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Metastatic colorectal cancer (Stage IV) is the most advanced stage of the disease where the cancer has spread to distant organs such as the liver or lungs. Recurrent colorectal cancer means that the cancer has come back again after treatment .

Treatment of stage IV and recurrent colon cancer may include resection of the affected area of the bowel either to remove the cancer or bypass the tumor and anastamosis (reconnection of the ends). Surgery may also be recommended to remove parts of other organs, such as the liver, lungs, and ovaries, where the cancer may have recurred or spread. Radiation therapy, chemotherapy and/or targeted/biologic therapies may be offered to some persons as palliative therapy to relieve symptoms and improve quality of life.

When colorectal cancer spreads (metastasizes), the liver is the most common site of metastatic disease. A small proportion (5%) of these liver metastases will be distributed within the liver in such a fashion that makes them amenable to surgical resection or ablation. Of those not thought to be resectable at the time of diagnosis, up to 30% of isolated metastatic lesions in the liver may be cured by surgical resection following the administration of irinotecan or oxaliplatin based combination treatments.

The aim of palliative systemic chemotherapy is to improve survival and quality of life in persons with advanced colorectal cancer. Because of its safety and tolerability, continuous infusion of fluorouracil had been the standard treatment. However, considerable progress has been made in the treatment of advanced colorectal cancer and therapy has changed from single agent therapy, to combination therapy, and, more recently, to sequential combination therapy. The use of triple combination therapies (i.e., irinotecan or oxaliplatin combined with infusional fluoruracil and leucovorin) given in various sequences can lead to significant improvement in overall survival and is becoming the new standard in palliative treatment.

Occasionally, chemotherapy may be administered directly into the hepatic artery, the main artery feeding the liver, to treat metastatic disease in that organ. This process is called chemoembolization. However, its use is limited because of side effects which include chemical hepatitis, cholangitis (infection of the common bile duct into the gallbladder), complications related to the catheter used for administration, and the high cost of this procedure.

Radiofrequency ablation uses microwave technology to help destroy metastatic colorectal cancer cells such as those that have metastasized to the liver. The procedure sends radiofrequency (electrical) energy with ultrasound guidance to liver tumors through a special catheter placed within the center of the tumor. It can be administered during a surgical procedure or through the skin.