New Stage 4 Colorectal Cancer Treatments Offer Hope

One of the first things specialists do after diagnosing colorectal cancer is see if cancer cells have spread beyond the local area of the tumor. If so, it means you have metastatic colorectal cancer (also known as stage 4 colorectal cancer).

At the time of initial colorectal cancer diagnosis, an estimated 1 in 5 people has cancer in other parts of their body. And 1 in 4 people has cancer cells in nearby tissue or lymph nodes (what’s known as localized cancer). There’s a higher risk of localized cancer advancing into stage 4 cancer.

“The liver is the most commonly affected organ,” says Lauren Dias, MD, a gastrointestinal medical oncologist at Mass General Cancer Center. “Cancer cells can also spread to other organs and distant lymph nodes in the upper abdomen and chest.”

Colorectal cancer on the rise

Colorectal cancer is the third most common cancer in the United States. More than 107,000 Americans will receive this diagnosis in 2025. Rates of colorectal cancer in young adults are increasing as well. The Center for Young Adult Colorectal Cancer cares for patients younger than 50.

It can be hard to learn you or a loved one has stage 4 cancer. But thanks to treatment advancements, this disease is more treatable than ever.

“An estimated 20% of patients with metastatic colorectal cancer are alive 5 years after receiving a diagnosis,” says Dr. Dias. “Previously, only about 1% of people could expect to live that long. In select cases, metastatic colon cancer can be cured.”

Treatments for stage 4 colorectal cancer depend on where cancer cells have spread in the body. Most people get chemotherapy to destroy cancer cells. Chemo can also shrink metastatic tumors, making it easier and less risky for surgeons to remove them. Some patients get chemotherapy or radiation therapy (or both) after surgery to destroy any lingering cancer cells. This is known as adjuvant therapy.

But colon cancer specialists are more aggressive with treatments — and have more options — than a couple of decades ago.

Drug pump for liver mets

Hepatic artery infusion (HAI) is a newer treatment that directly targets liver metastases (liver mets), which occur in 1 in 3 people with colorectal cancer. For this treatment, a surgeon places a pump into the body. The device delivers a powerful dose of medication into the hepatic artery that carries blood to the liver. The chemotherapy in an HAI pump is up to 400 times stronger than standard chemotherapy.

HAI helps when there are multiple tumors, or a tumor is too large or in a location too risky for a surgeon to remove it. If a large tumor shrinks enough, you may be able to have surgery. But even if you’re not, research suggests the treatment can improve your quality of life. It may add up to 2 years to your life.

“Because chemotherapy goes directly to your liver — and your liver does a great job breaking it down — you often don’t have severe nausea, fatigue, and other side effects that occur when the drug flows throughout your body,” says Dr. Dias.

Liver transplants cure liver mets

Starting in 2025, patients who meet certain criteria can get a liver transplant at the Mass General Brigham Liver Transplant Program. “Select patients are potentially cured by removing a liver with metastatic tumors and replacing it with a cancer-free liver,” says Dr. Dias.

If you have stage 4 metastatic colorectal cancer, you may qualify for liver transplantation if:

• A surgeon successfully removed the primary colon cancer
• You have metastatic tumors only in the liver that shrink with chemotherapy
• You have liver tumors that a surgeon can’t remove

Drugs that target cancer cells

New immunotherapy drugs are also proving to be an effective way for providers to treat stage 4 colorectal cancer. These drugs are especially helpful for people who have inherited conditions like Lynch syndrome that increase colorectal cancer risk. The drugs help the immune system find and destroy cancer cells that have certain gene changes (mutations).

There are also targeted therapy drugs that find and destroy cancer cells that have certain gene or protein changes.

Mass General Cancer Center patients can also participate in clinical trials. With clinical trials, you can try promising new drugs still in development.

“Not too long ago, stage 4 colorectal cancer was considered a terminal illness,” says Dr. Dias. “But new treatment discoveries continue to improve patient outcomes and survival rates. There are many reasons to be hopeful.”