Metastatic Colorectal Cancer Treatment

Colorectal cancer most often spreads to the following sites:

• Liver
• Lungs
• Lining of the abdominal cavity (peritoneum)
• Lymph nodes

Symptoms of metastatic colorectal cancer depend on where the cancer has spread. When colorectal cancer has spread to the liver, it may cause symptoms such as:

• Pain on the right side of the abdomen that may get worse with deep breaths
• Unexplained weight loss
• Yellow skin and eyes (jaundice)
• Fatigue out of the ordinary
• Blood in the stools
• Low red blood cell counts (anemia)

When colorectal cancer spreads to the lungs, it may cause:

• Shortness of breath
• Frequent respiratory infections
• Coughing
• Chest pain

However, some people with metastatic colorectal cancer may not have any of these symptoms. That is why it’s important to have an experienced team monitor your health.

“Oligometastatic” is another way of saying that colorectal cancer has spread to a limited number of sites in the body. The number varies, but typically this means a person has five or fewer metastases (tumors that have spread).

At UChicago Medicine, our Limited Metastatic Cancer Program specializes in helping people with oligometastatic colorectal cancer and other stage 4 cancers live longer lives. Even if you were told you are not a candidate for aggressive treatment elsewhere, you may benefit from therapies we offer. This includes immuno-oncology treatments, advanced radiation and interventional oncology therapies and surgical options that are not widely available.

Our researchers are also leading studies to determine which patients with liver metastases are most likely to benefit from aggressive treatment, based on the specific makeup of their tumors.

Our cancer team can order different types of tests to make a diagnosis. We will also determine the stage of cancer based on the extent and size of the tumors. This is important to plan the best course of treatment.

Some of the tools used to diagnose and stage colorectal cancer include:

• Blood tests
• Biopsies to remove and examine small tissue samples
• Advanced imaging tests, including:
  • Computed tomography (CT) scans, which use low-energy X-rays to produce 3D images of tissues and organs
  • Magnetic resonance imaging (MRI), which uses a strong magnet to produce detailed pictures of organs and other parts of the anatomy
  • Positron emission tomography (PET) scans, which use a radioactive substance to uncover cancer cells in the body

When you come to the UChicago Medicine Comprehensive Cancer Center, our team of medical oncologists, radiation oncologists, interventional radiologists, surgical oncologists, pathologists, radiologists, nurses and other experts will work together to determine the best treatment plan for you. This plan depends on several factors, including:

• Your specific type of colorectal cancer based on detailed molecular profiling of your tumor
• The number and size of tumors that have spread to other parts of your body
• Your personal goals and preferences
• Your overall health

For patients with colorectal cancer that has spread to the liver, a hepatic artery infusion pump delivers chemotherapy directly to the liver through a surgically implanted pump. The dose of chemotherapy is 300 to 400 times greater than regular chemotherapy, without any of the side effects. UChicago Medicine is one of only a select number of hospitals in the country to offer this procedure.

This type of treatment helps the body’s immune system fight cancer. Our cancer experts are considered international leaders in using immunotherapy against cancer and have been studying these treatments for more than three decades. Some examples of immunotherapy include:

• Vaccines: Our physician-researchers are currently testing how to use individualized vaccines based on the makeup of each patient’s cancer, combined with chemotherapy.
• CAR T-cell therapy: This innovative treatment helps doctors supercharge the immune system to target cancers. UChicago Medicine is leading clinical trials on CAR T-cell therapy for patients with metastatic colorectal cancer and other solid tumors.

This is a range of minimally invasive procedures performed with small needles inserted through the skin that kill cancer cells in different ways. Some types used for metastatic colorectal tumors include:

• Microwave ablation (MWA), which uses heat to burn away cancer cells in a tumor
• Irreversible electroporation (IRE), a treatment that uses electricity to destroy a tumor and is only available at leading hospitals like UChicago Medicine
• Cryoablation, in which tumors are frozen