What to do if colon cancer metastasizes to the liver

The incidence of colorectal cancer in my country has been increasing year by year, especially in cities such as Beijing and Shanghai, where it has ranked first among digestive tract tumors. Taking Shanghai as an example, the annual incidence of colorectal cancer is 48.8/100,000, with nearly 5,000 new cases each year. Among these patients, 25% of them were found to have liver metastasis when they first visited the doctor for colorectal cancer, and another 25% of them still had liver metastasis after immediate resection of the primary intestinal tumor. If these patients did not receive treatment, the median survival time would be only 6.9 months, and the 5-year survival rate would be close to 0. Liver metastasis is one of the main causes of death in patients with colorectal cancer.

The results seem very pessimistic, but unlike the metastasis of other tumors, liver metastasis is a special state of colorectal cancer that can occur in the early stages of colorectal cancer and may be confined to the liver without metastasis to other places. In layman's terms: the presence of liver metastasis does not necessarily mean that there will be metastasis to other places. As long as the liver metastasis can be removed by surgery, the treatment effect can be similar to that without liver metastasis.

In the past 10 years, Zhongshan Hospital has completed more than 500 surgical treatments for colorectal cancer liver metastasis, with a 5-year survival rate of nearly 50%, reaching the international advanced level. In 2011, "Surgical and comprehensive treatment of colorectal cancer liver metastasis" won the first prize of Shanghai Medical Science and Technology and the first prize of Science and Technology Progress of the Ministry of Education, and its treatment effect has attracted great attention from foreign peers.

Targeted therapy, the basis of precision medicine

Surgical treatment is very effective, but only 5%-10% of patients with colorectal cancer liver metastasis are eligible for surgical treatment. Most patients can only receive chemotherapy first because the liver metastasis is too large or for other reasons. If the liver metastasis shrinks after chemotherapy, they can get the opportunity to have the liver metastasis removed surgically. Once the liver metastasis is removed, the chance of survival is comparable to that of patients who undergo direct surgery.

At present, chemotherapy is divided into two types: ordinary chemotherapy and targeted therapy. What is "targeted therapy"? This is another term for precision chemotherapy. Ordinary chemotherapy drugs, while killing tumors, also have many negative effects on the normal tissue structure and physiological metabolism of the human body. Targeted therapy is the latest research result of biotechnology. It targets the special "receptors" of tumors and concentrates the drugs mainly on the tumors. While increasing the lethality to tumors, it greatly reduces the toxic and side effects caused by chemotherapy drugs. It is like the difference between ordinary bombs and missiles. When ordinary bombs destroy the target, additional damage to the surrounding area is inevitable, while missiles can accurately strike the target that needs to be struck, and carry out a "decapitation operation" on the tumor.

Surgery enters the robotic era

For patients like Xiao Wang, if they want to remove liver metastases and primary colorectal cancer at the same time, they need to undergo two operations in the past, with an interval of 2-3 months between the two operations, which is very traumatic. Zhongshan Hospital was the first in the world to propose the treatment concept of removing liver metastases and primary colorectal cancer in one operation. After 10 years of evaluation, it has been proven that one operation greatly reduces the impact of the operation on patients without increasing surgical complications, which is conducive to patients' effective "fighting" against tumors. It can also greatly reduce medical expenses by 1/3. In the selection process of the 2011 Shanghai Medical Science and Technology Award and the Ministry of Education Science and Technology Progress Award, experts gave it extremely high praise.

Even so, one operation still requires two surgical incisions, one in the lower abdomen and one in the right upper abdomen, which together are 40 cm long. The development of minimally invasive surgery technology has reduced the 40 cm incision to several 0.5-1 cm small incisions, and through several small holes, a complex major operation can be completed. Robotic surgery has not been popular abroad for long.