Bowel cancer that has spread to the liver (colorectal liver metastases)

Bowel Cancer UK explains that when it spreads to the liver it is called liver metastasis and that this is the most common place for it to spread. The liver sits above the stomach on the right side of the body, underneath the ribs.

The cancer in the liver is still bowel cancer, made of bowel cancer cells, so it is treated as such and is different from cancer that starts in the liver itself. Liver metastases may be found at the time bowel cancer is first diagnosed or, in some people, later during follow-up scans.

The NHS explains that treatment for bowel cancer depends on the size of the cancer, whether it is in the colon or rectum or both, whether it has spread, whether the cancer has certain genetic changes, and your age and general health.

Liver metastases do not always cause symptoms of their own. The NHS lists the main symptoms of bowel cancer itself, which can include changes in your poo, blood in your poo, bleeding from your bottom, tummy pain, a lump in your tummy, bloating, unexplained weight loss and tiredness or breathlessness from anaemia.

The NHS advises seeing a GP if you have any symptoms of bowel cancer. It says to ask for an urgent GP appointment or get help from NHS 111 if your poo is black or dark red or you have bloody diarrhoea, and to call 999 or go to A&E if you are bleeding non-stop from your bottom or there is a lot of blood or large blood clots. Anyone already under cancer care who develops new severe symptoms should contact their specialist team or use NHS 111.

The NHS describes how bowel cancer is first assessed in a GP appointment, with a stool or FIT test, blood tests and an urgent referral for specialist tests if cancer is suspected. Imaging scans of the body are then used by the specialist team to check whether the cancer has spread, and liver metastases are usually seen on those scans.

Bowel Cancer UK says a biomarker test, which can be a blood test or a test on a sample of the tumour from a biopsy, can help find out whether targeted therapies could work for you. The results can influence which treatments are offered.

The NHS adds that bowel cancer treatments may include surgery, chemotherapy, radiotherapy and targeted medicines, and that targeted medicines or immunotherapy are sometimes used for advanced bowel cancer that has spread to other parts of the body.

Bowel Cancer UK says surgery to remove cancer from the liver is called a liver resection and that the surgeon will try to remove all of the tumour or tumours and leave as much healthy liver as possible. For some people half of the liver is removed, and in some a two-stage operation is used to remove tumours from both sides over two separate operations several weeks apart.

The charity says open surgery usually takes around five or six hours and keyhole surgery is not suitable for everyone. Liver surgery is always carried out in specialist regional hospitals, so you may need to travel. After surgery there may be a short stay in a high dependency unit or liver intensive therapy unit.

It also gives typical recovery times: with open surgery around five to seven days in hospital and six to eight weeks to recover, and with keyhole surgery around two to three days in hospital and three to four weeks to recover. Some people have chemotherapy or another treatment first, which does not mean surgery will definitely follow. Some people also have treatment to encourage the healthy liver to grow before surgery, called portal vein embolisation.

The NHS says that if advanced bowel cancer cannot be cured, the aim of treatment is to slow the growth and spread of the cancer, help with symptoms and help you live longer. It says finding out that cancer cannot be cured is very hard to take in, and that you will be referred to a symptom control or palliative care team who help manage symptoms and support you and your loved ones.

Not everyone with liver metastases is in that position. Bowel Cancer UK describes situations where chemotherapy or other treatment is followed by surgery, and where other liver treatments are options if surgery is not possible. Because outlook depends on the number and position of tumours, the response to treatment and general health, the specialist team is the place to ask what applies to you.

The NHS encourages people to talk to their specialist team about any questions or worries and points to Cancer Research UK and Macmillan Cancer Support for coping and end of life information.

On the NHS, treatment for liver metastases is agreed by a multidisciplinary team, with liver surgery concentrated in specialist regional centres, as Bowel Cancer UK explains. Chemotherapy, targeted therapy and follow-up are usually delivered closer to home.

Some people also consult a private liver surgeon or oncologist for a second opinion or faster access. The scans and the evidence base are the same, and complex liver surgery is carried out in specialist centres in both sectors. Ask which team will be responsible at each stage, and who to contact if symptoms change.