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.
In the West, secondary liver cancer is much more common than primary liver cancer (Hepatocellular carcinoma). In Singapore, the incidence is about the same as primary liver cancer.
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
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 -
How to prevent
Prevention of Secondary Liver Cancer (Liver Metastases) depends on the site, the stage and treatment of the primary cancer.
There are several steps in the spreading (metastasis) process.
- 1. Local invasion: Cancer cells move from the primary site into nearby normal tissues/organs
- 2. Intravasation: Cancer cells move through the walls of nearby lymph and blood vessels
- 3. Circulation: Cancer cells migrate through the lymphatic system and the bloodstream to other parts of the body
- 4. Extravasation: Cancer cells stop moving when they reach a distant location or organ. They subsequently move out of the vessels (lymphatic or blood) and invade the nearby tissues or organs
- 5. Proliferation: Cancer cells grow at the distant location and become small tumours (micro-metastases).
- 6. Angiogenesis and Growth: Micro-metastases stimulate the growth of new blood vessels which in turn supply the nutrients and oxygen needed for further tumour growth
Treatment strategies for the primary cancer including surgery, chemotherapy and/or radiation all may play a role in stopping the cancer from spreading to the liver.
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
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:
- Locoregional therapy- Ablation, Trans-arterial embolization therapy +/- chemotherapy agents
- Radiation therapy
- 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.
Clinical trials test new drugs, surgical techniques, and strategies for advancing treatment and care. There may be suitable clinical trials available for selected patients.
Please consult our team of specialists here as we sub-specialise in the treatment for Secondary Liver Cancers e.g., Colorectal liver metastases.
Senior Consultant Hepatopancreatobiliary Surgeon
MBBS, MMed (Surgery), MSc, FAMS, FRCSEd
Prior to private practice, Dr Lee Ser Yee was a founding member and Senior Consultant at the Department of Hepatopancreatobiliary (HPB) and Transplant Surgery at Singapore General Hospital (SGH). He served as the Director of the Laparoscopic programme and the Director of the Surgical Skills Training Program and the SingHealth Surgical Skills Centre.
He started his medical training at the National University of Singapore in 1996 and completed his training in General Surgery, HPB surgery and Liver Transplantation at SGH and National Cancer Centre, Singapore.
He also completed dual USA-fellowships in Advanced Laparoscopic HPB surgery and Liver Transplantation under Professor Daniel Cherqui at the New York Presbyterian Hospital-Weill Cornell Medical Center and a Complex Surgical Oncology clinical fellowship at Memorial Sloan Kettering Cancer Center in New York.