Bowel cancer can spread through the body in a number of different ways. When cancer cells break away from the primary tumour in the bowel, they can travel around in the blood stream or in lymph fluid. We know that there is a common pattern in the way that bowel cancer spreads in the body. The name given to this kind of bowel cancer is ‘metastatic’ and each new area of growth away from the primary tumour is known as a ‘metastasis’.
Advanced bowel cancer commonly causes metastatic spread to the liver and/or the lungs. Sometimes, it can also spread locally into the abdomen. Less commonly, it may spread to the bones and brain.
Where is the liver?
If you place your right hand over the area under your ribs on the right side of your body it will just about cover the area of your liver.
The liver is connected to the first part of the small bowel (duodenum) by a tube called the bile duct. This duct takes the bile produced by the liver to the intestine.
The liver is made up of the larger right lobe and a smaller left lobe. It can also be thought about as eight different segments, based on its internal blood supply (see image below).
What does the liver do?
The liver is the largest gland in the body and has many functions, which include processing digested food and producing bile which is an important digestive juice. The liver breaks down the body’s waste products, which would otherwise build up to toxic levels. Many medicines are modified in the liver or, having had their desired effect, are broken down and removed. Additionally, the liver has an amazing ability to repair itself in a way that most organs (the heart, lungs and kidneys for example) do not. Following surgery it will re-grow to its original size in about three months.
Liver metastases are very common in people with advanced bowel cancer, but they are also becoming increasingly easier to treat. This is done using a combination of treatment options which can in some cases provide a real chance of long term survival from bowel cancer. The outcomes of treatment will depend on the pattern of spread of the disease, the number of metastases found and their position.
Conditions that can make liver metastases more difficult to treat include:
- tumours that sit close to major blood vessels
- lots of small metastases scattered across both lobes of the liver
- underlying problems with the general condition of the liver, including changes as a result of previous treatment.
Treatment for liver metastases
When bowel cancer spreads to the liver, the national treatment guidance states that you should automatically be referred to a specialist liver consultant. His/her opinion will be taken into account by your multidisciplinary team when they consider your treatment options. If you are referred for liver treatment, your liver multi-disciplinary team is likely to include:
- hepato-biliary surgeons: surgeons who specialise in operations on the liver
- hepatologists: doctors who specialise in diagnosing and treating liver disease
- hepato-biliary nurse specialists: nurses who have specialised skills in caring for patients with liver cancer and/or liver disease.
Patients with tumours in the liver which could be operable if they were successfully shrunk down can be given chemotherapy and targeted therapies (also sometimes referred to as monoclonal antibodies).