SECONDARY LIVER CANCERS
Liver metastases are cancerous tumors that have spread (metastasized) to the liver from another part of the body. These tumors can appear shortly after the original tumor develops, or even months or years later
Liver Metastases Diagnosis & Staging
To diagnose secondary liver cancer and figure out how far the cancer has spread, our doctors may recommend one or more of the following tests:
Clinical evaluation by the doctor to look for the presence of jaundice (yellowness of skin and eyes) or presence of scar marks (due to itching) and presence of any lumps in the tummy.
Blood tests including LFT’s (bilirubin level in your blood will be high due to the blockage of the bile duct).
Hemoglobin (Hb level) can be low
Tumor markers. These are substances normally seen in the blood, however, in people with a cancer they may be high. In bile duct cancer, the tumor marker that has been associated with liver metastases are; CEA, Ca125, Ca19.9.
MRI (magnetic resonance imaging)
Positron emission tomography (PET) scan: starts with an injection of radioactive sugar. Because cancer cells absorb sugar faster than normal cells, they are highlighted on the PET scan.
Biopsy (histology): All of the previously mentioned tests may lead the doctor to diagnose the liver metastases. However the only definite way to confirm this diagnosis is to examine some of the abnormal tissue (cancer cells) under a microscope. If a sample of tissue is required we may perform a biopsy. This is when a needle is passed through your skin, into the affected area. If your doctor is planning to treat your cancer with surgery, you may not undergo a biopsy, as tissue confirmation can be obtained after the operation, by the laboratory.
Stages of Liver Metastases
Cancer staging is a way of describing how advanced a cancer is, or to what stage it has developed. Because liver metastases have already spread to the liver from somewhere else in the body, they are called stage IV cancer. This is the most advanced stage of a cancer. Knowing the stage of a cancer helps our experts build a plan of care that fits your unique needs.
Laparoscopy: This is a small operation that allows the doctors to look at your gallbladder, liver and other organs close to the gall bladder. It is done under a general anaesthetic and you will have a short stay in hospital. While you are asleep under anaesthetic, the doctor makes a small cut (incision) in your tummy (abdomen). They will insert a thin, flexible tube with a light and camera (laparoscope). They may take a small sample of tissue (biopsy) to look at under a microscope. After a laparoscopy, you will have one or two stitches in your tummy. You may have uncomfortable wind or shoulder pains for several days after the operation. You can often ease the pain by walking or taking sips of peppermint water
Liver Metastases Treatment
Because liver metastases spread to the liver from another part of the body, they can be very difficult to treat. But with the right approach, remission and even a cure are possible for some patients. To build the most effective plan for you, our liver metastases experts carefully consider the latest surgical and interventional radiology techniques, including minimall invasive approaches that often can lessen pain and the time it takes to recover. To customize a treatment approach for you, we’ll want to learn about
- where in your body the primary cancer is located
- the size and number of liver metastases you have
- your general health
Overall, advances in surgical approaches and treatment strategies have improved the length and quality of life of people diagnosed with liver metastases. Treatment options we can consider include surgery, image-guided interventional therapies, radiation therapy, chemotherapy, and targeted therapy.
Our goal is to provide treatment options that give you the very best possible quality of life and chance for survival.
Surgery for Liver Metastases
When possible, surgeons use techniques that leave more of the healthy liver intact. This reduces the risk of complications and the need for the liver to grow back.
Surgery for People with Colon or Rectal Liver Metastases
For people with liver metastases from tumors in the colon or rectum, liver surgeons can often remove tumors in both places during the same operation. This can be a good approach when there are just a few small tumors in the liver.
Your treatment team often combines this approach with chemotherapy. This approach can significantly reduce complications and recovery time. Studies suggest that up to half of all people who have colorectal liver metastases survive for at least five years after this treatment.
For certain people, minimally invasive laparoscopic surgery can significantly reduce the time it takes to recover from an operation. In this procedure, surgeons insert a thin, lighted tube with a camera on its tip (a laparoscope) through a tiny abdominal incision (cut). The surgeon then guides surgical instruments through the laparoscope to remove tumors or, in some cases, part of the liver.
Ablation to Destroy Liver Metastases
Ablation is a technique for eliminating tumors without surgery. Our radiologists use several forms of energy to select which tumors to ablate. This procedure can be done with minimally invasive techniques on an outpatient basis (no hospital stay needed). Often, our doctors can deliver tumor-eliminating energy through a needlelike probe that they insert through the skin and guide into the tumor with the help of advanced imaging technologies. The most common ablation methods destroy the cancerous tissue through the application of heat delivered by radio waves (radiofrequency ablation) or microwaves (microwave ablation), or through cold gas to freeze the tumor (cryoablation).
Ablation may also reduce the risk of cancer coming back for people with liver metastases that can’t be completely removed. It may prolong survival for people with recurrent metastases whom doctors previously treated with surgery and chemotherapy.
Radioembolization/Selective Internal Radiation Therapy (SIRT)
Selective internal radiation therapy (SIRT), for people who have liver metastases that a surgeon can’t remove, or whose liver metastases are the primary problem. SIRT combines radiation therapy with embolization, which involves injecting tiny particles to block or reduce blood flow to cancer cells. In SIRT, tiny radioactive beads are delivered to the tumor site and trapped there.
Chemotherapy & Targeted Therapy for Liver Metastases
Chemotherapy uses chemical substances to destroy cancer cells wherever they are in the body. This approach can significantly increase the length of life in people with liver metastases. Given before surgery, chemotherapy can lower the risk of tumors coming back later on. Chemotherapy can also help shrink liver metastases from the colon and rectum so that they’re safer for a surgeon to take out.
Chemotherapy drugs destroy some healthy cells in addition to cancer cells. Biologic drugs are more targeted. They can stop tumor cells from replicating and can disrupt the flow of blood to a tumor. Your treatment team may recommend the following biologic drugs to treat liver metastases:
- anti-angiogenesis drugs stop the growth of blood vessels that nourish tumors. Our doctors can give anti-angiogenesis drugs with chemotherapy before or after surgery.
- epidermal growth factor receptor (EGFR) inhibitors block a protein that may contribute to the progression of colorectal cancer.
Before treating you with one of these drugs, your doctor will test you for a mutation in your KRAS gene. EGFR inhibitors aren’t effective when this mutation is present. Clinical trials are under way to evaluate drugs that may be effective in treating patients with a KRAS gene mutation.
Radiation Therapy for Liver Metastases
Radiation therapy can help to control the growth of liver metastases. This approach primarily used for patients when:
- the cancer can’t be removed with surgery
- the tumors in the liver are too large for treatment with ablation, a technique done by our interventional radiologists.
Your treatment team will work with specialists from our medical physics department to customize a plan of care that fits your unique needs. This plan includes the latest techniques to deliver radiation directly to the tumor and minimize damage to healthy tissue. Intensity-modulated radiation therapy and stereotactic body radiation are two approaches that can reduce damage to normal tissue being treated for liver metastases:
- intensity-modulated radiation therapy (IMRT) uses radiation beams of varying intensity that mold to the shape of the tumor. Sophisticated software and 3-D images from CT scans enable your doctor to focus radiation on cancerous tissue more precisely.
- stereotactic body radiation therapy uses a highly focused radiation field to deliver larger doses of radiation in fewer treatments. It combines IMRT and image-guided radiotherapy. Your doctor implants tiny markers into the tumor. A CT scan picks up the location of those markers, guiding radiation to the tumor.