Liver metastases

Alternative names

Metastases to the liver

Definition

Liver metastases are malignant (cancerous) tumors that originated at sites remote from the liver and spread to the liver via the bloodstream.

Causes, incidence, and risk factors

Common primary tumors that may spread to the liver include gastrointestinal cancers (such as colorectal, pancreatic, stomach and esophageal), as well as breast cancer, lung cancer, melanoma, and a number of other cancers. The reasons for such spread vary, and depend both on blood flow and on the characteristics of the different cancer cells. For example, cancers of the gastrointestinal tract often spread to the liver because blood flows directly from these organs to the liver. Cancer cells, therefore, have a direct path to the liver. Alternatively, melanoma usually spreads through the body's arteries to the liver.

The risk of cancer spreading to the liver depends on the primary cancer site. Liver metastases may be present at the time the primary cancer is diagnosed, or they may occur months or years after the primary tumor is removed.

Symptoms

Symptoms vary, and many times liver metastasis is asymptomatic. When symptoms occur, they may include:

• Weight loss
  
• Pain, usually in the right upper quadrant of the abdomen
  
• Jaundice
  
• Fevers
  
• Sweats
  

Signs and tests

• Elevated bilirubin
  
• Abnormal liver function tests
  
• Elevated tumor markers
  
• Abdominal CT scan or MRI revealing liver masses
  
• PET scan revealing liver masses
  
• Ultrasound of the liver that reveals masses
  

Treatment

Treatment depends on the primary cancer site, extent of spread to the liver (for example, only one tumor in the liver versus many tumors in the liver), whether it has spread to other organs, and the condition of the patient.

In situations where cancer has spread not only to the liver but to other organs as well, systemic chemotherapy (directed at treating the entire body) is usually used.

In situations in which spread is limited to the liver, systemic chemotherapy may be used, although other treatment methods may be effective. When the tumor is localized to only a few areas of the liver, the cancer may be removed surgically.