Metastatic Cancers

ETiology and PATHOGENESISTop

Most malignant liver tumors are metastases originating in other organs, supplied by the portal system (most often colorectal cancer representing one-third of all metastases to the liver), and less commonly metastases of lung, breast, and genitourinary system cancers and melanoma.

CLINICAL FEATURESTop

Nonspecific, typical of primary liver tumors and advanced cancer. Common: malaise, weight loss, weakness, sometimes abdominal fullness. Jaundice is not a symptom of metastasis but can occur in massive metastasis along with other symptoms of liver failure. Ascites is generally the result of cancer spreading into the peritoneum, but it can also be a symptom of liver failure or portal vein thrombosis. Large or superficial liver metastases may be palpable.

DIAGNOSISTop

Perform diagnostic tests to look for the primary tumor and liver imaging to assess the extent of metastatic lesions. On computed tomography (CT), metastatic tumors have density similar to that of the surrounding liver parenchyma (only 30%-40% of lesions are detected without a contrast agent). The presence of colorectal cancer metastases can be suspected on the basis of a characteristic image (large, nonvascularized center with a ring around the perimeter). Lesion biopsy is indicated if the primary lesion cannot be identified, and microscopic diagnosis is necessary to establish treatment. Look for liver metastases in all patients who are planning radical treatment of cancer of another organ.

TREATMENTTop

Liver resection is a method of radical treatment of secondary liver tumors. Surgery is justified if complete excision of the metastasis is possible (ie, with a clinical margin ≥1 cm), including recurrence. Surgical treatment of a patient with liver metastases can be combined with chemotherapy and radiotherapy, depending on the type of tumor. Complementary methods: liver-directed therapy such as transarterial chemoembolization (TACE), ablation, or hepatic artery infusion pumps.