You are here: Home Colorectal Cancer Colorectal ... Colorectal ... Summary
Information about all aspects of finances affected by a serious health condition. Includes income sources such as work, investments, and private and government disability programs, and expenses such as medical bills, and how to deal with financial problems.
Information about all aspects of health care from choosing a doctor and treatment, staying safe in a hospital, to end of life care. Includes how to obtain, choose and maximize health insurance policies.
Answers to your practical questions such as how to travel safely despite your health condition, how to avoid getting infected by a pet, and what to say or not say to an insurance company.

Summary

Colorectal cancer that has spread to other organs is classified as metastatic disease (also called Stage IV). The liver is the most common site for metastasis.

If surgical removal (reseciton) is not possible, and the tumor ("lesion") is not considered to be operable, liver directed or targed therapies are an alternative.

Liver directed treatments include the following:

Liver directed treatments can be used alone or in combination with chemotherapy and/or biologic agents.

NOTE: The information in this document was compiled with the generous help of Laura Porter, MD, Medical Consultant and Patient Advocate for the Colon Cancer Alliance, and Desiree Gray, Director of Health Economics & Patient Advocate for Sirtex Medical, Inc offsite link.

Ablative Therapies: Radiofrequency Ablation (RFA);Cryosurgery; Microwave Ablation

A variety of ablative therapies are available including Radiofrequency Ablation (RFA), Cyrotherapy and Microwave Ablation (MA). These procedures are performed by a surgeon or interventional radiologists (IR) who specialize in oncology procedures.

All of these techniques are applicable to patients who have a limited number of metastatic liver tumors.

RFA, Cyrotherapy and MA are considered to be beneficial for patients with unresectable liver-only disease who present with tumors less than or which equal to 3-4 cm.

RADIOFREQUENCY ABLATION (RFA)

Radiofrequency Ablation uses electrical energy to create heat in a tumor for a specific period of time. The result of this "super heating" is the death or destruction of the tumor.

The procedure can be performed percutaneously by inserting a needle through the skin under x-ray guidance, then placing a probe through the needle and positioning it in the liver tumor. The percutaneious procedure is usually performed by an interventional radiologist under local anesthesia.

Alternatively, the procedure can be performed by a surgeon as follows:

  • Laparoscopically, using a laparoscope that is inserted through a tiny incision in the abdomen. The doctor can examine the inside of the abdomen through the laparascope.
  • Through an open surgical procedure.

RFA is safe, well tolerated and an effective treatment for patients with inoperable metastatic liver tumors. RFA is most effective in liver lesions that are less than or equal to 3-4 cm in size.

Side effects: Many patients experience a low grade fever for a few days following the RFA procedure. There is a very low risk of infection, bleeding and skin burn.

Recovery:

  • If the percutaneous offsite link method is used then the patient will go home the same day. 
  • If a laparoscopic procedure is selected then the patient usually goes home the following day. 
  • An open surgical procedure offsite link requires that an incision be made in the abdomen, general anaesthesia offsite link is needed and the recovery period will be longer.

CYROTHERAPY (CYROSURGERY, CYROSURGICAL ABLATION)

Cryotherapy or Cryosurgery uses super cooled liquid nitrogen or liquid argon gas to freeze liver lesions offsite link thereby destroying the tumor offsite link. Similar to RFA, the procedure can be performed percutaneously offsite link. In cryotherapy the doctor uses MRI offsite link or ultrasound offsite link to guide the probe and monitor the formation of an “ice ball” in the tumor and limiting damage to surrounding tissue. The procedure may also be performed by a surgeon using an open surgical procedure offsite link. Clinical and laboratory research suggest that hepatic cryotherapy is effective in patients with inoperable tumors, which are located in a difficult section of the liver (near large vessels). Like RFA, cryotherapy is most effective in liver lesions that are less than or equal to 3-4 centimetres in size. 

Side Effects: Complications of cryotherapy may include bleeding, mild fever, increase in liver enzymes due to damage to the bile ducts, infection or abscess.

Recovery: If the percutaneous offsite link method is used, the patient will usually go home the same day. An open surgical procedure requires that an incision be made in the abdomen, general anaesthesia offsite link is needed and the recovery period will be longer.

MICROWAVE ABLATION (MA) 

Microwave Ablation (MA) is an ablative offsite link therapy that produces coagulation offsite link of soft tissue during apercutaneous offsite linklaparoscopic offsite link or open surgical procedure offsite link. Microwave ablation (MA) uses microwave energy and an antenna to cause coagulation of tissue by creating heat by friction and vibration of water molecules in the cells. The advantage of MA over other heating systems, such as RFA, is that the microwave technique is quicker and does not cause collateral damage and can be completed in 10 minutes.

Side Effects: Many patients experience a low grade fever and pain for a few days following the procedure. Major complications include liver abscess offsite linkbile duct offsite link injury, infections, bleeding and skin burn.

Recovery: If the percutaneous method is used the patient will usually go home the same day. If a laparoscopic procedure is selected then the patient often goes home the following day. An open surgical procedure requires that an incision be made in the abdomen, general anaesthesia offsite link is used, and the recovery time will be longer.

Internal Radiation Therapy

SIRT (Selective Internal Radiation Therapy) also known as radioembolization is a liver directed, outpatient radiation treatment for the management of inoperable offsite link liver tumors, from either primary liver cancer or colorectal metastases. SIRT delivers millions of tiny radioactive microspheres (beads) called SIR-Spheres® directly to the liver tumor offsite link to cause tumor destruction. SIRT is a non-surgical option for patients who are not candidates for surgical resection or ablation offsite link. SIR-Spheres are made of a biocompatible resin offsite link material. The SIR-Spheres microspheres or beads are very tiny (average size is 32 microns) about the diameter of a strand of human hair. SIR-Spheres preserve the blood vessels to allow for future therapies. Each yttrium-90 microsphere offsite link is charged with which will penetrate the tumor tissue up to 11 millimeters. SIR-Spheres are the only FDA-approved microsphere offsite link for patients with inoperable metastatic colorectal cancer to the liver. SIR-Spheres are administered by aninterventional radiologist offsite link in the radiology suite. Under local anesthesia, a small needle puncture is made in the groin area into the femoral artery offsite link. A small flexible guidewire offsite link is inserted and positioned into the artery where the microspheres will be delivered. A narrow tube, known as a catheter offsite link is then guided over the wire and positioned into the selected artery where the SIR-Spheres will be delivered to the tumors.  The advantages of radioembolization therapy, documented by clinical research, is that microspheres, when used in combination with chemotherapy or alone, provide an improvement in liver tumor control by shrinking the tumor and delayingprogression offsite link in the liver.

Side Effects: Many patients experience nausea and pain which normally subside in a short time after the procedure and are treated with routine medications. Patients may also develop a mild fever that may last up to one week and fatigue which may last several weeks. Major complications are rare but may include small number of microspheres inadvertently reaching other organs in the body, such as the stomach, intestine or pancreas.

Recovery: The entire procedure takes about 90 minutes. You will be sleepy during the procedure, but able to communicate with your doctor and the team. Most patients return home four to six hours following treatment.

Embolization Therapies

Embolization therapy is performed by interventional radiologists in the radiology suite. It is a non-surgical procedure to treat inoperable offsite link metastatic liver tumors offsite link. Small particles or beads, ranging in size from 100 to 900 microns made of a biocompatible resin offsite link, are injected into selected vessels to block the blood flow feeding the tumors causing the tumor to shrink. Under local anaesthesia offsite link, a small incision is made in the groin to access the femoral artery offsite link and a narrow guidewire offsite link is inserted. A delivery catheter offsite link is inserted over the wire and under x-ray guidance (angiography offsite link) the tip of the catheter is positioned so that the particles will be delivered to the tumor. Particles are injected until the embolization offsite link is complete and the artery is blocked. Over the following months, the embolized vessels will permanently shrink and the tumor will decrease in size. Embolization can be performed with bland particles (without drug added), or with drug added which is called TACE offsite link (Transarterial Chemoembolization). Cutting off the blood supply to the tumor allows for higher doses of chemotherapy to be delivered and remain in contact with the tumor, and preventing the chemotherapy reaching healthy tissue. TACE normally contains a mixture of bland particles and two to three chemotherapy agents. TACE may also be performed using different particles made of abiocompatible resin offsite link modified for the controlled loading and delivery of drug. These particles are calleddrug eluting beads (DC Bead or DEBIRI)  offsite link. Drug eluding beads are mixed with one chemotherapy agent (Irinotecan offsite link)4 and contrast dye. The beads will absorb the chemotherapy agent and once injected into the tumor will slowly release the drug over days.

Side Effects: The side effects will differ depending upon the type of embolization used. The most common complications reported are pain, nausea and severe post embolization syndrome (fever, pain, extreme fatigue, nausea/vomiting), hepatic injury and liver abscess. 

Recovery: Most patients can be discharged a few hours after the procedure. If post embolization syndrome occurs an overnight stay is normally required.