Liver metastases

• Alternative Names

  Metastases to the liver

• Causes, incidence, and risk factors

  Cancers that may spread to the liver include:

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

  Cancer cells often have aggressive tendencies and will invade other areas of the body. They usually do this by floating in the bloodstream and then multiplying themselves in a new place.

  Where and how cancer cells spread varies. It depends both on blood flow and on the characteristics of the different cancer cells. For example, cancers of the GI tract often spread to the liver because their blood drains directly through the liver. Melanoma usually spreads through the body's blood vessels to the liver.

  The risk of cancer spreading to the liver depends on the site of the original cancer. The liver cancer may also be present when the original (primary) cancer is diagnosed, or it may occur months or years after the primary tumor is removed.

• Symptoms

  In some cases, there are no symptoms. When symptoms occur, they may include:

  • Anorexia
  • Fevers
  • Jaundice
  • Nausea
  • Pain, usually in the upper right part of the abdomen
  • Sweats
  • Weight loss
• Signs and tests

  Tests that may be done to diagnose liver metastases include:

  • Bilirubin blood test
  • CT scan or MRI
  • Liver function tests
  • PET scan
  • Ultrasound of the liver
• Treatment

  Treatment depends on:

  • The primary cancer site
  • How much of the cancer has spread to the liver (for example, only one tumor versus many tumors in the liver)
  • Whether it has spread to other organs outside of the liver
  • The patient's condition

  When the cancer has spread to the liver and other organs, whole-body (systemic) chemotherapy is usually used.

  When the spread is limited to the liver, systemic chemotherapy may still be used. However, other treatment methods may be effective. When the tumor is only in a few areas of the liver, the cancer may be removed with surgery.

  The use of radiofrequency waves or injection of toxic substances may also be used to kill tumors. When larger areas of the liver are involved, treatment may involve chemotherapy directly into the liver, or a procedure to block blood flow to parts of the liver (embolization) to "starve" the tumor cells.

• Expectations (prognosis)

  How well patients do depends on the location of the original cancer and how much it has spread to the liver. In a small number of cases, surgery to remove the liver tumors may lead to a cure. This is usually only possible in patients with certain tumor types (for example, colorectal cancer), and when there are a limited number of tumors in the liver.

  In most cases, cancer that has spread to the liver is not curable. Patients with metastatic cancer to the liver usually die of their disease eventually. However, the treatments discussed above may help shrink tumors, improve life expectancy, and relieve symptoms.

• Complications

  Complications are generally the result of tumors spreading to a large area of the liver.

  They can include:

  • Blockage of the flow of bile
  • Decreased appetite
  • Fever
  • Liver failure (usually only in the late stages of disease)
  • Pain
  • Weight loss
• Calling your health care provider

  Call your health care provider if you have cancer and suspect that it has spread to the liver. Anyone who has had a type of cancer that can spread to the liver should be aware of the signs and symptoms listed above, and call a physician if any of these develop.

• Prevention

  Early detection of some types of cancer may prevent the spread of these cancers to the liver.

• References

  Kemeny N, Kemeny M, Dawson L. Liver metastases. In: Abeloff MD, Armitage JO, Niederhuber JE, Kastan MB, McKenna WG, eds. Abeloff's Clinical Oncology. 4th ed. Philadelphia, Pa: Churchill Livingstone Elsevier; 2008:chap 59.

Review Date: 9/4/2008

Reviewed By: Sean O. Stitham, MD, private practice in Internal Medicine, Seattle, Washington; and James R. Mason, MD, Oncologist, Director, Blood and Marrow Transplantation Program and Stem Cell Processing Lab, Scripps Clinic, Torrey Pines, California. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.