Advances in therapy, surgery extending lives of cancer patients

Some colorectal cancer patients with metastases only to the liver are having their lives extended by advances in treatment, say specialists in medical and surgical oncology at Ohio State University Medical Center.

In many cases, the patients have had tumors that most modern medical textbooks define as inoperable. But major advances in chemotherapy and in surgical techniques over the past five years have made previously inoperable tumors operable and greatly improved the possibility of cure for about 10 percent of these patients, says Dr. Mark Bloomston, assistant professor of surgery in the Division of Surgical Oncology.

Mark Bloomston, M.D.

“The traditional dogma of who shouldn’t get liver surgery is now being debunked,” says Bloomston, a specialist in liver and pancreas malignancies. “This means, of course, that it’s critical for physicians to correctly identify which patients may qualify for additional treatment.”

In determining the best treatment plan for each patient, Bloomston works closely with colleagues, such as Dr. Tanios Bekaii-Saab, assistant professor of hematology and oncology at Ohio State and a medical oncologist specializing in gastrointestinal cancer.

Both physicians, who are also researchers at the Ohio State University Comprehensive Cancer Center, stress the importance of multidisciplinary patient care. Each patient is seen by a team that includes a medical oncologist, a surgical oncologist, an interventional radiologist, and when needed, a radiation oncologist.

Colorectal cancer is the third most common cancer and the third leading cause of cancer-related mortality in men and women in the United States. About half of the 150,000 newly-diagnosed colorectal cancer cases this year will spread to the liver, Bloomston says.

“We almost always think of metastatic cancer as a death sentence,” Bekaii-Saab says. “But colorectal cancer that has spread only to the liver is one of the very few instances of metastatic disease with the potential for cure.”

The liver is one of the few solid organs capable of regenerating. “We can often remove up to 80 percent of the liver, and a year later, it will have restored itself to nearly normal size,” Bloomston says.

However, not every patient with colorectal cancer that has spread only to the liver is a candidate for liver surgery. At Ohio State, patients go through a rigorous screening process to make sure that their heart, lungs, and kidneys can withstand the treatments.

Bloomston and his colleagues are treating an increasing number of patients surgically. He says about 30 percent of patients with the disease are eligible for surgery.\

“We have some very effective chemotherapy and targeted agents that can shrink these tumors prior to surgery,” Bekaii-Saab says. “We can actually downstage the disease in a lot of patients who are deemed incurable, and give them a shot at a possible cure.”

Advances in surgical techniques make it possible to manipulate the liver. In some cases, Bloomston employs portal vein embolization, a technique that restricts blood flow to the portion of the liver to be removed and increases the flow to the healthy areas of the liver.

“We essentially block blood flow to the tumor-bearing portions of the liver, which then shrink,” Bloomston says. “We wait four to six weeks to operate, letting the part of the liver that wasn’t embolized to enlarge, which significantly improves the chances of a good recovery.”

The multidisciplinary approach and the advanced therapies are making a difference. “In the year 2000, patients with metastatic colorectal cancer survived an average of one year after diagnosis,” Bekaii-Saab says. “Today, it’s an average of three years. That’s something we’ve never seen before with metastatic disease. It’s revolutionary.” v