An approach to the newly diagnosed colorectal cancer patient with synchronous stage 4 disease.

At initial presentation, 20% to 30% of patients with colon and rectal cancer have detectable metastatic disease. Precise guidelines are lacking for the treatment of this special subset. Most of these patients have only hepatic metastases. Treatment recommendations for these stage 4 patients must take into account characteristics of the primary tumor, the potential resectability of the metastatic disease, and the proper role of chemotherapy and radiation therapy. Because of the tremendous variability of these characteristics, recommendations must be individualized. This article is a basic approach to the treatment of these patients.