What is Colorectal Cancer?

Colorectal cancer is the third most common cancer worldwide. The National Cancer Institute (NCI) estimates that approximately 150,000 people in the United States will be diagnosed with colorectal cancer in 2020.  These numbers are only the new cases; in 2017 the NCI estimated that there were 1,348,087 people living with colorectal cancer in the United States[1].

The colon, often called the large intestine, is a tube-like organ at the end of the digestive system.  The colon absorbs water, some nutrients and electrolytes from digested food, while the rectum is a repository for stool.  Most colorectal cancers start as a small polyp on the wall of the intestine, but not all polyps turn cancerous, and not all cancerous polyps spread to liver.

Colorectal cancer
Cancer that spreads beyond the wall of the colon often requires more complex treatment than localized CRC.  Of the approximately 150,000 patients who are diagnosed with colorectal cancer every year, about 15% will learn that their cancer has spread to their liver when they are initially diagnosed.  A further 35% are likely to spread to the liver during disease advancement or recurrence.  Up to 60% of all people diagnosed with CRC will ultimately develop tumors in the liver.[2]

The ‘gold standard’ for a cure is to surgically remove the tumors from the liver, a procedure called tumor resection; unfortunately, at the time of diagnosis only 15% to 20% of the patients who are diagnosed with liver metastases are candidates for surgical resection of their tumors.[3]

For patients who have undergone potentially curative resection, disease recurrence is thought to arise from clinically occult micrometastases(tiny clusters of cancer cells) that are present at the time of surgery. The goal of postoperative (adjuvant) therapy is to eradicate these micrometastases, thereby increasing the cure rate.[4]  To treat suspected micrometastases in the remaining liver and prevent extrahepatic spread, a reasonable approach involves the use of a combination of regional therapy, such as hepatic arterial infusion of chemotherapy, and systemic chemotherapy[5].

[1]https://www.cancer.gov/publications/dictionaries/cancer-terms/def/colon

[2]Daly JM, Kemeny N. Therapy of colorectal hepatic metastases. Important Adv Oncol. 1986:251‐256. 3330537 https://doi.org/10.1007/s00270-019-02284-9

[3] Adam R, Vinet E. Regional treatment of metastasis: surgery of colorectal liver metastases. Ann Oncol. 2004;15(Suppl 4):iv103-6.

[4]Sanoff, H. Adjuvant chemotherapy for resected stage II colon cancer. ed. UpToDate. Waltham, MA: UpToDate Inc. https://www.uptodate.com (Accessed on January 01, 2021.)

[5]Kemeny, N. et al. Hepatic Arterial Infusion of Chemotherapy After Resection of Hepatic Metastases From Colorectal Cancer. New England Journal of Medicine, 1999:341(27). https://doi.org/10.1056/nejm192802231980115

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