Colorectal Metastasis

Comprehensive, Leading-Edge Treatment

A multidisciplinary treatment team – including surgeons, radiation oncologists, radiologists, interventional radiologists, medical oncologists, pathologists and hepatologists – combine to provide the full range of tailored treatment for metastasizing colorectal cancer.

            “We have a multidisciplinary team here that functions very well together and is extremely collaborative,” says Tyvin Rich, M.D., a radiation oncologist.

            The treatment team comes together at a weekly gastrointestinal tumor board meeting to discuss all cases and determine the best treatment course. “We’ll tailor therapy to your patient – their age, health and their wishes for treatment,” adds surgeon Charles Friel, M.D.

            The most common location for colorectal cancer to metastasize into is the liver, says surgeon Reid Adams, M.D. More than half of colon cancers, for instance, metastasize into the liver, says interventional radiologist John Fritz Angle, M.D. Here’s a look at how UVA treats liver metastasis at its National Cancer Institute-designated Clinical Cancer Center.

Diagnosing the Disease

Plotting the best treatment course begins with imaging led by radiologists who specialize in the thoracoabdominal region, including Eduard de Lange, M.D.

            “We know what to look for to make sure you detect the disease and how to communicate that to the surgeons and oncologists,” he says.

            Along with ultrasound, UVA uses state-of-the-art CT and MRI scanners to evaluate patients. For instance, UVA’s dual-source CT – which combines two 64-slice CT scanners – can reduce patients’ radiation exposure while providing higher-quality imaging in less time.

            UVA also has a specialized GI pathologist, Christopher Moskaluk, M.D., Ph.D, to aid in diagnosis.

Comprehensive Surgical Approaches

Together with chemotherapy, UVA offers several procedures that include surgery, Adams says:

• Portal vein embolization: Blood supply is blocked to the portion of the liver where the cancer has metastasized, causing the healthy portion of the liver to grow in response and allowing the diseased portion of the liver to be resected.
• Staged procedures: For patients with cancer that has metastasized throughout the liver, multiple procedures may be performed in a series of stages. For instance, surgeons may remove lesions from one side of the liver, then perform portal vein embolization on the more-diseased portion of the liver, which is later removed.
• Radiofrequency ablation and resection: A small metal probe is inserted into the liver and opened like an umbrella. High-frequency waves heat the tissues and seek to kill the tumor. It’s very effective on smaller lesions, Angle says. Removing tumors on one side of the liver, Adams says, enables surgeons to remove the more-diseased portion of the liver.

Unique Nonsurgical Approaches

UVA also offers several nonsurgical procedures available only at larger cancer centers. “You’re not going to see this at a community hospital,” Rich says.

Approaches include:

• Tomotherapy: This approach uses a relatively short, four-week radiation course together with chemotherapy. The intensity-modulated, image-guided radiation therapy allows the treatment team to target the cancer from the outside of the liver, sparing healthy tissue along the way. “We’ve found it to be well tolerated,” Rich says.

• Radioactive microspheres: If the liver is full of tumor, a second approach uses microscopic polymer beads filled with yttrium-90, a radioisotope. Yttrium-90 is injected through a catheter directly into the hepatic artery, which is the main blood supply for metastatic cancer in the liver. Because the beads are beta particles with a range of about ½ centimeter, they are able to target the cancer while sparing surrounding healthy tissue.
• Chemotherapy beads: Small plastic beads soak up chemotherapy and are injected into a patient’s arteries, Angle says, delivering a high dose of chemotherapy with limited side effects.

Primary Cancer Treatment

UVA also offers the same multidisciplinary approach to treating primary liver and colorectal cancer.

            UVA hepatologist Stephen Caldwell, M.D., notes that there has been a sharp rise in primary liver cancer since the 1990s due to an increase in Hepatitis C and non-alcoholic fatty liver disease associated with increases in obesity and diabetes. UVA offers the full range of treatment options, including medical treatment, chemoembolization, radiation and transplants.

            UVA also offers several minimally invasive procedures to treat colorectal cancer, Friel says, including laparoscopic surgery. UVA surgeons also perform transanal incisions for small, appropriate cancers as well as endoscopic approaches for rectal polyps.

To refer a patient for cancer treatment, call UVA Physician Direct at 800-552-3723.