The liver is a common site for the spread of colorectal cancer because part of the blood supply leaving the intestine leads directly to the liver instead of first passing through the lungs.

Surgery

Surgery to completely remove certain liver tumors can result in five-year survival rates in 20 to 30 percent of carefully selected patients who experience liver metastases. At this time, between 11 and 30 percent of patients who experience spread of disease to the liver are found to have tumors that are suitable for surgery. The tumors most successfully treated with traditional surgical removal are:

• Those that affect only a small part of the liver
• No more than three tumors
• A few small tumors that are clustered very near each other
• Tumors with negative margins; that is, with two centimeters of normal liver tissue surrounding the surgical margin
• No other organs concurrently affected by colorectal cancer metastases; that is, no cancer outside the liver
• No liver tumors located very near large blood vessels or other vital organs

Cryosurgery

Cryosurgery, a freezing of the tumor to destroy it, may yield five-year survival rates of 20 percent among carefully selected patients. These patients are:

• Those with localized liver metastases that cannot be surgically removed owing to their location near major blood vessels or other organs
• Those with two lobes of the liver involved, but not more than three to four tumor nodules

Regional chemotherapy

Some studies have shown that chemotherapy with floxuridine (FUDR) directed only into the liver, and combined with surgery, may provide better results than surgery alone. This combination results in a higher rate of tumor regression and greater likelihood that the tumor can be removed surgically. The value of regional chemotherapy still is being assessed; not all researchers agree that it will result in longer survival.

Hepatic arterial infusion (HAI)

Liver metastases might also be treated with infusion of chemotherapy into the hepatic artery. This technique is a form of regional chemotherapy. A drug combination recently shown to be promising is floxuridine (FUDR) and dexamethasone infused into the hepatic artery, plus fluorouracil and leucovorin given systemically.

Tumor embolization

Clinical trials are underway to evaluate methods that cause blood clots within liver tumors. Deliberate formation of blood clots inside the blood vessels that feed liver tumors is also being attempted. Some research centers are combining this technique with infusion of chemotherapy into the hepatic artery.

Radiotherapy

Radiotherapy is used to control symptoms for inoperable liver metastases. The liver is quite sensitive to radiation; the dose that would be required to kill all cancer cells throughout the liver is higher than this organ can tolerate, resulting in significant radiotoxicity.

Radiofrequency ablation (RFA)

Another apparently promising method is the destruction of liver tumors using heat generated by high-frequency radio waves. Results with this technique have been inconsistent, however, and the method requires further study.

I had radiofrequency ablation (RFA) last month for a single 2.5 x 3.0 liver tumor. Excepting for the general anesthesia (I've always had spinals before), its impact seems less than having a wisdom tooth removed--actually a lot less.

I went to the hospital in the morning, and had hardly any prep at all. I just hung out with the surgical staff for 30 minutes or so waiting for the final lab tests to come back. Then into the operating room, awake for 30 seconds, then waking up in post-op 5 hours later.

As I understand it, most of the time was spent removing scar tissue and adhesions from my prior liver resection. I was back in my room in less than an hour, and was able to use oral medications immediately. Amazingly, no tubes. I could probably have escaped for dinner.

At about 5:00 PM my other surgical team who had performed bilateral wedge resection to my lungs a month before stopped by to say hi, asking when I was to have surgery. Even they seemed amazed that surgery had already happened, as I was walking around the floor by this time.

The night went quite well. I even slept for a while, although most of the time, sleeping in the hospital is not possible for me. They served me something that they called food for breakfast. I've built buildings out of more appetizing stuff. By 9:30 AM I was released.

I took a cab home. A great friend picked me up for lunch. I had a wonderful lobster salad at Fabrizio's in Larkspur. Within a day of the surgery!

Okay, I would have rather spent a day at Club Med, but as far as hospital procedures go, this truly was a walk in the park.