Liver Metastases

Overview

Liver metastases are cancerous tumors in the liver that began as cancer somewhere else in the body and then spread, or metastasized, to the liver. They are also called secondary liver cancer because the liver is not where the cancer started. This is different from primary liver cancer, which originates in the liver itself.

The liver is one of the most common sites for cancer to spread, in part because it filters a large volume of blood from the digestive organs. Cancers of the colon, rectum, breast, lung, pancreas, and other organs can travel to the liver. The presence of liver metastases generally means the original cancer is advanced, and treatment is aimed at controlling the disease, relieving symptoms, and in some cases removing limited tumors.

Symptoms

Liver metastases often cause no symptoms in their early stages and may be found during tests for the original cancer. As tumors grow, symptoms can develop, including:

• Fatigue and weakness.
• Loss of appetite and unintended weight loss.
• Pain or discomfort in the upper right abdomen.
• Nausea and a feeling of fullness.
• Jaundice, a yellowing of the skin and eyes, with dark urine.
• Swelling of the abdomen from fluid buildup, known as ascites.
• Itchy skin and an enlarged liver that a doctor may feel during an exam.

Because these symptoms can also occur with many other conditions, they should be evaluated by a healthcare provider, especially in someone with a known history of cancer.

Causes

Liver metastases are caused by cancer cells that break away from a primary tumor elsewhere and travel to the liver, usually through the bloodstream or lymphatic system. Once there, they settle and grow into new tumors. Cancers that commonly spread to the liver include those of the:

• Colon and rectum.
• Breast.
• Lung.
• Pancreas.
• Stomach and esophagus.
• Skin (melanoma) and certain neuroendocrine tumors.

The liver's rich blood supply, which receives blood directly from the intestines, helps explain why digestive cancers in particular often spread there.

Risk Factors

The main risk factor for liver metastases is having a primary cancer that tends to spread to the liver. Factors that influence the likelihood include:

• The type of original cancer, with colorectal, breast, lung, and pancreatic cancers among those that frequently spread to the liver.
• The stage of the cancer, as more advanced cancers are more likely to have spread.
• Delayed diagnosis or treatment of the original cancer.

Liver metastases are not caused by lifestyle factors in the way some primary liver cancers are; they reflect the behavior of an existing cancer.

Diagnosis

Liver metastases are usually identified through imaging and confirmed with tissue testing. Common steps include:

• Imaging tests such as ultrasound, CT, MRI, or PET scans to find liver tumors and assess their number, size, and location.
• Blood tests, including liver function tests and tumor markers, which can support the diagnosis and help monitor the disease.
• Biopsy, in which a small tissue sample is taken from a liver tumor and examined under a microscope to confirm cancer and identify where it came from.

Determining the original source of the cancer is important, because treatment is guided by the type of primary cancer rather than by the fact that it is in the liver.

Treatment

Treatment depends on the type and extent of the original cancer, the number and location of liver tumors, and the person's overall health. Options may include:

• Systemic therapy: Chemotherapy, targeted therapy, immunotherapy, or hormone therapy chosen according to the primary cancer.
• Surgery: In selected cases, particularly when metastases are limited and from cancers such as colorectal cancer, removing part of the liver may be possible and can improve outcomes.
• Local treatments: Procedures such as ablation (using heat or cold to destroy tumors), embolization (blocking the tumor's blood supply, sometimes with chemotherapy), and radiation therapy.
• Supportive and palliative care: Treatments to manage pain, jaundice, fluid buildup, and other symptoms and to improve quality of life.

Care is often coordinated by a team of specialists who tailor the plan to each person's situation.

Prevention

Liver metastases cannot be prevented directly, but the best protection is the early detection and effective treatment of the primary cancer before it can spread. Helpful steps include:

• Following recommended cancer screening, such as colorectal and breast cancer screening, to find cancers early.
• Completing prescribed treatment for a diagnosed cancer.
• Attending follow-up appointments and surveillance imaging so any spread can be caught and addressed promptly.

When to See a Doctor

Anyone with a history of cancer should report new or worsening symptoms to their care team, especially:

• Persistent upper-right abdominal pain.
• Unexplained weight loss, loss of appetite, or fatigue.
• Yellowing of the skin or eyes (jaundice) or dark urine.
• Abdominal swelling.

Seek prompt medical attention for severe abdominal pain, confusion, significant abdominal swelling, or signs of internal bleeding. People without a known cancer who have persistent abdominal symptoms, jaundice, or unexplained weight loss should also see a doctor for evaluation.

Related Topics

Frequently Asked Questions

References

1. American Cancer Society.
2. National Cancer Institute (NCI).
3. Mayo Clinic. Liver metastases.
4. MedlinePlus, U.S. National Library of Medicine.