Colorectal Cancer and Liver Metastases : determinants of outcome

Colorectal cancer (CRC) is one of the most common forms of cancer with annually, 1.36 million new patients and 694 000 deaths. The liver is the most common organ affected by metastatic disease. Disease staging is performed by the TNM classification system and therapeutic strategies are based on this system. Following international guidelines, patients with stage II CRC are not offered adjuvant chemotherapy after surgical resection of the primary tumor, while 25-30% of the patients will develop distant metastases. For stage III CRC patients adjuvant chemotherapy is part of the standard care. Unfortunately, only a small portion (5-15%) of these patients will benefit from this therapy with is accompanied by toxic side effects. The existing tools for identification of individual patients with high risk for disease recurrence are not sufficient, therefore regular follow-up visits plus blood analyses and liver imaging are necessary. This thesis discusses clinical and biomarker approaches to determine the outcome of patients with colorectal cancer and patients with colorectal liver metastases