What Is Stage IV Colon Cancer With Metastasis To The Liver?

When you learn that you or a loved one has colorectal cancer that has already spread to the liver, that news can be devastating. However, there are many ways to successfully treat some liver cancers that started in the colon or rectum, and there are several options for managing pain and controlling symptoms. 

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What to expect when colon cancer spreads to the liver

Metastatic colon cancer, or colorectal cancer that has spread to other parts of the body, most commonly appears in the liver first. From there, it may spread to other organs throughout the body.

When you are diagnosed with colorectal cancer, it’s important to determine its stage. Colorectal staging¹ is an essential part of detection and diagnosis and each stage reflects the growth of cancer throughout the body. 

When colorectal cancer spreads to the liver, this is referred to as stage IV colorectal cancer² with liver metastasis³. If the metastasis is restricted to only one site (such as the liver), the disease is classified as stage IVA. If cancer is stage IVB, it has metastasized to two or more sites; stage IVC is if it has spread to the lining of the abdominal cavity (peritoneum).


When colorectal cancer spreads to the liver, you may have no symptoms before it's detected.

On the other hand, you may experience several of these symptoms:

  • Blood in the stool

  • Fever

  • Pain in the right side of the abdomen

  • Itching

  • Jaundice

  • Stomach swelling or bloating

  • Weight loss

  • Fatigue

  • Sickness or nausea.

Learn more about the symptoms of colon cancer.

Treatment options

There are various treatments available to treat colon cancer that has spread to the liver. Your doctor will probably try a combination of methods that are tailored to your specific case. 


Surgical removal of the liver metastasis is possible in approximately 25% of the patients with liver-only metastatic disease.

Surgery is a limited option for many patients with colorectal cancer that has metastasized to the liver. As a result, there are specific guidelines⁴ for when surgery can be used. Patients may not be a candidate for surgery, depending upon the following factors:

  • Tumor size, or location

  • Presence of multifocal⁵ tumors (multiple tumors originating from the same cell) in the liver

  • Not enough liver to safely remove the cancers (liver reserve). 

Any pre-existing medical conditions are also taken into account. When surgery is possible, it is the first option for eliminating cancer.

In patients with four or fewer metastases, the five-year relapse-free survival rate after surgery ranges from 24-58%. If surgery is not possible, the treatment options include chemotherapy and loco-regional treatments (see below).


Chemotherapy is the main treatment option when cancer has spread too far to be surgically removed. After chemotherapy treatment, 10-20% of inoperable tumors may be converted to operable, and potentially curative surgery could be performed. The five-year survival rate for systemic chemotherapy alone, however, is less than 11%. 

Radiation therapy

Radiation therapy is normally utilized to control the growth of liver metastasis when surgery is not possible. That is because the lesions are too large for treatment with ablation (see below) or after the patient has failed multiple cycles of systemic chemotherapy.

There are specialized forms of radiation therapy that can be offered, such as:

  • Stereotactic radiotherapy, in which precisely targeted radiation beams are delivered to the tumor, minimizing radiation to adjacent normal tissue. 

  • Selective internal radiotherapy, which uses resin microspheres to deliver radioactive isotopes to the tumor via the hepatic artery.

Hepatic intra-arterial chemotherapy

In this treatment, a chemotherapy drug is administered directly into the hepatic artery, one of the two blood supplies to the liver. This treatment is designed to destroy cancer cells in the liver without harming the healthy liver cells. 


This process entails injecting substances into the blood vessels to block or reduce the blood flow to cancer cells present in the liver. 


This method uses alcohol, radio frequencies, or microwaves, to target and kill cancer cells. It leaves the tissues immediately surrounding the tumor more or less intact. 

Palliative care

Sometimes colorectal cancer of the liver has advanced to the point that it may not respond to the above treatments. Under these circumstances, your cancer care team may suggest palliative care, which focuses on reducing symptoms and managing pain.  


Below are some statistics on colorectal cancer in general as well as colorectal cancer that has spread to the liver:

  • Estimated new cases⁶ of colorectal cancer in 2021: 149,500

  • Estimated new deaths of colorectal cancer in 2021: 52,980(1).

Approximately 14 to 18% of patients⁷ with colorectal cancer are found to have cancer cells that have spread or metastasized at their initial medical consultation.

According to the NIH, about 20 to 30% of patients with stage 4 colorectal cancer have cancer confined to the liver. Cancer in these cases can be treated with surgery. However, stage IV colorectal cancer patients who receive no treatment have a median survival of five to 20 months.

Survival rates

According to the NIH, if cancer goes untreated, the median survival of metastatic colorectal patients (patients with stage IV colorectal cancer) is less than eight months from the time of diagnosis. However, when a colorectal cancer patient with cancer that has spread to the liver (but not beyond) is treated, the patient may have a 40-60% chance of surviving an additional five years⁸.

In other words, patients with the highest chance of surviving stage IV colon cancer are those whose cancer is limited to the liver. They may be able to have surgery to remove tumors from the liver.

The lowdown

Outcomes can vary after a diagnosis of stage IV metastatic colorectal cancer. Your treatment and prognosis depend upon how far cancer has spread. If your cancer is diagnosed before it spreads beyond the liver, surgery is an excellent option. It may remove all cancer, giving you a chance of prolonging your life by five years or more.

If cancer has already spread beyond the liver, there are several non-surgical treatments available designed to target cancer, reduce pain, and in some cases prolong your life.

Contact your physician for more information on diagnosis, treatment, and prognosis for metastatic colon cancer.

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