Colorectal cancer in the liver: New treatment gives more people hope for a cure

By Sharon Doering-Domanus

The third most common cancer in the U.S., colorectal cancer, begins in the colon or the rectum, parts of the large intestine. While colorectal cancer incidence has declined overall, the disease is on the rise in people younger than 50 and is often diagnosed at a later stage in this age group.

As colorectal cancer progresses, it can spread to other body parts — often to the liver. Colorectal cancer has already spread to the liver in 15% of people by the time they are diagnosed, and up to 60% of people with colorectal cancer will eventually have it spread to the liver, according to Cornelius Thiels, D.O., M.B.A., a Mayo Clinic surgical oncologist.

Some people with colorectal cancer which has spread to the liver — but nowhere else — can be cured with surgery. "Trying to get people to surgery is important because we know surgery is their best chance of a cure," says Dr. Thiels. However, not all patients are candidates for surgery.

Reasons a person with colorectal cancer that has spread to the liver might not qualify for surgery include:

• The tumor is too big for surgical removal.
• There are too many tumors in the liver.
• The tumor is in a place that makes it difficult to remove, such as near a large blood vessel.

Health care professionals are overcoming these obstacles with a new treatment called hepatic artery infusion pump chemotherapy that shrinks liver tumors, giving more people a chance for surgery. This treatment also can shrink tumors in the bile ducts inside the liver, called intrahepatic cholangiocarcinoma.

"Our goal is to expand the number of patients who could be offered curative treatment," says Dr. Thiels. "We are also aiming to reduce the risk of cancer recurring in people with high-risk liver tumors."

How does hepatic artery infusion pump chemotherapy work?

The hepatic artery carries oxygen-rich blood to the liver. A hepatic artery pump delivers chemotherapy directly into the liver’s blood supply. Because chemotherapy from the pump only reaches the liver, the approach can use higher doses to shrink liver tumors more effectively. "We can often achieve a higher response rate than conventional chemotherapy," says Dr. Thiels.

Pump placement is done under general anesthesia (sedation). During the procedure, surgeons insert the pump underneath the skin of the abdomen. A thin plastic tube called a catheter connects the pump to the liver through the hepatic artery. In some cases, doctors will place the pump using robotic surgery. 

After a surgeon places the pump, it is filled with chemotherapy every two to four weeks. The pump delivers chemotherapy to the liver throughout treatment, which typically lasts six months. "We can now treat tumors that are not responding to normal chemotherapy, or tumors that are responding but we need a better response," says Dr. Thiels.

Who is eligible for hepatic artery infusion pump chemotherapy?

Mayo Clinic uses hepatic artery infusion pump chemotherapy for select adults whose cancer has spread to the liver. People best suited for pump chemotherapy include:

• People whose colorectal cancer has spread to the liver but whose liver tumor(s) cannot be removed with surgery. They may or may not still have their primary tumors in place, and they must have minimal other disease outside of the liver and their primary tumor.
• People whose colorectal cancer has spread to the liver and whose liver tumor(s) can be removed with surgery, but who have a high risk of cancer recurring in the liver. These people may have tumors that disappear, multiple tumors, tumors that recur after surgical treatment or ablation, or cancer that continues to progress after chemotherapy.
• People with tumors in the bile ducts inside the liver, called intrahepatic cholangiocarcinoma, whose cancer cannot be treated with surgery. Their cancer cannot have spread outside the liver.

At Mayo Clinic, a specialized team of medical and surgical oncologists, including Dr. Thiels or one of his colleagues, meets with people to evaluate them for hepatic pump chemotherapy. Evaluation includes specialized scans and diagnostic tests to assess the cancer stage, type and location. Health care professionals use these factors, along with a person's liver function and overall health, to determine eligibility for the pump.

Care teams often use hepatic artery infusion pump chemotherapy when people have exhausted all other treatment options. It is often used alongside other systemic therapies, which are treatments that travel through the blood to affect cells all over the body. "Most importantly, hepatic artery pump chemotherapy opens up the potential for curative options for patients who did not have those options before," says Dr. Thiels.

Learn more

Watch Dr. Thiels discuss hepatic artery infusion pump chemotherapy in this video:

Learn more about colon cancer, rectal cancer and intrahepatic cholangiocarcinoma.

Find a colon cancer, rectal cancer or intrahepatic cholangiocarcinoma clinical trial at Mayo Clinic.

Join the Colorectal Cancer Support Group on Mayo Clinic Connect.

Also, read these articles:

• "Answers to 4 questions about colorectal cancer treatment and survivorship"
• "Gen Z and Millennials: Do you know the signs of early-onset colorectal cancer?"
• "What to know when colorectal cancer runs in the family