Colon cancer stages and symptoms
Colon cancer has four stages, with stage IV as the most severe stage because it means the cancer cells have spread (metastasized) to other organs like the liver (or lungs, lymph nodes, stomach or other organs). Although some individuals may show no symptoms when this spread occurs, other people may develop the following symptoms in addition to the symptoms they had or have with their colon cancer:
- Pain in the right side of the abdomen or stomach
- Abdominal swelling
- Blood in stool
- Weight loss
- Appetite loss
- Leg swelling
All of these symptoms may be caused by the spread of the colon cancer cells into the liver, thereby disrupting liver functions and/or killing liver cells. This information will focus on colon cancer that has metastasized to the liver.
If any of the above symptoms develop, you should contact a doctor immediately. If any of the above symptoms were the result of your colon cancer, and the symptoms have gone into remission and now recurred, you should still contact your doctor immediately to determine if they are related directly to your colon cancer or due to it spread to the liver. Your doctor is likely to order liver function tests plus one or more imaging studies (CT, MRI, PET), and possibly a liver biopsy to confirm metastases of your colon cancer into the liver.
What is the treatment for stage IV colon cancer that has spread to the liver?
Stage IV colon cancer is difficult to treat. Stage IV cancers don't have a good prognosis as their relative survival rate for 5 years is about 11%. However, survival rates are only estimates do not predict what can happen in any individual. Consequently, the patient and their doctor(s) need to discuss how to approach this new problem of metastasis to the liver. Some people may even want to get a second opinion. However, there are still treatment options that may allow symptom reduction and perhaps increase the 5-year survival rate even with the spread of colon cancer to the liver, but there are no guarantees that this will happen. In fact, some of the drugs utilized specifically to treat metastatic colon cancer show that on the average, some lifespans were only increased by a few months.
Basically, physicians attempt to treat metastatic colon cancer cells in the liver like colon cancer and not like liver cancer. The main treatment options are:
- Surgery removal of tumors from both the colon and the liver: Some surgery may be needed to take out part of the colon (partial colectomy) and can result in the patient requiring a diverting colostomy (collection of feces in a bag by routing part of the colon to empty outside the abdomen into a colostomy bag).
- Chemotherapy: Oral or IV therapy with drugs that are designed to kill or harm colon cancer cells wherever they occur. Most regimens involve multiple drugs such as fluorouracil (5-FU), leucovorin, oxalplatin, capecitabine, and irinotecan. Drugs are typically given as combinations, with regimens termed, for example, FOLLFIRI, FOLFOX, and CapeOX. In 2015 the US FDA approved another chemotherapy medication, Lonsurf (trifluridine and tipiracil).
- Radiation: High-energy radiation administered to kill colon cancer cells and/or shrink colon cancer tumors in the liver. (Colon or colon tumors pressing on the portal vein that carries blood to the liver.)
- Radioembolization implants: Puts radioactive beads into arteries that feed the colon tumors.
- Radiofrequency ablation uses heat generated by radio waves to destroy the cancer cells.
- Brachytherapy inserts radioactive implants directly into colon cancer tissue.
Targeted therapies are therapies designed to damage and/or kill colon cancer cells wherever they occur by specifically directing designed drugs that act on certain receptors or surface chemicals present on the colon cancer cells. The drugs interact with the receptors or regulating proteins like vascular endothelial growth factor (VEGF) or epidermal growth factor receptor (EGFR), and cause changes in them that ultimately damage or kill colon cancer cells. Some of the drugs used in targeted therapies no matter where colon cancer cells are located are cetuximab, panitumumab and Stivarga (regorafenib).
You and your doctors (the medical team) can decide what treatments, if any, are best for you as an individual. In addition, you and your doctors may wish to discuss the possibility of participating in a clinical study where the newest anticancer drugs are being developed.
If you have further questions, especially if you would like to talk to a support group with people who have had to face the same problems you have, you and your family can contact the American Cancer Society, the Colon Cancer Foundation or other groups that may be located at your treatment center near your home.