Colorectal Cancer: Management of Stage IV Disease

  • Glenn T. Ault
  • Kyle G. CologneEmail author


Despite screening protocols, approximately 20% of colorectal cancer patients present with established distant metastasis (Siegel et al. CA Cancer J Clin, 65(1):5–29, 2015). Computed tomography (CT) scan or magnetic resonance imaging (MRI) generally detects this metastasis at the time of the initial staging of the cancer. Once the diagnosis of stage IV disease is made, a multidisciplinary team should plan appropriate curative or palliative therapy. Unfortunately for the clinician, there is enormous heterogeneity with respect to sites of disease, extent of disease and symptoms, performance status, and comorbidities in these patients. Stage IV patients have a range of presentation from the asymptomatic patient with a single metastatic lesion to the rapidly deteriorating patient with colon obstruction and advanced multiorgan metastases. While treatment algorithms may exist for some forms of metastatic disease such as a solitary liver lesion, others, especially for those with multiple sites of metastases, are still being defined. This chapter aims to provide a reference source for colorectal surgeons managing patients who present with metastatic stage IV colorectal cancer.


Metastatic colorectal cancer Liver metastases Ovarian metastases Multidisciplinary evaluation Simultaneous resection Metastasectomy Liver resection Chemotherapy Treatment strategy Radiofrequency ablation Hepatic artery infusion of chemotherapy HIPEC Peritoneal metastases Stents Tumor biology Performance status in elderly Frailty index in elderly Bone metastases Brain metastases Adrenal metastases Retroperitoneal metastases 

Copyright information

© ASCRS (American Society of Colon and Rectal Surgeons) 2019

Authors and Affiliations

  1. 1.Division of Colorectal Surgery, Department of SurgeryUniversity of Southern CaliforniaLos AngelesUSA
  2. 2.Department of Surgery, Division of ColorectalUniversity of Southern California Keck School of MedicineLos AngelesUSA

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