Colon cancer is appearing more often in younger adults, and many of those cases go undetected until the disease has already spread. Doctors are increasingly using aggressive, innovative treatments when cancer has metastasized, and one once-unthinkable option -- replacing the liver with a transplant -- is emerging for carefully selected patients.
Andrew Sweeney knew to be on the lookout for colon cancer.
“I had a family history of colon cancer. My mother had colon cancer when I was a child and passed away when I was 15.”
Because of that family history, his doctor scheduled him for earlier screening at age 31, 10 years earlier than his mother’s diagnosis.
“I actually had a colonoscopy scheduled,” Andrew said.
Shortly before the scheduled colonoscopy, he developed severe abdominal pain.
“I was getting my youngest out of her crib and I just simply couldn’t even lift her out of the crib. The pain was just so severe.”
He went to the emergency room and staff initially found nothing. Because of his family history, he pressed for more testing, doctors ordered a CT scan.
Sweeney described the moment he first saw the results on his phone.
“Sitting on that stretcher and I see the test results hit my portal on my phone. I pull it up and that’s when I see, you know, mass in the sigmoid colon, uh, you know, possible metastasis in the liver, uh, lymph node involvement. And I knew just then, I knew in my heart, I knew what that meant. And my jaw just dropped. I dropped my phone in my lap.”
He had his scheduled colonoscopy shortly after, and physicians confirmed the diagnosis of colon cancer.
A multidisciplinary team provided aggressive care, including surgery and chemotherapy. Sweeney wanted doctors who would fight hard, and he connected with specialists at the University of Michigan.
“I wanted to work with someone who was going to be aggressive, who wasn’t going to, you know, give up on me and thought that we could throw the kitchen sink at it.” He said.
Systemic chemotherapy shrank Sweeney’s liver tumors, but their location made removing only the tumors dangerous. That left transplant as an option for patients whose disease remains confined to the liver.
Dr. John Krauss, Sweeney’s oncologist at the University of Michigan, said institutions have begun offering liver transplants for colorectal metastases only in recent years because chemotherapy has improved the ability to clear disease outside the liver.
“For colorectal cancer, it’s just been over the last three to five years that institutions have started doing this (liver transplant), mainly because we have better chemotherapy to clear the rest of the body and metastasis.”
Dr. Krauss said doctors do not offer liver transplants to every patient whose colon cancer spreads to the liver.
“The first part is rigorously testing to make sure that there’s not cancer anywhere outside the liver. So the patients have to be on systemic chemotherapy for at least a year and not show any cancer outside the liver.”
Sweeney learned he was eligible for a transplant in the summer of 2023 and remained on the transplant list until he received the life-changing phone call on Jan. 7, 2024.
“It was January 7th. I remember it like it was yesterday. I was at the Detroit Lions game. They were playing the Minnesota Vikings. I remember getting home that night. We had our bags packed. We were going to make a whirlwind day trip to Houston to go see University of Michigan football team, playing in the national championship that year against Washington. I got the call right then.”
The transplant team successfully completed the surgery. Sweeney woke in the intensive care unit and noticed the Michigan game still on the TV.
“I remember kind of blinking through my eyes and my eyelids and looking up in the corner and seeing that little TV screen up there and there they were. It was Michigan in Washington. It was the 3rd quarter and Michigan was winning.”
Transplant patients must take immunosuppressive drugs to prevent organ rejection. Treatment teams balance the increased risk of cancer recurrence from immunosuppression against the potential survival benefit of transplant.
“The patients that I’ve seen after a liver transplant are living a pretty normal life. They have to take immunosuppression, which is much better than it used to be, and they’re off of chemotherapy. So that’s a really big thing. But I think the biggest thing was that people who got the liver transplant, who had liver-only disease, lived longer. That was just key.” Dr. Krauss said.
Andrew has had lung recurrences after the transplant, and they were successfully treated. Sweeney has been cancer-free for the past year.
Sweeney said, “At this point, I’m thinking about more than just months or years, you know, I’m thinking way beyond that.” He and his wife are expecting another child, and the transplant has shifted the family’s outlook toward longer horizons.
This approach remains rare and requires a large multidisciplinary team -- surgical oncologists, medical oncologists, transplant surgeons, radiation oncologists and transplant specialists -- plus rigorous screening to ensure cancer has not spread beyond the liver.
“It’s the wave of the future for some patients. A lot of patients have cancer that spread beyond their liver, and so they won’t be a candidate for that. Some patients are not well enough medically to get intensive chemotherapy, but for those patients with liver-only disease, I think it’s a very good option” Dr. Krauss says
More information can be found on the official Michigan Medicine website here.