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Metastatic Liver Cancer

by Steven K. Herrine, MD

Metastatic liver cancer is a cancer that has spread to the liver from elsewhere in the body.

  • Weight loss and a poor appetite may be the first symptoms.

  • Doctors base the diagnosis on results of blood tests and usually biopsy.

  • Chemotherapy drugs and radiation therapy may help relieve symptoms but do not cure the cancer.

Metastatic liver cancer most commonly originates in the lungs, breasts, large intestine, pancreas, or stomach. Leukemia (a cancer of white blood cells) and lymphoma (a cancer of the lymph system), especially Hodgkin lymphoma, may involve the liver.

Cancers spread to the liver because the liver filters most of the blood from the rest of the body, and when cancer cells break away from a primary cancer, they often enter and travel through the bloodstream. Sometimes the discovery of metastatic liver cancer is the first indication that a person has cancer.

Symptoms

Often, the first symptoms are vague. They include weight loss, poor appetite, and sometimes fever. Typically, the liver is enlarged and hard. It may feel tender and often lumpy. Occasionally, the spleen is enlarged, especially if the cancer originated in the pancreas. At first, unless the cancer is blocking the bile ducts, the person has mild or no jaundice (a yellowish discoloration of the skin and the whites of the eyes). Later, the abdomen may become swollen (distended) with fluid (a condition called ascites—see Ascites).

In the weeks before death, jaundice progressively worsens. People may become confused and drowsy as toxins accumulate in the brain because the liver is too damaged to remove them from the blood. This condition is called hepatic encephalopathy (see Hepatic Encephalopathy).

Did You Know...

  • Sometimes the discovery of metastatic liver cancer is the first indication of cancer elsewhere in the body.

Diagnosis

Doctors may suspect metastatic liver cancer in people who lose weight and have an enlarged liver or who have a cancer that tends to spread to the liver. However, doctors often have difficulty diagnosing the cancer until it is advanced.

If doctors suspect liver cancer, liver function tests, which are simple blood tests, are done to evaluate how well the liver is functioning. Results may be abnormal, as they are in many disorders. Thus, this finding cannot confirm the diagnosis. Ultrasonography is usually helpful, but computed tomography (CT) and magnetic resonance imaging (MRI) of the liver are usually more accurate in detecting the cancer. Before CT or MRI is done, a dye is injected into a vein. The dye helps make abnormalities, if present, easier to see. However, imaging tests cannot always detect small tumors or distinguish cancer from cirrhosis or other abnormalities.

A liver biopsy (removal of a sample of liver tissue with a needle for examination under a microscope—see Biopsy of the Liver) is done if the diagnosis is unclear after imaging tests or if more information is needed to help with treatment decisions. To improve the chances of obtaining cancerous tissue, doctors use ultrasonography or CT to guide the placement of the biopsy needle. Alternatively, doctors may insert a flexible viewing tube (laparoscope) through a tiny incision in the abdomen to better identify and obtain cancerous tissue.

Treatment

Treatment depends on how far the cancer has spread and what the primary cancer is. Options include the following:

  • Chemotherapy drugs: These drugs may be used to temporarily shrink the tumor and prolong life, but they do not cure the cancer. Chemotherapy drugs may be injected into the liver’s main artery (the hepatic artery), delivering a large amount of the drugs directly to the cancer cells in the liver. With this method, the rest of the body is less exposed to the drugs, and thus side effects are fewer and milder.

  • Radiation therapy to the liver: Sometimes this treatment reduces severe pain caused by advanced cancer, but it has little other benefit.

  • Surgery: If only a single tumor or a few tumors are found in the liver, they may be surgically removed, especially if they originated in the intestines. However, not all experts consider this surgery worthwhile.

If the primary cancer is leukemia or lymphoma, doctors focus on treating that cancer (see Overview of Leukemia : Treatment and Hodgkin Lymphoma : Treatment and Prognosis).

If cancer has spread extensively, usually all a doctor can do is relieve the symptoms (see Symptoms During a Fatal Illness). People may prepare an advance directive (see Advance Directives) to specify the type of care they desire if they become unable to make decisions about care.

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