Secondary liver cancer (Liver metastases)
Secondary liver cancer (Liver metastases) are cancers that have spread (metastasized) to the liver from another organ of the body. These can appear shortly after initial cancer or even months to years later.
Most liver metastases spread from cancer in the colon or rectum (colorectal cancer). Up to 70% of people with colorectal cancer eventually develop liver metastases, as all the blood from the intestines flows back to the liver through the portal vein. Although much less common, liver metastases can also originate from other cancers in neuroendocrine organs, pancreas, stomach and small intestines.
Symptoms of liver metastases
Most patients will not have symptoms at an early stage. Some may notice non-specific or symptoms such as -
- Abdominal discomfort or pain
- Fatigue, loss of appetite and weight,
- Swelling of the legs (oedema)
- Yellowing of the skin or eyes (jaundice), itching
- Abdominal bloating due to fluid accumulation (ascites)
Depending on the site of the primary cancer, the patient may experience symptoms related to the primary cancer before the liver metastases are noticed e.g., Bloody stools, change in bowel habits, or constipation due to obstruction from a colorectal cancer.
Causes and risk factors of liver metastases
How likely cancer will spread (metastasize) to the liver depends on the site of the primary cancer and its behaviour (biology). Primary cancers that most commonly spread to the liver are -
- Colon and rectum (Colorectal cancer)
- Neuroendocrine tumours – e.g., of the pancreas, intestines
- Pancreas
- Digestive tract- e.g., esophagus, small intestines, stomach
- Breast
- Others – kidney, lung, skin, ovaries and uterus
As part of the work-up for the primary cancer, following tests may be recommended for diagnosis and to determine how extensive the cancer has spread (Staging). This includes a medical and family history, review of lifestyle and a physical examination.
Investigations that may be necessary include –
Blood tests - Tumour markers, Liver function test and Full blood count
Imaging- Ultrasound, X-rays, CT and/or MRI scans, Bone scan etc.
Biopsy - a sampling of the liver tumour may be necessary if the diagnosis is unclear or to guide treatment options
Treatments for liver metastases
After Secondary Liver Cancer is found, your specialist team will discuss the treatment options and these are some factors to consider:
- The type, location and extent of the primary cancer and the secondary liver cancer
- The role of surgery and if the cancer is resectable (removable by surgery)
- The risks of surgery and the other alternative treatments available
- their various roles, rationale, pros and cons, risks vs. benefit etc.
- Patient’s overall health, fitness for surgery and if the remnant liver would be adequate
- The chances of curing the disease, extending life, or relieving symptoms
- The main types of treatment for secondary liver cancer include:
- Surgery
- Locoregional therapy- Ablation, Trans-arterial embolization therapy +/- chemotherapy agents
- Radiation therapy
- Chemotherapy
- Palliative therapy and Supportive care
- A combination of various treatment options may be offered to optimise the treatment
- Clinical trials - if available
As surgery is the only effective method for treating some secondary liver cancers e.g., colorectal or neuroendocrine cancers, it is important to get an assessment by a Hepato-Pancreato-Biliary (HPB) surgeon in conjunction with the surgeon for the primary cancer.
If there are no spread of the cancer to other parts of the body and the patient is suitable, liver surgery (liver resection) may be a potential curative treatment. The recommended treatment strategy is often based on consensus by a group of different specialists’ opinions (multi-disciplinary team tumour board) which weighs the pros and cons of every treatment strategy and tailors the plan for each patient. Please consult our team of specialists as we sub-specialize in the treatment for Secondary Liver Cancers.