Specialists in Liver metastases
21 Specialists found
Information About the Field of Liver metastases
Treatment of liver metastases – Chances of cure and life expectancy
Liver metastases are by far the most common malignant tumors of the liver. Metastases are secondary lesions that stem from a primary tumor outside the liver.
The following tumors commonly metastasize to the liver, listed in descending order:
What are liver metastases and how do they develop?
Liver metastases are malignant secondary tumors that arise from a primary tumor elsewhere in the body. In contrast, tumors that have originated in the liver cells are called primary liver tumors such as liver cancer (hepatocellular carcinoma). The tumor cells spread partly through the bloodstream (hematogenous spread) and partly via the lymphatic system (lymphogenous spread).
Primary tumors of the digestive organs, such as colorectal cancer, stomach cancer, or pancreatic cancer, mainly spread through the bloodstream via the portal vein into the liver, which is the body’s main metabolic organ. Usually, multiple liver metastases are present at the time of diagnosis. The number, appearance, size, and particularly the location of the metastases are important for planning treatment.
What symptoms are caused by liver metastases?
Patients with liver metastases may experience symptoms of their primary tumor, such as cough in lung cancer or bleeding in colorectal cancer. In addition, patients may experience the following B symptoms that occur in many cancers:
- Fever
- Night sweats
- Unintentional weight loss
Liver metastases often remain asymptomatic for a long time. When numerous or large liver metastases are present, they can cause upper abdominal pain and loss of appetite. Only when two-thirds of the liver is affected, does a yellow discoloration of the skin and sclera (the whites of the eyes) appear, a condition referred to as jaundice.
How do physicians diagnose liver metastases?
Once a malignant cancer is detected, tumor staging is performed. This process involves a series of diagnostic tests to determine the extent and stage of the cancer. This always includes a search for abdominal metastases, usually using CT or MRI imaging.
Liver metastases can also be detected before the primary tumor, sometimes even leading to the initial cancer diagnosis. Symptoms such as upper abdominal pain or jaundice often prompt an ultrasound examination, where liver metastases become visible. The ultrasound can provide early clues about the possible origin of the metastases. For instance, if the lesions appear dark (hypoechoic) on ultrasound, they often originate from breast, lung, or pancreatic cancer or from lymphomas. In contrast, if the lesions appear bright (hyperechoic), this suggests that metastases originate from a gastrointestinal or renal primary tumor.
Cure of liver metastases – only by complete removal of the tumor
Malignant tumors of the liver can generally only be removed through surgical resection with complete removal of tumor tissue. In many cases, a complete removal of tumor tissue is no longer possible, as metastases are a sign of advanced cancer. Nevertheless, various therapeutic options are available that can improve quality of life and extend survival.
Generally, the primary tumor (e.g. colorectal cancer) has to be treated first to prevent further tumor spread before attempting the removal of the metastases.
Numerous liver metastases from colorectal cancer can be removed in otherwise healthy and stable patients. As the liver has a strong regenerative capacity, resection of numerous metastases is also possible in several stages.
However, if the liver metastases are classified as unresectable due to their number or size, chemotherapy or partial resection may be performed to restore resectability (the possibility of complete surgical removal). Therefore, neoadjuvant chemotherapy is often administered to shrink the tumor and metastases prior to surgery, improving resectability.
Therapeutic concepts for inoperable liver metastases
Inoperable metastases are usually treated palliatively with chemotherapy. Palliative care aims to provide symptom relief rather than curing the disease. Moreover, thermal ablation therapies, such as radiofrequency ablation (RFA) or microwave ablation, can shrink the lesions by applying local heat.
In transarterial chemoembolization (TACE), a chemotherapeutic drug is directly injected into the tumor through a catheter. This allows for a maximal local effect with minimal damage to the surrounding tissue and patient.
Another treatment option that targets the liver lesions directly through a catheter is selective internal radiation therapy (SIRT). This procedure involves injecting radioactive particles directly into the tumor tissue for localized radiation, minimizing damage to the surrounding tissue.
High-Intensity Focused Ultrasound (HIFU) therapy is yet another modern method. This method applies intense heat to tumor cells, leading to their destruction. Although this method is still in its early stages of development, numerous studies have shown promising results, suggesting it may be an effective treatment option with few side effects.
According to current evidence, multimodal therapy concepts that combine liver surgery, chemotherapy, and thermal ablation are the most promising.
Radiation of liver metastases
With the continuous advances in precise radiation techniques, radiotherapy for liver metastases is on the rise. Particularly stereotactic radiosurgery and brachytherapy show promising results in controlling tumor growth. The targeted use of radiation spares the healthy surrounding tissue.
Life expectancy - survival with liver metastases
The median survival after diagnosis, without surgical removal, depends on the primary tumor and is about 4-8 months. Following complete surgical removal of liver metastases from colorectal cancer, 5-year survival rates of up to 45 have been reported in current literature. In other words, 45% of cancer patients are alive five years after surgery.
Which physicians and clinics specialize in liver metastases?
The treatment of liver metastases is carried out by an interdisciplinary team, including visceral surgeons specialized in liver surgery, radiation oncologists specialized in radiotherapy, oncologists, and pathologists.