15 doctors weighed in:

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

15 doctors weighed in
Dr. Richard Orr
Surgery - Oncology
5 doctors agree

In brief: 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.

In brief: 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.
Dr. Richard Orr
Dr. Richard Orr
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Dr. Carlo Contreras
Surgery - Oncology
3 doctors agree

In brief: 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.

In brief: 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.
Dr. Carlo Contreras
Dr. Carlo Contreras
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1 comment
Dr. Benjamin Kim
Surgical resection of both the primary tumor and liver metastasis may be feasible and effective. You need an experienced multidisciplinary team to evaluate and customize your treatment.
Dr. Andres Katz
Surgery - Vascular
2 doctors agree

In brief: 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.

In brief: 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. Andres Katz
Dr. Andres Katz
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Dr. Lance Stein
Internal Medicine - Hepatology
2 doctors agree

In brief: Depends

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

In brief: Depends

Some patients undergo resection first and some undergo chemotherapy.
These decisions are best made in conjunction with your medical team (surgeon, oncologist).
Dr. Lance Stein
Dr. Lance Stein
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Dr. Kenneth Cheng
Family Medicine
1 doctor agrees

In brief: 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.

In brief: 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. Kenneth Cheng
Dr. Kenneth Cheng
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Dr. Andrew Carroll
Family Medicine

In brief: 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.

In brief: 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.
Dr. Andrew Carroll
Dr. Andrew Carroll
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