why we were doing it at all. We had ineffectual cancer treatment medications, 5 Fluorouracil, 5-FU. This was useless in metastatic colon cancer treatment. Dr. Graeme Poston, MD. Leading liver cancer surgeon. Very few patients were being offered any form of active treatment for metastatic stage 4 colorectal cancer. Then everyone realized this. We actually had patients living five years after the liver operation for metastatic stage 4 colorectal cancer. Initially it was something like 25-30% of patients who had liver cancer surgery. They were alive five years later without disease. Dr. Graeme Poston, MD. Then, we had new medications coming in the 1990s. Irinotecan, Oxaliplatin. They were extremely effective for stage 4 metastatic colon cancer treatment. We had new medications in the marketplace. Most importantly, these new medications would convert patients with unresectable metastatic stage 4 colon cancer disease to resectability. Then patients could have a liver resection operation of their metastatic tumors. Because the tumors had become much smaller. Sometimes liver tumors become smaller. They were technically operable. Dr. Anton Titov, MD. These patients with liver metastases from stage 4 colorectal cancer had a chance of cure. Suddenly, everything changed. Also, we were very conservative in the 1990s. Dr. Graeme Poston, MD. We used to say, if a patient had more than three metastatic tumors in the liver, they were incurable. Dr. Graeme Poston, MD. Leading liver cancer surgeon. If metastatic tumor was involving both sides of the liver, patients were incurable. Then we realized that was not true. More data emerged that the number of metastatic lesions didn't matter. Dr. Graeme Poston, MD. What mattered most for metastatic stage 4 colon cancer surgery was this. How much liver did not have cancer. You could remove the cancerous liver. Patients must have about 30% of their healthy liver with a good blood supply that was free of cancer. Then it was reasonable to remove the cancerous liver. Dr. Anton Titov, MD. You could remove the 70% of essentially diseased liver. Liver was affected by colorectal cancer metastases. But the 30% of healthy liver would be sufficient to maintain metabolism and to regenerate? Dr. Graeme Poston, MD. Leading liver cancer surgeon. Liver would regenerate. We knew that their prognosis wasn't as good. We know the factors that give metastatic stage 4 colorectal cancer patient a worse prognosis. These factors are: higher numbers of tumors, size of tumors, the differentiation degree of the primary colon cancer tumor. Sometimes the primary colon cancer tumor is poorly differentiated. The metastases are going to be poorly differentiated. Dr. Graeme Poston, MD. Important metastatic colorectal cancer prognostic factors are these. The blood CA-125 level very high. Lymph node status of the primary colon cancer tumor. Sometimes lymph nodes were involved as well as the liver. That affected prognosis to the worse. Dr. Anton Titov, MD. The last thing is crucial. The liver surgeon can control the size of the resection margin on the liver around the metastatic colon cancer tumor. Dr. Graeme Poston, MD. We used to say it had to be a centimeter of healthy liver tissue. We now know that is not necessary. We will take two or three millimeters of healthy liver tissue around the metastatic colon cancer tumor that we remove. Sometimes we can get the cancer out. Dr. Graeme Poston, MD. Even if that cancer is pushing into other anatomical structures. That helps patients a lot. Dr. Anton Titov, MD. The whole philosophy of treating stage 4 metastatic colorectal cancer to the liver changed overnight about 15 years ago. Then we had some even more important developments. In particular the EGFR receptor antibodies, Cetuximab (Erbitux), Panitumumab (Vectibix). These targeted colon cancer medications have a very high response rate. Sometimes targeted chemotherapy is added to conventional chemotherapy for colorectal cancer. The response rate of metastatic stage 4 colon cancer almost doubles. Double the number of patients who were previously not suitable for surgery to remove liver metastases. They now had resectable liver metastatic lesions. Dr. Graeme Poston, MD. We call that "conversion" of irresectable to resectable colon cancer liver metastases. We now think probably the following is true. Patients with liver-limited stage 4 metastatic disease. Probably up to 40% of patients could be candidates for surgery to remove liver metastases from colon cancer. This has been the real change in the whole treatment of advanced colon cancer over the last 20 years. Dr. Anton Titov, MD. That is very dramatic results, clearly. Dr. Graeme Poston, MD. That is the primary role for the surgeon to surgically cure metastatic colon cancer disease at the metastatic level. Dr. Graeme Poston, MD. Leading liver cancer surgeon. Yes. 40% of stage 4 colon cancer patients are candidates for surgery to remove liver metastases. Metastatic colorectal cancer surgical treatment improved much.

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