If bowel cancer has spread to the liver
Your healthcare team will talk to the liver (hepatobiliary) surgeons about your test results. Treatment options include:
Chemotherapy uses drugs to kill cancer cells. Your healthcare team may offer you chemotherapy to shrink the cancer and relieve any symptoms. You may have one chemotherapy drug or a combination of two or three drugs.
If your cancer comes back after treatment, you may be able to have chemotherapy again. This is called ‘second line’ chemotherapy.
Read more information on chemotherapy drugs and their side effects.
Biological therapies are also called targeted therapies. They help your body control the way cancer cells grow. You may have them as a drip into a vein or you may take them as tablets, depending on which drug you’re having.
Biological therapies may be used together with chemotherapy to treat bowel cancer that has spread to other parts of the body.
Biological therapies include the following drugs:
- Cetuximab (Erbitux®)
- Panitumumab (Vectibix®)
- Bevacizumab (Avastin®)
- Aflibercept (Zaltrap®)
- Regorafenib (Stivarga®)
Cetuximab and Panitumimab work by blocking messages that tell cancer cells to grow. They won’t work if your cancer cells have a change (mutation) in some of the RAS genes.
Bevacizumab, Aflibercept and Regorafenib stop the cancer cells growing their own blood supply.
Biological therapies are not routinely available on the NHS. Your doctor can apply for NHS funding for Cetuximab but the process is difficult and not always successful. It can be hard to accept this decision if you can’t get the treatment you need. Macmillan Cancer Support has information on what to do if a treatment isn’t available.
In Scotland, you can have Aflibercept together with FOLFIRI chemotherapy (irinotecan, 5-fluorouracil and folinic acid) as a second line treatment if you have already had oxaliplatin.
Cancer Research UK provides information on biological therapies to treat advanced bowel cancer.
If you have been diagnosed with advanced (metastatic) bowel cancer, your specialist may offer you a biomarker test. This looks for changes (mutations) in a group of genes, called RAS genes. If the cancer has a normal RAS gene, we call it ‘wild type’. If is abnormal, it is called a ‘mutated’ RAS gene.
Cancer cells are collected during endoscopy or surgery and are usually stored in a laboratory. So if you can’t have biomarker testing straight away, you may be able to have it in the future.
Your cancer specialist can use the results of biomarker testing to see which treatments would work best and which ones are unlikely to work for you. This is called personalised medicine, because your treatment is being tailored to the genetic make-up of your cancer. For example, if you have a mutated RAS gene, you will not benefit from two biological therapies, called Cetuximab and Panitumumab.
Biomarker testing is not offered to everyone and we are campaigning for this to change. If you have been diagnosed with advanced bowel cancer, ask your specialist if you can be tested.
You may have surgery to remove cancer that has spread to your liver, depending on the number of tumours, their location and size. Your liver is able to re-grow, even after large parts are removed.
You may have chemotherapy before liver surgery to shrink the cancer and make it easier to remove. You may also have chemotherapy after surgery if the cancer has spread to the lymph nodes or there is a high chance of it coming back.
A specialist liver surgeon will do the operation. Your healthcare team will refer you to a liver surgery centre, which may be at a different hospital.
If your cancer comes back after surgery, you may be able to have another operation or one of the other treatments for advanced bowel cancer.
Cancer Research UK has more information on surgery for bowel cancer that has spread to the liver.
Your healthcare team may offer you radiofrequency ablation to treat bowel cancer that has spread to the liver.
You may have radiofrequency ablation if:
- You can’t have surgery,
- There are any small areas of cancer left after surgery, or
- Your cancer has come back after surgery.
Treatment involves placing one or more needles into the affected parts of the liver. The doctor uses a CT scan to guide the needle into the tumour. Radio waves passing through the needle destroy the cancer cells by heating them to a high temperature.
Cancer Research UK describes radiofrequency ablation and its side effects.
National Institute for Health and Care Excellence (NICE) provides guidance on radiofrequency ablation to treat bowel cancer that has spread to the liver.
Microwave ablation is a fairly new treatment so there isn’t as much information about how well it works compared to other treatments. If you are thinking about having it, your healthcare team will explain the benefits and risks to you.
Microwave ablation is similar to radiofrequency ablation but uses microwave energy to heat and destroy cancer cells in the liver. One or more needles are inserted into the tumour, using a CT scan or ultrasound scan to make sure they’re in the right place. The microwave energy passes through the needles into the cancer cells.
National Institute for Health and Care Excellence (NICE) produces guidance on microwave ablation to treat cancer that has spread to the liver.
Selective internal radiotherapy (SIRT)
SIRT is a fairly new treatment and is only available in a small number of hospitals. It isn’t routinely available on the NHS.
You may be able to have SIRT as part of a clinical trial or if your specialist liver team think you will benefit from it. The treatment isn’t suitable for everyone. You will need to meet certain treatment criteria, you must be fit enough for the treatment and your liver must be working well.
There isn’t much evidence to show how well SIRT works in people who haven’t had chemotherapy. If you have had chemotherapy, SIRT can keep the cancer under control for longer than if you had no treatment. But more research needs to be done before we can say whether it improves quality of life or increases survival.
You may have SIRT on its own or together with chemotherapy. If you have chemotherapy, you will take a break from it while you have SIRT.
Treatment involves inserting a very fine tube into a blood vessel in your groin, which passes into the major blood vessel (artery) that leads to the liver. The doctor injects tiny radioactive beads into the tube, which block the tiny blood vessels that feed the cancer cells and release a high dose of radiation into the tumour.
Before you have your treatment, your doctor will check the blood supply to your liver to make sure the beads won’t travel to other parts of the body. You will only be able to have the treatment if this procedure shows it is safe to go ahead.
Cyberknife (Stereotactic radiotherapy)
If you can’t have other treatments, you may be able to have stereotactic radiotherapy to treat secondary cancer in the liver. This is a new way of using radiotherapy and it is only available in a few hospitals.
A machine, sometimes called a Cyberknife, sends beams of radiotherapy from different angles. The beams overlap at the tumour. This gives a very high dose of radiotherapy to the cancer while limiting damage to the surrounding healthy tissue, reducing the risk of side effects.
Macmillan Cancer Support has more information on stereotactic radiotherapy.
Updated March 2016. Due for review March 2018