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Understanding Colorectal Liver Metastases (CRLM)

Learn about a diagnosis of colorectal cancer that has spread to the liver, and potential treatment options.

How does colorectal cancer form and spread?

Tumors first form in the inner lining of the colon or the rectum (parts of the digestive system). As with many cancers, if the tumors have spread beyond the origin, patient treatment can become more complex and challenging. The main location of spread of colorectal tumor cells is to the liver.

Focusing treatment on the liver can help when colorectal cancer has spread to the liver

Common symptoms of colorectal liver metastases

When colorectal cancer metastasizes (spreads) to the liver, symptoms may come from the original cancer in the colon/rectum and from liver involvement. Some people have few or no symptoms early on, but as the cancer progresses, symptoms may include:

Colorectal or digestive symptoms from the primary cancer:

Changes in bowel habits (diarrhea, constipation, or narrowing of stool)
Blood in stool (bright red or dark color)
Abdominal cramping or pain
Feeling that the bowel does not empty completely

Liver-related symptoms

Abdominal pain or discomfort
Jaundice (yellowing of the skin and eyes)
Dark urine and pale stools
Itchy skin

General/systemic symptoms

Unexplained weight loss
Fever or fatigue
Nausea and vomiting

If you are diagnosed with colorectal cancer, scans can determine if the cancer has spread to your liver

Healthcare professional speaking with a patient during a consultation in an exam room.

Diagnosis of colorectal liver metastases

The diagnosis of colorectal cancer liver metastases involves two parts – first the diagnosis of the primary colorectal cancer, and then the determination that it has spread to the liver.

A colonoscopy may be performed as part of routine screening, due to family history, or because of digestive-related symptoms. This colonoscopy can determine if there is a mass in your colon or rectum.

If there is a mass, then a biopsy may be performed to take cells from the mass, examine them, and determine if the cells in the mass are cancerous.

To see if the cancer may have spread beyond the colon/rectum, imaging tests may be performed. These imaging tests include ultrasound, CT scans, or MRI. The main location of spread of colorectal tumor cells is to the liver.

Treatment options for colorectal liver metastases

Doctors consider multiple treatment options for colorectal cancer that has spread to the liver, depending on the nature of the tumors and where it has spread. A Patient Educator can talk with you about the specialists who are available to discuss your options with you. These options may include liver-directed therapies, surgery, or systemic therapies.

Liver-directed therapies

HAI therapy, which delivers medicine continuously and directly to the liver, using an implantable pump.
Y-90 therapy that precisely treats tumors in the liver by delivering millions of tiny beads containing Y-90 radiation directly to the blood vessels that feed the tumors.
Ablation therapies that use heat or other methods to treat tumors.
In some cases, liver-directed therapy may be used to shrink the tumors to a point where they can be resected (removed by surgery) at a later time.

Surgery

Surgery to remove tumors in the liver, known as resection, may be possible depending on the size and location of the tumors.
Seeing a surgeon early in your treatment journey can help you evaluate your full set of treatment options. The surgeon can help you understand if you may be a candidate for surgery now or in the future.
Some patients may become candidates for liver transplant, which replaces a diseased liver with a healthy donor liver.

Systemic therapies

Systemic chemotherapy is often considered as a first-line treatment following diagnosis. Your doctor can describe the systemic chemotherapies that may be available to you.
Targeted therapies focus on specific pathways that cause cancer to grow. Molecular targets that may be evaluated for colorectal cancer include KRAS, BRAF, and HER2.
Immunotherapies harness the body’s own immune system to go after cancer cells. Biomarkers that may be evaluated to determine candidacy for immunotherapy include MSI and TMB.
Combination therapy, combining more than one of the systemic therapies described above, may be considered for some patients.

Important facts about colorectal liver metastases

3 in 4 patients younger than age 50 diagnosed with colorectal cancer are diagnosed in the advanced stage.¹
Care for colorectal liver metastases involves a multidisciplinary team, including surgical oncologists, medical oncologists, infusion nurses, and interventional radiologists.

Take the next step

A brief quiz can help you understand if liver-directed therapy may be an option.

Take the quiz

References:

1. Siegel RL, et al. Leading Cancer Deaths in People Younger Than 50 Years. JAMA. 2026. doi:10.1001/jama.2025.25467.

Important Safety Information for HAI

The Intera 3000 Hepatic Artery Infusion Pump is used to deliver medications such as chemotherapy to the blood vessels in the liver. With all medical procedures, there are risks associated with the procedure to place the pump in your abdomen and with the use of the pump to deliver medications. The risks associated with placement and use of the pump include but are not limited to bleeding, blood clots, blockage within the device, damage to the blood vessels, fluid or blood build-up around the device under the skin, infection, movement or displacement of the pump or catheter, pump damage, and leakage or incorrect delivery of the medications. Special care may be required after placement of the Intera 3000 Pump and includes but is not limited to avoiding rough physical activity, avoiding deep sea or scuba diving, avoiding saunas, avoiding long periods in hot tubs and avoiding direct sun exposure, heating pads or hot water bottles over the area of your abdomen where the pump is placed. Additional care may be needed for air travel, moving to or visiting a high-altitude place, or if you have a fever. The Intera 3000 Pump is MRI Conditional, which means that certain conditions must be met to safely have an MRI after placement of the pump. Be sure to talk with your doctor so that you thoroughly understand all of the risks and benefits associated with the use of the device. PI-2257307-AA

Important Safety Information for TheraSphere

TheraSphere Microspheres are small radioactive glass beads that treat liver cancer. With all medical procedures, there are risks associated with the procedure and the use of the device. Although the radioactivity continues to go down over time, the glass beads will remain permanently in your liver. The risks include but are not limited to • Bleeding from the stomach or intestines • Fatigue (feeling very tired) • Fever • Infection • Loss of appetite • Mild abdominal discomfort • Nausea • Radiation damage to other locations (including but not limited to lungs, gallbladder, stomach, intestines) • Stomach or intestinal ulcer • Temporary changes in liver and blood tests • Vomiting. Rarely the treatment may cause worsening of your liver function that could lead to liver failure and death. Tell your doctor if side effects continue or get worse. Be aware that some side effects may last longer or, rarely, become permanent. Everyone responds differently to their treatment. These are not all the possible side effects you may feel. Contact your doctor if you experience any side effects. Be sure to talk with your doctor so that you thoroughly understand all of the risks and benefits associated with the use of the device. 97574929