Percentage Of Colon/Rectal Cancer That Metastasis To The Liver?

[boxhill]

I had no idea it was that high a percentage!

On the up side, you don't have one now, and many liver mets can be removed one way or another, especially if they are found when small. Which is an argument for regular scans in followup.

[CRguy]

Be it far from me to question MSK .....
BUTT that number seems much higher than I have seen over the years

Since I have been here (2008), nowhere near 70% of posting members had liver mets
JMO

I would look deeper into the numbers and get more info before throwing in the towel,
metaphorically speaking.

Best wishes
CRguy

[boxhill]

It could be that almost 70% of those THEY see have liver mets because so many people go to them specifically for the HAI pump and liver treatment...?

[CRguy]

Yup that would make sense in their patient population base ... BUTT ...
they state that as a general population stat and I am not buying it.

I found a 2017 paper which referenced a much lower liver met rate :

The liver is the most common site of metastasis in patients with colorectal cancer due to its anatomical situation regarding its portal circulation. About 14 to 18% of patients with colorectal cancer present metastasis at the first medical consultation, and 10 to 25% at the time of the resection of the primary colorectal cancer. The incidence is higher (35%) when a computed tomography (CT) scan is used.

AND this paper also referenced a 2005 paper which did quote the 70% number ... BUTT ....

Eventually, about 70% of patients with colorectal cancer will develop metastasis in the liver.

is almost verbatim from the MSK reference

AND ... AND ....
the 2005 paper includes THAT very statement from the following 2 references from 1978 and 1979
https://www.annalsofoncology.org/article/S0923-7534(19)57626-8/pdf

2. Wanebo HJ, Semoglou C, Attiyeh F, Stearns MJ Jr. Surgical manage-ment of patients with primary operable colorectal cancer and synchro-nous liver metastases. Am J Surg 1978; 135: 81 – 85.
3. Welch JP, Donaldson GA. The clinical correlation of an autopsystudy of recurrent colorectal cancer. Ann Surg 1979; 189: 496 – 502.

Sorry, maybe just me ... BUTT
I am NOT going to assume multiple quoted references from 1978, 1979, 2005 reflect the current state of medical information I would rely upon making any treatment decisions.

Like I said IMO, just me ?
... YMMV

Cheers all
CRguy on the Journey

[FightCRC]

https://www.mskcc.org/cancer-care/types/liver-metastases

“Most liver metastases start as cancer in the colon or rectum. Up to 70 percent of people with colorectal cancer eventually develop liver metastases. This happens in part because the blood supply from the intestines is connected directly to the liver through a large blood vessel called the portal vein.“

70%?

Is this what I have to look forward to?

If you progress to Stage IV, then yes, this is likely what you have to look forward to. As you've stated repeatedly that it's cCR or bust, since you will refuse any surgery, then this is the probable outcome if you don't achieve pCR. It really does seem that you've been so singularly focused on cCR that you haven't considered all the other possibilities.

If it was me, I'd do everything I could to avoid Stage IV. I put that at a higher priority than avoiding an ostomy. But as always, to each their own.

[I_will_fight]

For what´s worth, I found this study that offers a much lower figure

https://www.ncbi.nlm.nih.gov/pmc/articl ... cer%20(CRC)%20is%20a,higher%20incidence%20of%20liver%20metastases.

A retrospective population-based study was performed on a cohort of patients diagnosed with CRC in the region of Stockholm, Sweden during 2008. Patients were identified through the Swedish National Quality Registry for Colorectal Cancer Treatment (SCRCR) and additional information on intra- and extra-hepatic metastatic pattern and treatment were retrieved from electronic patient records. Patients were followed for 5 years or until death. Factors influencing overall survival (OS) were investigated by means of Cox regression. OS was compared using Kaplan-Meier estimations and the log-rank test.

Results
Liver metastases were diagnosed in 272/1026 (26.5%) patients within five years of diagnosis of the primary. Liver and lung metastases were more often diagnosed in left-sided colon cancer compared to right-sided cancer (28.4% versus 22.1%, p = 0.029 and 19.7% versus 13.2%, p = 0.010, respectively) but the extent of liver metastases were more extensive for right-sided cancer as compared to left-sided (p = 0.001). Liver metastatic left-sided cancer, including rectal cancer, was associated with a 44% decreased mortality risk compared to right-sided cancer (HR = 0.56, 95% CI: 0.39–0.79) with a 5-year OS of 16.6% versus 4.3% (p < 0.001). In liver metastatic CRC, the presence of lung metastases did not significantly influence OS as assessed by multivariate analysis (HR = 1.11, 95% CI: 0.80–1.53).

Conclusion
The worse survival in liver metastatic right-sided colon cancer could possibly be explained by the higher number of metastases, as well as more extensive segmental involvement compared with left-sided colon and rectal cancer, even though the latter had a higher incidence of liver metastases. Detailed population-based data on the metastatic pattern of CRC and survival could assist in more structured and individualized guidelines for follow-up of patients with CRC.

[boxhill]

One possible reason for the disparity in right vs left outcomes is that right side cancers are likely to be diagnosed later because they are later to produce identifiable symptoms. They are more likely to be sessile polyps, which are harder to find. They are more likely to be MSI-H and less likely to respond well to folfox and the other chemotherapies.

All of those things tend to explain the disparity **in 2008 and the preceding years**. Now, with the development of immunotherapies, which are vastly more successful in treating MSI-H disease, things have completely changed.

Here's an interesting newer article on the differences between left- and right-sided CRC:

https://www.ncbi.nlm.nih.gov/pmc/articl ... 2C%2039%5D.

This is a PERFECT example of why it's important to check dates and keep things in perspective when researching!

BTW, I know CRguy only cited the other article regarding the issue of percentages of those who develop liver mets. But as a person with right-side cancer, if I read the outcomes described in that article without an understanding of the contemporary context, I'd freak. (And when I was first diagnosed, I read plenty of stuff that suggested I ought to be dead by now. )

[CRguy]

This is a PERFECT example of why it's important to check dates and keep things in perspective when researching!

WORD !!!!!
So much information and research is ongoing, and being updated with a different focus, that we ALL need to keep attuned to the exact info which is relevant to our own sitrep ... AND to bring it to the forum to help others in the discussion.

Thanks boxhill !!!!

Cheers and Harmony
CRguy