Metastases to Liver

When cancer spreads from another part of the body to the liver, it creates a condition that is far more common than cancer that starts in the liver itself. Understanding this disease, recognizing its symptoms, and knowing the treatment options available can help patients and their families navigate this challenging diagnosis.

Table of contents

• What Are Liver Metastases?
• Which Cancers Commonly Spread to the Liver?
• Symptoms of Liver Metastases
• How Liver Metastases Are Diagnosed
• Treatment Options
• Understanding Survival and Outlook

What Are Liver Metastases?

Liver metastases occur when cancer that started in one part of the body spreads to the liver. This is also called metastatic liver disease or secondary liver cancer. The cancer cells found in the liver are not liver cells, but cells from the part of the body where the cancer originally began^[1].

liver metastases, metastatic liver disease, secondary liver cancer, metastasis (one cancerous tumor), metastases (more than one cancerous tumor), advanced cancer

Liver metastases are much more common than primary liver cancer, which is cancer that starts in the liver itself^[1]. In fact, metastatic tumors in the liver are 20 times more common than primary liver tumors^[4].

The liver is particularly vulnerable to cancer that has spread from other parts of the body. This is because the liver has a rich, dual blood supply. It receives blood through both the hepatic artery and the portal vein. Every day, the liver filters more than 250 gallons of blood, which increases the chance that cancerous cells will travel through the bloodstream to reach the liver^[3][6].

• Liver
• Hepatic artery
• Portal vein

Which Cancers Commonly Spread to the Liver?

Some types of cancer are more likely to spread to the liver than others. The most common types of cancer that spread to the liver include^[1]:

• Colorectal cancer
• Lung cancer
• Breast cancer
• Pancreatic cancer
• Stomach cancer
• Esophageal cancer
• Melanoma
• Neuroendocrine cancer

Colorectal cancer is by far the most common source of liver metastases. Nearly 20 to 25 percent of patients diagnosed with colorectal cancer will develop liver metastases. Of these, 15 to 25 percent present with synchronous disease, meaning the liver metastases are found at the same time as the primary cancer^[3]. Nearly 70 to 80 percent of cases with metastatic colorectal disease remain confined to the liver^[3].

Most metastatic tumors are adenocarcinomas, though other less common types such as squamous cell carcinoma, neuroendocrine tumors, lymphoma, sarcoma, and melanoma can also spread to the liver^[3][4].

Cancer can spread to any part of the liver. Sometimes there is only one liver metastasis, but most people develop many metastases in both lobes of the liver^[1].

Symptoms of Liver Metastases

Liver metastases may not cause any symptoms at first because the liver is large and can continue to work normally even if cancer is present. Symptoms vary depending on the number of metastases and where they are located in the liver^[1].

When symptoms do appear, common signs include^[1][6]:

• Loss of appetite
• Unintentional weight loss
• Nausea and vomiting
• Fatigue and weakness
• Fever
• Discomfort or pain in the abdomen, particularly in the upper right area
• Swelling of the abdomen caused by fluid buildup, called ascites
• Swelling of the ankles
• Jaundice, which causes yellowing of the skin and the whites of the eyes, along with dark-colored urine
• Itchy skin

When the liver is enlarged, a lump can sometimes be felt on the right side of the abdomen below the ribcage^[5]. These symptoms can also be caused by other health conditions, so it is important to see a doctor if you experience any of these signs, especially if they are getting worse^[1].

How Liver Metastases Are Diagnosed

Diagnosing liver metastases involves several steps. The following tests may be used to confirm the presence of cancer in the liver and help plan treatment^[1].

Health History and Physical Examination

Your doctor will ask questions about your symptoms and any previous cancer diagnosis or treatment. During a physical exam, the doctor may feel your abdomen to check if the liver is enlarged or tender to the touch^[1].

Blood Tests

Several blood tests can provide important information about liver function and the presence of cancer^[1]:

• Liver function tests measure how well the liver is working and can detect liver damage caused by metastases
• A complete blood count (CBC) checks overall health and bone marrow function
• Tumor marker tests measure specific proteins that may indicate cancer. For example, if you previously had colorectal cancer, your doctor may measure levels of carcinoembryonic antigen (CEA). An increase in CEA levels over time could mean the cancer has returned and spread to the liver

Imaging Tests

Imaging tests are essential for diagnosing liver metastases. You may have one or more of the following^[1][4]:

• CT scans (computed tomography) create detailed 3D images of the liver using X-rays
• MRI scans (magnetic resonance imaging) use magnets and radio waves to create detailed images of the liver’s soft tissues
• Ultrasound uses sound waves to create real-time pictures of the inside of the body
• PET scans (positron emission tomography) can show how tissues and organs are functioning and help identify cancer

Triple-phase CT scans or MRIs are typically required to properly evaluate and diagnose suspected liver metastases^[4].

Liver Biopsy

A liver biopsy involves taking a small tissue sample from the liver, usually under ultrasound guidance. A medical pathologist examines the tissue to identify the type of cancer cells present. This helps determine where the cancer originally started, which is important for planning treatment^[6].

Treatment Options

The treatment for liver metastases depends on several factors, including where the cancer started, how many tumors are in the liver, whether cancer has spread to other parts of the body, your general health, and your symptoms^[1][10].

For some types of cancer that have spread to the liver, it may still be possible to cure the disease. For other types, the goal may be to control the cancer and manage symptoms. This is called palliative treatment^[10].

Surgery

Surgery is the only treatment that offers the possibility of cure for patients with liver metastases. Five-year survival rates after surgical removal of all detectable liver metastases can reach up to 40 percent^[12]. However, only about 25 percent of patients with liver metastases are candidates for surgical removal^[12].

Surgery is not suitable for everyone. It depends on where the cancer started (it is most common for colorectal cancer that has spread), whether cancer is only in the liver, how many tumors are present and their size, and whether the primary cancer is under control^[10].

Removing part of the liver, called liver resection, is major surgery that can take several hours. After the operation, patients usually stay in intensive care or a high-dependency unit for at least 24 hours. Most people need to be in the hospital for about 10 to 21 days, and it typically takes about six weeks to start feeling normal again^[10].

Sometimes doctors perform a two-stage liver resection, removing part of the liver first, then removing another part a week or so later^[10].

Ablation Therapy

Ablation therapy destroys tumors in the liver without surgery. These treatments include^[6]:

• Radiofrequency ablation, which uses extreme heat to destroy cancer cells
• Cryotherapy, which uses extreme cold to freeze and destroy tumors
• Histotripsy, which uses high-energy ultrasound waves to destroy cancer cells

These regional therapies may be offered to patients with isolated unresectable metastases but no cancer outside the liver^[12].

Chemotherapy

Chemotherapy uses anti-cancer drugs to kill cancer cells throughout the body. The type of chemotherapy depends on the type of primary cancer^[10].

For patients with metastatic cancer beyond the liver, systemic chemotherapy is often the most appropriate choice^[12]. If the first type of chemotherapy does not control the cancer, you might be able to have a different type of chemotherapy as a second-line treatment^[10].

Hepatic Artery Infusion

Hepatic artery infusion (HAI) delivers chemotherapy directly into the artery that supplies blood to the liver. A small tube called a catheter is placed into the main artery leading to the liver. This allows a high concentration of chemotherapy to reach the tumor. This treatment is not suitable for everyone with liver metastases^[10].

Chemoembolization

Transarterial chemoembolization (TACE) involves giving chemotherapy drugs into an artery along with an embolic agent that blocks the artery. The doctor threads a catheter into the main artery that carries blood to the liver, then injects the chemotherapy followed by the embolic agent. This cuts off most of the blood flow to the liver, depriving cancer cells of oxygen and nutrients while concentrating chemotherapy at the tumor site^[10].

Targeted Therapy

Targeted drugs destroy cancer cells while avoiding healthy cells. These medications target specific proteins or genetic mutations that help cancer grow^[6][14].

Targeted drugs are typically prescribed if liver cancer has spread to other organs or when surgery is not possible. Examples include drugs that block blood vessel formation to starve tumors, or medications that slow tumor growth by targeting specific cell signals^[14].

Immunotherapy

Immunotherapy stimulates the body’s immune system to recognize and fight cancer cells. This is a relatively new approach that has shown promise in treating certain types of liver metastases^[14]. Immunotherapy can be a good option when used in combination with other treatments to enhance effectiveness^[12].

Radiation Therapy

Stereotactic body radiotherapy (SBRT) delivers a focused and precise high dose of radiation to tumors while sparing nearby healthy tissue. It is a non-invasive, computer-assisted therapy used to treat smaller liver tumors when other ablation therapies are not possible or recommended^[14].

Understanding Survival and Outlook

The outlook for people with liver metastases varies widely depending on several factors, including the type of primary cancer, how far the cancer has spread, overall health, and how well the cancer responds to treatment^[6].

Nearly 25 percent of all cancer metastases occur in the liver^[3]. Liver metastasis is common in people with advanced cancer. The liver’s role in filtering blood from the digestive organs and its diverse cell types make it a common site for cancer spread^[4].

For colorectal cancer that has spread only to the liver, surgery combined with chemotherapy can offer hope for long-term survival. Five-year survival rates after complete surgical removal can reach up to 40 percent^[12].

Treatment strategies for liver metastases are rapidly evolving, with new approaches and combinations of therapies offering improved outcomes. An interprofessional approach involving medical oncologists, surgeons, radiologists, and other specialists working together has been shown to provide better results^[3][9].

Even when cure is not possible, many treatment options can help control the disease, manage symptoms, and maintain quality of life. Regular follow-up care and monitoring are important parts of managing this condition^[16].