When Colon Cancer Spreads to the Liver New Treatment Options Offer Hope

In March of 2022, Ivette Claro-Iglesias learned that the constipation and bloating she had attributed to aging was actually colorectal cancer. She was 49. Soon after the diagnosis, she got more bad news: The cancer had already spread to her liver. “It felt like the world was crushing me,” she recalls.

Today, however, Ms. Claro-Iglesias is feeling energetic and like her younger self, thanks to an entire team of specialists at Baptist Health Miami Cancer Institute. Armed with innovative, new treatments and technologies, the team pulled together a multipronged approach to tackle her complex condition.

“In today’s day and age, there is no one physician who can manage every aspect of the patient’s care,” says Ripal Gandhi, M.D., an interventional radiologist with Miami Cancer Institute and Baptist Health Miami Cardiac & Vascular Institute. “There are so many different therapies available and often, by utilizing these therapies in combination, you get the best results for patients.”

Upwards of 70 percent of people who have colorectal cancer eventually develop secondary liver cancer, according to the American Cancer Society. With liver cancer numbers tripling since 1980, physician scientists continue their push to improve care and to raise awareness of the disease. October is Liver Cancer Awareness Month.

Typically, patients whose liver lesions can be removed surgically have better survival rates than those who cannot undergo surgery. But for many like Ms. Claro-Iglesias, surgery alone isn’t the answer.

Ripal Gandhi, M.D., an interventional radiologist with Miami Cancer Institute and Baptist Health Miami Cardiac & Vascular Institute

“The liver can regenerate,” Dr. Gandhi explains. That makes it possible for surgeons to remove a portion of the liver safely. “But you need to have at least 30 percent of liver left behind in the setting of prior chemotherapy so that the patient doesn’t go into liver failure. In her case, she had several tumors in the right side of her liver and a small tumor in the left side.” Doctors didn’t think there would be enough liver left after surgery to prevent Ms. Claro-Iglesias from going into liver failure.

Ms. Claro-Iglesias’s case was discussed at Miami Cancer Institute’s Tumor Board, a weekly meeting of medical and surgical oncologists, radiation oncologists, interventional radiologists, geneticists, pathologists and other cancer specialists who provide their expertise. The group agreed that a combination of therapies was most appropriate.

They included:

·       Portal vein embolization – During separate minimally invasive outpatient procedures, the blood supply to the part of the liver containing the tumors was blocked and blood was redirected to the healthy part of the liver so that it could grow large enough to make surgery possible.

·       Y90 radioembolization – In another minimally invasive procedure, tiny radioactive particles were injected into the liver to target and kill the tumors.

·       Laparoscopic surgery to remove a lobe of her liver.

·       Chemotherapy to help shrink the tumors.

Ms. Claro-Iglesias, who lives in West Kendall, also benefitted from treatment that put Institute physicians on the map in May, when they became the first in the U.S. to use Epione robotic technology ― robot-guided microwave ablation ― on a liver cancer patient. During the procedure, a needle is inserted through the skin and into the tumor to destroy it with microwave heat. Because of the proximity of this tumor to her heart and lungs, the procedure helped destroy the tumor without damaging the nearby organs.

“This was a very difficult procedure, but the robotic system allowed us to target the lesion safely, quickly and efficiently with a single stick. It’s very accurate,” Dr. Gandhi said.

Finally, in September, Ms. Claro-Iglesias had surgery to remove the cancer in her rectum. “Surgery went very, very good,” she said. “I’ve been so fortunate to meet all of these doctors. They’ve been amazing,” she said. Throughout her treatment, she continued working at her job as a property manager.

“She is full of life and always optimistic,” Dr. Gandhi said of his patient. “She has had a great, supportive family and a great attitude.” Ms. Claro-Iglesias likely will need additional treatment and follow-up.

In addition to Dr. Gandhi, Ms. Claro-Iglesias’s team included oncologist Fernando deZarraga, M.D.; hepatobiliary and pancreatic surgeons Horacio Asbun, M.D., and Domenech Asbun, M.D. (a father-son team); colon and rectal surgeon Luis Hernandez, M.D.; and radiation oncologist Michael Chuong, M.D.

“The multidisciplinary care that we offer, and our ability to provide more options thanks to the development of newer technologies and medications such as immunotherapies, is helping extend lives and maintain quality of life,” says Dr. Gandhi. The Institute also participates in research and clinical trials that are impacting patients now and in the future.