What to do about liver metastasis from transverse colon cancer?

Written by Sun Wei
Surgical Oncology
Updated on September 16, 2024
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Liver metastasis in transverse colon cancer is relatively common, especially in cases where the disease has progressed. Because the transverse colon is located close to the liver region, tumors in this area can potentially metastasize to the liver via the lymphatic or blood circulation, or through local infiltration. In cases where the liver metastasis is localized, there is still an opportunity for surgical treatment involving a radical resection of the transverse colon cancer combined with partial hepatectomy. If there are multiple metastases in the liver, radical surgery may not be feasible. Initially, preoperative neoadjuvant chemotherapy or targeted therapy is performed. If the liver metastatic lesions can be reduced or disappear, there may still be a chance for surgical treatment afterwards.

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Colorectal Cancer CT Manifestations and Differential Diagnosis

Early-stage colon cancer is difficult to clearly detect on a CT scan. In the moderate to late stages, colon cancer has more typical manifestations on CT, mainly characterized by thickening of the colon wall, irregular narrowing of the intestinal lumen, and stiffness of the intestinal wall. After enhancement, significant enhancement can be observed. The pericolonic fat space may appear blurred, and in the late stages, small lymph nodes can be seen, and even distant metastasis, most commonly to the liver, can be detected. It is necessary to differentiate colon cancer from colonic inflammation. Inflammatory lesions are usually more widespread and have typical clinical features such as fever and abdominal pain. It is also necessary to differentiate from lymphoma, as lymphomas also cause narrowing of the intestinal lumen but the narrowing is not eccentric and the intestinal wall remains soft, generally not leading to obstruction, whereas in late-stage colon cancer, colonic obstruction can be observed.

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Is colon cancer surgery a major surgery?

Colon cancer surgery is considered a relatively major procedure, ranking as a class three or four surgery in general surgery. Generally, it involves the resection of the entire transverse colon or tumors located in other areas such as the ascending or descending colon, accompanied by the removal of surrounding lymph nodes, followed by intestinal anastomosis and digestive tract reconstruction. Post-surgery, comprehensive anti-tumor treatment is usually required. After colon cancer surgery, the main focus is on preventing intestinal leakage, which is a serious complication. Dietary intake needs to be gradually restored after surgery. Initially, the patient may only be able to consume liquid and easily digestible foods, gradually transitioning to semi-liquid and regular diets, while also paying attention to eating smaller, more frequent meals.

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Can late-stage colon cancer be completely removed by surgery?

In clinical practice, for patients with mid-to-late-stage colon cancer, even after curative surgical resection, it is often difficult to completely remove the tumor. This is because by the mid-to-late stages, the colon cancer has typically started to invade surrounding tissues. Despite curative surgery, patients may still have subclinical lesions, which are typically hard to detect either under a microscope or with the naked eye. The presence of these subclinical lesions leads to a higher likelihood of recurrence and metastasis after curative surgery in mid-to-late-stage colon cancer patients. Therefore, to reduce the rates of recurrence and metastasis, it is common clinical practice to administer adjuvant chemotherapy and radiotherapy after the curative surgical resection for patients with mid-to-late-stage colon cancer, aiming to decrease the risk of cancer recurrence and metastasis.

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Late-stage colon cancer can still potentially allow for a relatively long survival time, such as living more than one year, two years, or even three to five years. Of course, this also depends on the treatment provided. Generally, it may not be possible to perform curative surgery directly in the advanced stages, but preoperative neoadjuvant chemotherapy, targeted therapy, and so on, can be administered first. If these treatments can reduce the size of the tumor and lower its stage, there could still be a chance for surgical treatment later. Clinically, if there is no recurrence after more than five years, it is considered to have achieved a clinically curative effect. For instance, surpassing five years can possibly mean extending survival beyond ten years or even longer. However, treatment for late-stage patients needs to be adjusted as it proceeds, and it is impossible to specifically determine how long one can live.

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What should be done after the complete removal of colon cancer?

After surgical removal of colon cancer, the postoperative treatment strategy should be determined based on the precise staging of the cancer according to the surgical pathology. If the colon cancer has invaded the mucosal layer and the submucosal layer, or the muscular layer, it is staged as stage I; postoperative adjuvant chemotherapy is not required, and regular follow-up is sufficient. If the colon cancer reaches stage II or III, postoperative adjuvant chemotherapy is needed to reduce the risk of postoperative recurrence and metastasis. Stage IV colon cancer does not fall under the aforementioned conditions of clean removal of the cancer.