Metastatic Liver Cancer
Liver Metastases are common in many types of cancer, especially those of the GI track, breast, lung, and pancreas.
The first symptoms usually are nonspecific (e.g weight loss, right upper quadrant discomfort) but are sometimes the presenting symptoms of the primary cancer. Liver metastases are suspected in patients with weight loss and hepatomegally and in those with primary tumors at high risk of hepatic spread.
Diagnosis is usually supported by an imaging test, most often ultrasound or spiral CT with contrast.
Treatment usually involves palliative chemotherapy.
Metastatic liver cancer is more common than primary hepatic malignancy and is sometimes the initial clinical manifestation of cancer originating in the GI tract, breast, lung, or pancreas.
Symptoms and Signs
Early liver metastases may be a symptomatic.
Non specific symptoms of malignancy (e.g weight loss, anorexia, fever) often develop first. The liver may be enlarged hard or tender, massive hepatomegaly with easily palpable lumps signifies advanced disease.
Hepatic bruits and pleuritic type pain with an overlying friction rub are uncommon but characteristic.
Splenomegaly is occasionally present, especially when the primary cancer is pancreatic.
Concomitant peritoneal tumor seeding may produce ascites ,but jaundice is usually absent or mild initially unless a tumor causes biliary obstruction. In the terminal stages, progressive jaundice and hepatic encephalopathy presage death.
Diagnosis
In suspected cases, liver function tests often are obtained but usually are not specific for the diagnosis.
Alkaline phosphatase , gamma-glutamyl transpeptidase and sometimes LDH typically increase earlier or to a greater degree than do other tst results , aminotransferase levels vary , Imaging tests have good sensitivity and specificity .
Ultrasound is usually helpful, but spiral CT with contrast often gives more accurate results. MRI is comparably accurate.
Liver biopsy provides the definitive diagnosis and is performed if other studies are equivocal or if historic information (e.g cell type of the liver metastasis) may determine the treatment plan.
Ultrasound or CT guided biopsy is preferable to blind biopsy.
Treatment
Treatment depends on the extent of metastasis .With solitary or very few metastases due to colorectal cancer, surgical resection may prolong survival.
Depending on the characteristics of the primary tumor, systematic chemotherapy may shrink tumors and prolong life but is not curative, hepatic intra-arterial chemotherapy sometimes achieves the same ends with fewer or milder adverse systemic effects.
Radiation therapy to the liver occasionally alleviates severe pain due to advanced metastases but does not prolong life.
Extensive disease is fatal and best managed by palliation for the patient and support for the family
Hematologic Malignancies and the Liver
Hepatic involvement in advanced leukemia and related blood disorders is exceedingly common.
Liver biopsy is not needed. In hepatic lymphoma, especially Hodgkins disease, the extent of liver involvement determines staging and treatment but unfortunately but may be difficult to assess.
Hepatomegaly and abnormal liver function tests may reflect a systemic reaction to hodgkins disease rather than spread to the liver, and biopsy often shows nonspecific focal mononuclear infiltrates or granulomas of uncertain significance.
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