Regional Hepato-Pancreatico-Biliary Unit - Surrey and Sussex

Associated sites:   Livercancer.co.uk,    Liver.org.uk,   Bowel-cancer.co.uk

Chemotherapy for Secondary Colorectal Cancer in the Liver

Chemotherapy for colorectal cancer that has spread to the liver has changed the outlook for many patients with this condition. The standard treatment has been based on chemotherapy regimes using a combination of 5FU and folinic acid with reasonable response rates. Although chemotherapy has been shown to increase the median survival it does not improve 5 year survival which remains bleak at <2%. 

For patients with inoperable liver tumours neo-adjuvant chemotherapy may  be used to downstage (reduce in size) such liver tumours. If this is successful then downstaged tumours may be successfully removed surgically. It has been shown that such downstaged and operated patients can have a 35-40% 5 year survival. In particular combination treatments of 5-FU or capecitabine combined with oxaliplatin or irinotecan can effectively downstage liver tumours (shrink the tumours) thus rendering these operable.

Example

This patient had a small deposit of tumour in the right liver found at operation. She opted for alternative therapy with carrot juice and coffee enemas and the tumour grew large in the right liver. A year later she presented with pain in her right shoulder referred from the enormous tumour in her right liver. Figure 1 shows this large deposit of tumour in right liver encroaching on the vena cava and surgery at this time would not provide any satisfactory clearance of healthy tissue around the tumour. Figure 2 shows the results of downstaging after 6 cycles of Oxaliplatin / DeGrammont  chemotherapy and the the tumour is seen to have shrunk by over 75% in volume. Figure 3 shows the operative specimen after a  right hemi-hepatectomy and it is clear that the tumour has been removed with a clear margin of healthy tissue.