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Definition

Liver metastases refer to cancer that has spread to the liver from somewhere else in the body.

Liver metastases are not the same as cancer that starts in the liver, which is called hepatocellular carcinoma.

Causes

Almost all types of cancer can spread to the liver. Cancers that often spread to the liver include:

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

The risk for cancer spreading to the liver depends on the location (site) of the original cancer. A liver metastasis may 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:

• Decreased appetite
• Confusion
• Fever, sweating
• Jaundice (yellowing of the skin and whites of the eyes)
• Nausea
• Pain, often in the upper right part of the abdomen
• Weight loss

Exams and Tests

Tests that may be done to diagnose liver metastases include:

• CT scan of the abdomen
• Liver function tests
• Liver biopsy
• MRI of the abdomen
• PET scan
• Ultrasound of the abdomen

Treatment

Treatment depends on:

• The primary cancer site
• How many liver tumors you have and their location in the liver
• Whether the cancer has spread to other organs
• Your overall health

Types of treatments that may be used are described below.

SURGERY

When the tumor is only in one or a few areas of the liver, it may be removed with surgery.

CHEMOTHERAPY

When the cancer has spread to the liver and other organs, whole-body (systemic) chemotherapy is usually used. The type of chemotherapy used depends on the original type of cancer.

When the cancer has only spread to the liver, systemic chemotherapy may still be used.

Chemoembolization is a type of chemotherapy to one area. A thin tube called a catheter is inserted into an artery in the groin. The catheter is threaded into an artery in the liver. Cancer-killing medicine is sent through the catheter. Then another medicine is sent through the catheter to block blood flow to the part of the liver with the tumor. This "starves" the cancer cells.

OTHER TREATMENTS

• Alcohol (ethanol) injected into the liver tumor -- A needle is sent through the skin directly into the liver tumor. The alcohol kills cancer cells.
• Heat, using radio or microwave energy -- A large needle called a probe is placed into the center of the liver tumor. Energy is sent through thin wires called electrodes, which are attached to the probe. The cancer cells are heated and die. This method is called radiofrequency ablation when radio energy is used. It is called microwave ablation when microwave energy is used.
• Freezing, also called cryotherapy -- A probe is placed in contact with the tumor. A chemical is sent through the probe that causes ice crystals to form around the probe. The cancer cells are frozen and die.
• Radioactive beads/spheres -- These beads/spheres deliver radiation to kill the cancer cells.

Outlook (Prognosis)

How well you do depends on the location of the original cancer and how much it has spread to the liver or anywhere else. In rare cases, surgery to remove the liver tumors leads to a cure. This is usually only possible when there are a limited number of tumors in the liver.

In most cases, cancer that has spread to the liver cannot be cured. People whose cancer has spread to the liver often die of their disease. However, treatments may help shrink tumors, improve life expectancy, and relieve symptoms.

Possible Complications

Complications are often 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

When to Contact a Medical Professional

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 contact their health care provider if any of these develop.

Prevention

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

References

Lamps LW. Liver: Tumors and tumorlike conditions. In: Goldblum JR, Lamps LW, McKenney JK, Myers JL, eds. Rosai and Ackerman’s Surgical Pathology. 11th ed. Philadelphia, PA: Elsevier; 2018:chap 20.

Mahvi DA. Mahvi DM. Liver metastases. In: Niederhuber JE, Armitage JO, Kastan MB, Doroshow JH, Tepper JE, eds. Abeloff's Clinical Oncology. 6th ed. Philadelphia, PA: Elsevier; 2020:chap 58.

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