# Symptoms and stages of metastatic colorectal cancer
Metastatic colorectal cancer (metastasized colorectal cancer) means that cancer cells have spread from the colon to other organs. The course of the disease depends on where the metastases are located, how quickly they grow, and how the body responds to them. Below is a description of how the disease usually develops and what symptoms come with it.
Local disease in the colon (before metastases occur)
Before colorectal cancer metastasizes, the tumor first grows in or through the colon wall. In this phase, symptoms can already develop that lead people to see their general practitioner.
**Most common complaints: **
- Changes in bowel habits: chronic diarrhea, stubborn constipation, or alternation between the two
- Blood in stool (usually visible dark or mixed with stool)
- Crampy abdominal pain or discomfort in the abdomen
- Unexplained fatigue and weakness
- Unintended weight loss
- Feeling that the bowels do not empty completely
In daily life, these symptoms can lead to social discomfort (rushing to the toilet, unexpected diarrhea), caution with eating, and increasing worry. Many people feel run down or tired without a clear reason.
When the tumor grows larger and potentially grows through the colon wall, these complaints can worsen. Sometimes constipation also develops or even a bowel obstruction (blockage), which requires acute intervention.
Stage with metastases to the liver (most common)
This is the most common place where colorectal cancer metastasizes. Liver metastases can be small and without symptoms, or larger and noticeable.
**Symptoms that can occur in this stage:**
- Persistent fatigue and lack of energy (very frequent)
- Unwanted weight loss and weakness
- Abdominal pain, particularly on the right side under the ribs (where the liver is)
- Bloating or fullness in the abdomen
- Nausea or reduced appetite
- Sometimes yellowing of skin and eyes (jaundice), especially if the metastases press on the bile ducts
- A palpable swelling sometimes in the upper right abdomen
- Swelling of legs or feet (less frequent, depending on location of metastases)
In daily life this often means difficulty functioning normally: less energy to care for yourself, harder to go to work, canceling appointments. Food becomes less appealing and getting nutrition becomes an effort.
**Figures for this stage:**
- Liver metastases occur in approximately 25-30% of colorectal cancer patients at the time of diagnosis, and in another 30-40% of patients who later metastasize (source: various oncological cohort studies, 2020-2024).
- Median survival for patients with liver metastases was estimated in earlier studies at 18-24 months without treatment, but can extend significantly with modern chemotherapy and targeted therapies (source: Surveillance, Epidemiology, and End Results data, USA, 2015-2022).
- In patients undergoing surgical removal of liver metastases ('resection'), remission rates and long-term survival are more favorable, but this is not possible for all patients.
*Important: these figures are averages across large groups. Individual outcomes vary greatly depending on factors such as number and size of metastases, suitability for surgery, how well the tumor responds to treatment, and the overall health of the patient.*
Stage with metastases to lungs, peritoneum or elsewhere
Colorectal cancer can also metastasize to the lungs, peritoneum (peritoneum), brain or bones. This occurs less frequently than liver metastases, but produces different symptoms.
**Metastases to the lungs:**
- Persistent cough
- Shortness of breath, even with minor exertion
- Sometimes chest pain
- Reduced exercise tolerance
- Fatigue
**Metastases to the peritoneum:**
- Palpable abdominal swelling (ascites — fluid accumulation)
- Abdominal pain
- Nausea and quick feeling of fullness
- Abdominal tension, difficulty bending or sitting upright
- Increase in bowel complaints
**Metastases to bones:**
- Bone pain, particularly in the spine, pelvis, or large joints
- Fatigue (cancer drains you)
- Sometimes swelling or palpable hardness
**Metastases to the brain (rarer):**
- Headache
- Balance disorders or coordination problems
- Changes in memory or concentration
- Sometimes seizures
In daily life, these symptoms have major consequences: breathing can become strenuous, pain limits movement, and overall exhaustion makes normal activities increasingly difficult.
**Figures for this stage:**
- Lung metastases occur in approximately 15-20% of patients with metastatic colorectal cancer (source: Dutch Cancer Registry and ESMO guidelines, 2020-2024).
- Peritoneal metastases occur in 5-15% of patients and generally have a more difficult course (source: surgical oncology researchers, 2019-2023).
- Median survival with lung metastases was historically 12-18 months, but can be longer with additional chemotherapy (source: registry studies, 2015-2022).
*Here too: these are population averages. Prediction for one person is impossible and depends on many individual factors.*
Phase with advanced disease and progression despite treatment
As the disease progresses and treatments lose their effectiveness, a phase emerges in which multiple complaints can occur simultaneously.
**Predominant symptoms:**
- Severe and persistent fatigue (cancer fatigue), independent of rest
- Unintentional weight loss that cannot be stopped
- Reduced appetite and weakness
- Concentration problems and mental fog
- Persistent pain in various locations
- Sometimes depressive feelings or worry
- Fluid retention (swelling of legs, abdomen, face)
- Breathing difficulties
- Possibly diarrhea or constipation, depending on where the cancer grows in the body
- Sometimes inflammation of mouth lining or difficulty swallowing
In daily life, independence becomes increasingly difficult. Washing, dressing, cooking — this requires preparation and help. Social contacts decrease due to fatigue. Sleep can become disrupted.
**What we are cautious about with numbers:**
- Survival in this phase strongly depends on when palliative care and supportive care are properly established. Studies from 2020-2024 show that early contact with specialized palliative care (not only at the end, but at an earlier stage) can help maintain quality of life.
- The moment when someone reaches this phase varies greatly. Some stabilize for months; others experience rapid decline.
When to contact your healthcare provider
With someone who has metastatic colorectal cancer, regular contact with the treatment team is essential. Call or email your doctor immediately if you experience:
- **Acute:** inability to eat or drink anything, severe abdominal pain, unexplained coughing up blood, sudden shortness of breath, loss of consciousness, or severe confusion
- **Rapid deterioration** of fatigue, pain, or mobility within days
- **Signs of inflammation:** fever, swollen abdomen with significant pain, redness or warmth on skin
- **Medication side effects** that you can no longer handle
- **Emotional distress:** depression, anxiety, or feeling that you cannot cope — the team can help you with this too
- **Practical questions** about treatment, hospital visits, or family caregiving
Regular consultation with your treatment team — doctor, nurse, possibly dietician or psychologist — helps manage symptoms and keep your life as much as possible in your own hands.
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_This information never replaces a doctor's judgment. Always discuss your situation with your own healthcare provider._