Nearly 15% of all cancer deaths in the United States are caused by colorectal carcinomas, and nearly 98% of these are adenocarcinomas. They are generally curable by resection, however, in this patient with Duke's class D stage cancer because of the distant metastasis to the stomach, duodenum, and portal vessels, he unfortunately falls into the 25-30% of patients with colon cancer that has spread beyond the realm of curative surgery. The 5 year survival rate for patients with advanced gastric cancer remains below 10%. In general, for Duke's class D patients the 5 year survival rate is less than 23%.

The pre-operative management of patients found to have colon cancer usually includes a colonoscopy or barium enema to look for synchronous lesions in the large bowel, and a Chest X-ray and CT scan of the abdomen and pelvis, generally to look for patients with metastasis. The favored sites of metastasis, in order of decreasing incidence, are as follows: regional lymph nodes, liver, lungs, and bones. Approximately 20% of patients are found to have liver metastasis at the time of surgery, and another 25% are believed to have occult liver metastasis. The IV contrast CT scan is reported to have a 79% sensitivity for liver metastases, although there is a significant false positive rate usually due to comorbid liver disease, such as focal steatosis, regenerative nodules, and intrahepatic ductal dilitation. MRI has shown similar sensitivity when compared to CT for evaluation of liver metastasis, and CT is reported to be superior for the detection of pulmonary, peritoneal, and ovarian metastasis. There are techniques that provide better liver metastasis detection, such as CT arterioprotography which uses contrast injected into the superior mesenteric artery. This technique provides better liver lesion contrast and boosts the sensitivity up to 90% according to some studies.