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'Secondary’ cancer: See a surgeon before starting chemotherapy for ‘liver mets’

Dilip Kittur, MD (left), and Ajay Jain, MD.

Dilip Kittur, MD (left), and Ajay Jain, MD, perform up to 40 liver surgeries a year, making Upstate a high-volume center.


Medical progress in the last decade or so has improved the survival chances for people whose colorectal cancer has spread to the liver. Today, surgery may provide a cure – depending on the steps a patient takes after diagnosis.

Blood that leaves the colon circulates through the liver via the portal vein. It is through this large blood vessel that colorectal cancer cells can spread to the liver. Up to 70 percent of patients with cancers of the colon or rectum will also develop tumors in their liver.

When that happens, the patient is said to have colorectal cancer liver metastases, also known as secondary liver cancer or liver mets.

The diagnosis may sound dire, and oftentimes, patients with liver metastases are offered only palliative chemotherapy with the goal of prolonging survival. But a growing body of evidence shows that some patients can survive for long periods of time or be cured by having their colorectal liver mets surgically removed.

Such surgery can be challenging, which is why patients need to find experienced doctors who frequently operate on the liver. Dilip Kittur, MD, and Ajay Jain, MD, hepatobiliary and pancreatic surgeons at Upstate, perform up to 40 liver surgeries per year, making Upstate a “high volume” center.

The timing of surgery in relation to other treatment is critical.

“Someone who has liver mets should be seen by a surgeon before they start chemotherapy, to see whether surgery is an option now or maybe in the future,” Jain says. “Preoperative consultation allows the surgeon and medical oncologist to plan how much chemotherapy should be given and when.”

Kittur says that “too often, patients receive too much chemotherapy in advance, leaving their livers congested and in no condition for surgery. That ruins the patient‘s best chances for a cure.”

Cancer experts say surgery provides up to 40 percent of patients with five or more years of survival. Radiation therapy or chemotherapy are treatment options, too, but their success rates are lower.

Ideally, a patient‘s oncologist would collaborate with a surgeon early on, says Jain. He and Kittur work closely with oncologists throughout Central New York to develop individual treatment plans for each patient.

spring 16 cancer magHLOA logoThis article appears in the spring 2016 issue of Cancer Care magazine. Hear a radio/podcast interview with Jain about the latest techniques surgeons use to fight cancer and other diseases of the liver, pancreas, gallbladder.