Liver first?? Intestine first?? Or Together?? What should be the ideal treatment strategy in treating simultaneously detected intestinal cancer, which it’s spread to liver

In my yesterday’s post I have just briefly explained that intestinal cancer with spread to liver can be treated but do the confusion ends here??

If one is detected with intestinal cancer that is spread to liver at the same time confusion arises.

What to treat first?? Should we treat intestine cancer first and its spread to liver at a late date?? Or should we treat intestine first and liver at a later date or should we treat them simultaneously??

Recent researches have shown that intestinal cancer cell first reach liver and then to rest of the body so if we want to treat the patient we have to stop cancer from spreading to other part of the body.

So if possible we have to treat liver cancer first which is known now a days as “LIVER FIRST APPROACH”

 what is the liver first approach mean?? Does it mean that surgically remove every tumor that is surgically removable (i.e we can keep 20% of the healthy liver)

Well answer is yes and no. I mean jury is still out some surgeons believe that before attempting surgery patient are given 2-4 doses of liver specific chemotherapy (mind well liver specific chemotherapy) and if tumor remains same or decreases you should immediately go for surgery but if tumor increases in size or number that indirectly suggest that tumor is very aggressive biologically and surgery is not going to help much where as some believe that as surgery is the only chance of cure every surgically resectable disease should be offered surgery regardless of tumor biology.

What to do if 20% of liver cannot be saved??

Well answer is still the same. Start liver specific chemotherapy and resect the disease as soon as it becomes surgically resectable.

So after liver resection is completed after some time you can resect intestinal primary cancer. Intestinal cancer should be given radiotherapy in the mean time to arrest its growth.

When to resect intestinal cancer first??

However there are certain exceptions to this approach. When ever there is complicated intestinal cancer, i.e. if intestinal are occluded (obstructed) or ruptured you have to deal with intestinal cancer first.

When to resect both the things simultaneously??

 Simultaneous resection is a major surgical procedure with very high risk. How ever when liver disease is limited and patient is young, physically very fit this option can be considered with evaluating due risks.

 Liver post tumor removal