Metastatic liver disease

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A liver metastasis is a malignant tumor in the liver that has spread from other organs affected by cancer. The liver is a common place for metastatic disease due to the rich double blood supply (the liver receives blood through the hepatic artery and portal vein). Metastatic tumors in the liver are 20 times more common than primary tumors. In 50% of all cases the primary tumor is the gastrointestinal tract, other common sites including breast, ovary, bronchial and kidney.

The embolic tumors entering the sinusoids through the blood supply of the liver appear to be physically blocked by Kupffer cells, but if the embolic tumors are larger, they tend to become caught in the branches of the portal vein.

Video Metastatic liver disease

Features

Hepatomegaly - with a nodular free liver
Softness
Cachexic
Asites
Jaundice
Pyrexia - up to 10% of patients
Alkaline Phosphatase (ALP) and gamma glutamyl transpeptidase (GGT) increase
Ultrasonic scan and CT scan - multiple charging defects.

Maps Metastatic liver disease

Diagnosis

Decrease in hemoglobin
Liver function test: increased ALP, increased bilirubin, decreased albumin
Carbinoembryonic antigen for colorectal secondary
Ultrasound scan
CT scan
Biopsy under ultrasound control

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Treatment

Treatment may consist of surgery (hepatectomy), chemotherapy and/or specific therapy aimed at the liver such as radio frequency ablation, arterial transcatheter chemoembolization, selective internal radiation therapy and irreversible electroporation. For most patients there is no effective treatment because both lobes are usually involved, so surgical resection is not possible. Young patients with metastases from colorectal cancer confined to one lobe of the liver and up to 4 can be treated with partial hepatectomy. In certain cases, chemotherapy may be given systemically or through the hepatic artery.

In some tumors, particularly those arising from the colon and rectum, metastasis or solitary metastasis to one or the other lobes may be resected. Careful search for other metastases is necessary, including local recurrence of the original primary tumor (eg, through colonoscopy) and dissemination elsewhere (eg, via CT thorax). 5-year survival rate 30-40% has been reported after resection.