If i have colon or rectal cancer that has spread to the liver, should i have chemotherapy first?

Depends: Some patients undergo resection first and some undergo chemotherapy. These decisions are best made in conjunction with your medical team (surgeon, oncologist).

Dr Orr and another doctor agreed

Depends: There are too many variables to be able to give a succinct answer. Your team of physicians (oncologist, surgeon, primary care physician, etc.) collectively should be able to provide you with the best answer for your specific situation. Don't be afraid to ask questions.

Dr Orr agreed

Possibly: Different cancers (types) have different optimal treatment regimens. It may involve surgery in tandem with chemotherapy, radiation with chemo, or chemo only. You need to discuss your best options with your oncologist.

Find a good team: Colorectal cancer with spread to the liver is a hotly debated and controversial topic. Multiple variables include - the location of the tumor, the symptoms it is producing, the location of the liver mets and their potentail for surgical removal. You need an experienced team that deals with this commonly (surgical and medical oncologists, maybe rad onc, as well). Good ct/pet is vital.

Usually yes: Unless you have an impending obstruction or severe bleeding from the colorectal tumor, chemotherapy is generally the best way to start. Starting with an operation often delays the time until you can start getting the chemo. Surgery is effective for the bowel, but does nothing to address the liver disease. Chemo also kills tumor cells in your blood stream that can lead to tumors in other organs.

Depends: If the primary tumor is not producing severe bleeding or obstruction the most serious condition is the liver metastasis and should be treated first with chemo. Response to chemo will determine the next step which may be hepatectomy with or without colon resection. A colectomy will control primary disease but the metastasis will determine long term survival. No question about it.

Dr Berg and another doctor agreed