Stage IV colorectal cancer

This page is dedicated for patients with advanced colorectal cancer. For general information and early stage treatment please refer to the National Cancer Institute website.

Help is also available for certain patients suffering from stage IV cancers (metastases). A very selected group of patients with metastases limited to liver may be candidates for surgery and enjoy substantially prolonged life, even possible cure. Those with unresectable metastases may be candidates for minimally invasive procedures as Radiofrequency Ablation (RFA), Transarterial Chemoembolization (TACE), or specialized forms of radiation. Certain patients with peritoneal carcinomatosis may be helped by cytoreductive surgery and Hyperthermic Intraperitoneal Chemoperfusion (HIPEC).

Liver, peritoneal and lung metastases

The cancer has spread from the colon/rectum to distant organs such as the liver, lungs, or peritoneum. Nearly all patients can be treated with chemotherapy, which provides longer lifespan. If cancer is spread to more sites prognosis is less favorable.

Typical sites of spread include:



3.peritoneum (inner lining of abdominal organs and bowel surface).

For a small number of patients surgery may greatly improve survival, even provide a chance of cure from stage IV disease. These are typically patients with only a few metastases, which can be resected (removed by operation) or ablated with radiofreqency ablation (RFA). We provide a full range of liver procedures for our patients, including major open liver resection and laparoscopic liver resection in selected patients. RFA can be provided either way depending on a particular situation, and is always guided by intraoperative ultrasound for superior precision.

Decisions about when and for how long chemotherapy should be used are very complex and coordinated by discussion between patient, surgical oncologist and medical oncologist. In some cases, hepatic artery infusion may be used if unresectable tumors are in the liver only.

A special form of spread within surfaces of abdominal organs is called peritoneal carcinomatosis. This is in general associated with less favorable prognosis. Treatment options include systemic chemotherapy, palliation or cytoreductive surgery with HIPEC.