Treatment of liver and lung metastasis from colorectal cancer

The effect of complete surgical resection of colorectal cancer in the early stage is better, and chemotherapy after surgery can prevent recurrence. However, the effect of surgery after liver metastasis of colorectal cancer is not very ideal, and sometimes it has the opposite effect. Patients with liver metastasis of colorectal cancer can consider Chinese medicine treatment. With the development of Chinese medicine and the understanding of cancer, Chinese medicine treatment of cancer has received attention from many doctors.

The traditional view is that rectal cancer liver metastasis is clinical stage IV and has lost its treatment significance, thus depriving patients of the opportunity for treatment. With the advancement of imaging technology, early, isolated, and smaller metastatic lesions can be discovered; the improvement of surgery, anesthesia, and perioperative management has greatly reduced surgical complications and mortality; adjuvant treatments, mainly neoadjuvant chemotherapy, can reduce the patient's clinical stage and can convert unresectable tumors into resectable tumors. The treatment of rectal cancer liver metastasis can be divided into surgical treatment and non-surgical treatment, the latter includes systemic chemotherapy, portal vein chemotherapy, hepatic artery embolization chemotherapy, etc. Surgical resection is still the first choice for the treatment of rectal cancer liver metastasis. For the treatment of synchronous liver metastasis:

(1) The primary lesion can be resected, and the liver metastases can also be resected. Efforts should be made to resect the primary lesion and the liver metastases in stage I.

(2) If the primary lesion is resectable but the metastatic lesion is not, the primary lesion is removed and a portal vein catheter is placed. Postoperatively, chemotherapy via portal vein + hepatic artery chemoembolization + systemic chemotherapy is then performed.

3) If both the primary lesion and the metastatic lesion cannot be removed, palliative surgery may be performed as appropriate. This includes short-circuit surgery and ostomy, and postoperative adjuvant chemotherapy. For the treatment of metachronous liver metastasis, that is, liver metastasis that occurs after the primary lesion is removed,

(1) If the liver metastasis is resectable, the tumor can be surgically removed;

(2) If liver metastases cannot be removed, local treatments such as TACE, radiofrequency, and cryosurgery plus systemic chemotherapy can be used. It is generally believed that the later the liver metastasis occurs after the first primary lesion is removed, the better the prognosis. A comprehensive and detailed systemic examination should be performed before liver resection to exclude metastases from other parts. Irregular liver resection is recommended for liver resection. Adjuvant comprehensive treatment should be added after surgery. For liver metastases that occur within a short period of time after colorectal cancer surgery (within 1 year after surgery), even if the metastases are resectable, 1 to 2 cycles of systemic chemotherapy should be performed before irregular liver resection. The most important factor determining the resectability and prognosis of liver metastases is the number of liver metastases, i.e., the "metastatic burden." In a small number of patients with liver metastases, liver metastases are limited to one lobe or one segment. Surgical resection is not only simple, but also has a 5-year survival rate of up to 40%. The choice of surgical indications and the experience of the surgeon are the key factors in determining the operation. Factors affecting surgical resection of liver metastases include poor tumor differentiation, abdominal lymph node metastasis, metastasis to extrahepatic organs, incomplete surgical margins, and metastasis to both lobes of the liver. Clinical studies have confirmed that neoadjuvant chemotherapy can provide a chance for surgical resection of some unresectable rectal liver metastases. 95 cases of rectal cancer liver metastases were surgically resected after three weeks of chemotherapy with FOLFOX (oxalateplatin, calcium folinate, 5-FU), with a 5-year survival rate of 40%. For unresectable rectal cancer liver metastases, the main chemotherapy regimens are currently continuous intravenous drip of 5-FU, calcium folinate biochemical regulators, and combined or alternating use of oxalateplatin and irinotecan. Chemotherapy can be combined with targeted therapy, such as bevacizumab (Avastin, anti-tumor angiogenesis) and cetuximab (C-225, anti-epidermal growth factor receptor).

Due to the anatomical characteristics of intestinal venous return, the liver may sometimes be the only metastatic site of colorectal cancer. Liver resection provides an important treatment opportunity. Therefore, the importance of surgical resection is self-evident. For unresectable metastatic lesions, non-surgical treatment methods include the following aspects:

Systemic chemotherapy: Currently, 5-Fu is still the main chemotherapy regimen, with an effective rate of 18% to 31% and a median survival of 8 to 14.2 months. There are reports of oral urea treatment, with individual cases surviving for more than 10 years.