Like most malignancies, colorectal cancer is an extraordinarily heterogeneous disease. From surgically curable early-stage tumors to almost uniformly lethal diffuse metastatic disease, the treatment and outcome of colorectal cancer runs a wide spectrum. Unlike most malignancies, this spectrum of treatment and outcome exists within the group of patients diagnosed with stage IV disease. Patients who have widely disseminated, multior-gan, metastatic disease are treated with palliative chemotherapy with a median survival of approximately 2 years. To add further complexity and heterogeneity to this, up to 10 % of patients treated with palliative chemotherapy survive 5 years, and the group of patients with resected liver and/or lung metastases have an associated 5-year survival rate of ~50 %. By contrast, ~1 in 5 patients who have limited and resectable liver metastases is cured by hepatic resection.4 Both early death and prolonged disease-free survival are therefore possible in patients with "stage IV" colorectal cancer.
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