Metastatic liver cancer is more common than primary liver cancer Primary Liver Cancer Primary liver cancer is usually hepatocellular carcinoma (HCC). The first manifestations of liver cancer are usually nonspecific, delaying the diagnosis. When diagnosed at advanced stages, prognosis... read more and is sometimes the initial clinical manifestation of cancer originating in the gastrointestinal tract, breast, lung, or pancreas.
Symptoms and Signs of Metastatic Liver Cancer
Early liver metastases may be asymptomatic. Nonspecific symptoms of cancer (eg, weight loss, anorexia, fever) often develop first. The liver may be enlarged, hard, or tender; massive hepatomegaly with easily palpable nodules signifies advanced disease. Hepatic bruits and pleuritic-type pain with an overlying friction rub are uncommon but characteristic. Splenomegaly is occasionally present, especially when the primary cancer is pancreatic. Concomitant peritoneal tumor seeding may produce ascites, but jaundice is usually absent or mild initially unless a tumor causes biliary obstruction Tumors of the Gallbladder and Bile Ducts Gallbladder and bile duct tumors can cause extrahepatic biliary obstruction. Symptoms may be absent but often are constitutional or reflect biliary obstruction. Diagnosis is based on ultrasonography... read more .
In the terminal stages, progressive jaundice Jaundice Jaundice is a yellowish discoloration of the skin and mucous membranes caused by hyperbilirubinemia. Jaundice becomes visible when the bilirubin level is about 2 to 3 mg/dL (34 to 51 micromol/L)... read more and hepatic encephalopathy Portosystemic Encephalopathy Portosystemic encephalopathy is a neuropsychiatric syndrome that can develop in patients with liver disease. It most often results from high gut protein or acute metabolic stress (eg, gastrointestinal... read more presage death.
Diagnosis of Metastatic Liver Cancer
CT with contrast or MRI with contrast
Liver metastases are suspected in patients with weight loss and hepatomegaly or with primary tumors likely to spread to the liver. If metastases are suspected, liver tests Laboratory Tests of the Liver and Gallbladder Laboratory tests are generally effective for the following: Detecting hepatic dysfunction Assessing the severity of liver injury Monitoring the course of liver diseases and the response to treatment... read more are often done, but results are usually not specific for the diagnosis. Alkaline phosphatase, gamma-glutamyl transpeptidase, and sometimes lactate dehydrogenase typically increase earlier or to a greater degree than do other test results; aminotransferase levels vary. Imaging tests Imaging Tests of the Liver and Gallbladder Imaging is essential for accurately diagnosing biliary tract disorders and is important for detecting focal liver lesions (eg, abscess, tumor). It is limited in detecting and diagnosing diffuse... read more have good sensitivity and specificity. Ultrasonography is usually helpful, but CT with contrast or MRI with contrast is often more accurate.
Liver biopsy Liver Biopsy Liver biopsy provides histologic information about liver structure and evidence of liver injury (type and degree, any fibrosis); this information can be essential not only to diagnosis but also... read more guided by imaging provides the definitive diagnosis and is done if other tests are equivocal or if histologic information (eg, cell type of the liver metastasis) may help determine the treatment plan.
Treatment of Metastatic Liver Cancer
Sometimes surgical resection
Sometimes systemic chemotherapy; sometimes hepatic intra-arterial chemotherapy
Occasionally, radiation therapy for palliation
Treatment depends on the extent of metastasis.
With solitary or very few metastases due to colorectal cancer Colorectal Cancer Colorectal cancer is extremely common. Symptoms include blood in the stool and change in bowel habits. Screening using one of several methods is recommended for appropriate populations. Diagnosis... read more , surgical resection may prolong survival.
Depending on characteristics of the primary tumor, systemic chemotherapy may shrink tumors and prolong life but is not curative; hepatic intra-arterial chemotherapy sometimes has the same effect but with fewer or milder systemic adverse effects.
Radiation therapy to the liver occasionally alleviates severe pain due to advanced metastases but does not prolong life. Extensive disease is fatal and is best managed by palliation for the patient and support for the family (see The Dying Patient The Dying Patient Dying patients can have needs that differ from those of other patients. So that their needs can be met, dying patients must first be identified. Before death, patients tend to follow 1 of 3... read more ).
Hematologic Cancers and the Liver
The liver is commonly involved in advanced leukemia Overview of Leukemia Leukemia is a malignant condition involving the excess production of immature or abnormal leukocytes, which eventually suppresses the production of normal blood cells and results in symptoms... read more and related blood disorders. Liver biopsy is not needed. In hepatic lymphoma, especially Hodgkin lymphoma, the extent of liver involvement determines staging and treatment but may be difficult to assess. Hepatomegaly and abnormal liver tests Laboratory Tests of the Liver and Gallbladder Laboratory tests are generally effective for the following: Detecting hepatic dysfunction Assessing the severity of liver injury Monitoring the course of liver diseases and the response to treatment... read more may reflect a systemic reaction to Hodgkin lymphoma Hodgkin Lymphoma Hodgkin lymphoma is a localized or disseminated malignant proliferation of cells of the lymphoreticular system, primarily involving lymph node tissue, spleen, liver, and bone marrow. Symptoms... read more rather than spread to the liver, and biopsy often shows nonspecific focal mononuclear infiltrates or granulomas of uncertain significance. Treatment is directed at the hematologic cancer.