Liver Metastases (Secondary Liver Cancer)

How cancer spreads to the liver

The liver filters blood from the intestines through the portal vein and from the rest of the body through the hepatic artery. Its rich blood supply makes it a common site for cancer cells to lodge and grow. Cancers of the digestive tract spread through the portal vein, which is why colorectal, pancreatic and stomach cancers so often affect the liver.

Liver metastases are made up of cells from the original cancer. Liver metastases from colon cancer are treated as colon cancer, not as liver cancer.

Symptoms

Many people have no symptoms, and metastases are found on staging or follow-up scans. When symptoms occur:

• discomfort or pain in the upper right abdomen, sometimes spreading to the right shoulder
• fatigue and weakness
• loss of appetite, feeling full quickly, nausea
• unexplained weight loss
• jaundice: yellow skin and eyes, dark urine, pale stools, itching
• swollen abdomen from fluid (ascites) or an enlarged liver
• fever and night sweats
• confusion in advanced liver failure

Neuroendocrine tumors in the liver can cause flushing and diarrhea (carcinoid syndrome).

Diagnosis

• CT scan of the chest, abdomen and pelvis: the standard staging test
• MRI of the liver with special contrast: the most sensitive test for small lesions and for surgical planning
• PET-CT: finds spread elsewhere
• Ultrasound, including contrast-enhanced ultrasound
• Liver biopsy: confirms the diagnosis when the primary cancer is unknown or new, and allows tumor testing
• Blood tests: liver function, tumor markers such as CEA (colorectal) or CA 19-9 (pancreatic)
• Molecular testing: for targeted treatment options (for example RAS, BRAF, HER2 and MSI in colorectal cancer)

Treatment

Treatment is planned by a multidisciplinary team and depends on the primary cancer, the number and location of metastases, liver function, other spread and general health.

Systemic therapy

Chemotherapy, targeted therapy, hormone therapy (breast cancer) or immunotherapy treats cancer throughout the body. It is the main treatment for most liver metastases.

Surgery (liver resection)

Removing part of the liver can cure some patients, particularly with colorectal cancer metastases and some neuroendocrine tumors. The liver regenerates, so up to about two-thirds can be removed if the remaining liver is healthy. Chemotherapy may shrink metastases to make surgery possible. Two-stage operations and portal vein embolization can increase the amount of liver left.

Ablation

Radiofrequency or microwave ablation destroys small tumors (usually under 3 cm) with heat, through a needle or during surgery.

Liver-directed therapies

• Transarterial chemoembolization (TACE): chemotherapy delivered into the liver's arteries
• Radioembolization (Y-90, SIRT): radioactive beads delivered into the arteries feeding the tumors
• Hepatic artery infusion pump chemotherapy in specialized centers

Radiation

Stereotactic body radiation therapy (SBRT) delivers precise, high doses to a small number of tumors.

Liver transplant

Considered in highly selected patients with unresectable colorectal liver metastases or neuroendocrine tumors in specialized centers.

Supportive and palliative care

Pain relief, stents for blocked bile ducts, drainage of ascites, nutrition support and symptom control improve quality of life at every stage. Palliative care can be provided alongside active cancer treatment.

Outlook

Outlook varies widely:

• Colorectal cancer: after resection of liver metastases, around 40 to 50% of patients are alive at 5 years in many series, and some are cured
• Neuroendocrine tumors: often slow-growing, with long survival
• Breast cancer: many live for years with treatment
• Pancreatic, stomach and esophageal cancers: generally poorer outlook, measured in months to a few years, though newer treatments continue to improve results

Your oncology team can give a more personal estimate based on your cancer and its response to treatment.

Frequently asked questions

What are liver metastases?

They are tumors in the liver formed by cancer cells that have spread from another part of the body, most often the colon or rectum. They are treated according to the original cancer type, not as primary liver cancer.

What are the symptoms of cancer that has spread to the liver?

Often there are none at first. Later symptoms can include pain in the upper right abdomen, fatigue, weight loss, loss of appetite, yellowing of the skin and eyes, and a swollen abdomen from fluid buildup.

Can liver metastases be cured?

Sometimes. People with colorectal cancer or neuroendocrine tumors that have spread only to the liver may be cured by surgery or ablation, often with chemotherapy. For most other cancers, treatment aims to control the cancer and extend life.

What is the life expectancy with liver metastases?

It depends greatly on the type of cancer, how much of the liver is involved, and response to treatment. It ranges from months for some cancers to many years, and cure in selected colorectal cases. Your oncologist can discuss your specific situation.

Is secondary liver cancer the same as primary liver cancer?

No. Primary liver cancer, such as hepatocellular carcinoma, starts in liver cells, often in people with cirrhosis. Secondary liver cancer is cancer from another organ that has spread to the liver, and it is treated like the original cancer.