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Metastatic liver disease

• Liver is a common site for metastatic disease because it is rich, dual blood supply (the liver receives blood via the hepatic artery and portal vein), which is 20 times more common than primary ones.
• 50% cases of primary tumor is gastrointestinal tract
  • Other common sites - breast,ovaries,bronchus and kidney
• Tumor emboli entering the sinusoids through the liver blood supply appear to be physically obstructed by the Kupffer cells, but if tumor emboli are larger, they tend to become lodged in the portal venous branches.

Features

• Hepatomegaly
• Tenderness
• Cachexic
• Ascites
• Jaundice
• Pyrexia- up to 10% of patients
• ALP and gamma glutamyl trandspeptidase elevated
• Ultrasound scan and CT scan - multiple filling defects

Investigations

• Hemoglobin decrease
• Liver function test: ALP elevated, bilirubin elevated, albumin decrease
• Carcinoembryonic antigen for colorectal secondaries
• Ultrasound scan
• CT scan
• Biopsy under ultrasound control

Treatment

• No effective treatment for most patients --- because both lobes usually involved --- making surgical resection impossible
• Younger patients with metastases from colorectal cancer, confined to one lobe of liver and up to 4 in number, should be treated by partial hepatectomy.
  • In selected cases, chemotherapy may be given systematically or via hepatic artery.
• In some tumors, notably arising from the colon and rectum, apparently solitary metastases/metastases to one or other lobes --- may be resected
• Careful search for other metastases is required, including local recurrence of original primary tumor (eg:colonoscopy) and dissemination elsewhere (eg:CT of thorax) --- 5 year survival rates of 30-40% have been reported following resection

References

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