How Liver Metastasis Is Treated

Liver metastasis, also known as secondary liver cancer, refers to cancer that has spread to the liver from the site of the original tumor—most often the colon or rectum, although it's possible for cancer that originates anywhere in the body to spread to the liver. This disease is considered advanced, or stage IV cancer, so in most cases, the goal of treatment is to shrink tumors, extend life expectancy, and boost quality of life rather than try to cure the cancer. Treatments for liver metastasis include surgery to remove the tumor, chemotherapy, biologic drugs, radiation, or a procedure called ablation which destroys cancerous lesions. If none of these treatments is an option, palliative care may be necessary.

Surgeries and Specialist-Driven Procedures

Liver metastasis requires immediate attention. One or more treatment approaches may be recommended by an oncologist, depending on:

• The stage and grade of the cancer
• The person's age and overall health
• The number and location of tumors in the liver
• The health of unaffected areas of the liver
• The location of veins or arteries in relation to the metastases
• The approaches that were used to treat the primary cancer (such as chemotherapy, radiation, or surgery)

Surgical Removal

The surgical removal of a liver tumor is called a hepatic resection. Advances in imaging and surgical techniques, such as laparoscopy and robotics, have made this option increasingly available.

Many factors must be considered regarding the safety and feasibility of resection. For instance, a substantial portion of healthy functioning liver must be available to remain after surgery.

Chemotherapy

Chemotherapy is the use of medications to destroy, shrink, or inhibit cancer cells. Most chemotherapy drugs are delivered intravenously—directly into a vein. This means the medication will circulate throughout the entire body, which is why chemotherapeutic drugs can have side effects like nausea and hair loss.

The specific chemotherapy drug used to treat secondary liver cancer will depend on the site of the primary tumor. For example, if the original cancer was on the colon, medications approved for treating colon cancer will be used.

The type of chemotherapeutic drugs used most often for liver metastasis that originated in the colon are fluoropyrimidines. A fluoropyrimidine is a type of antimetabolite that works by tricking cancer cells into thinking they are a nutrition source. By taking up the drug instead of actual nourishment, the cancer cells eventually die.

Hepatic Arterial Infusion (HAI)

This is a technique for delivering chemotherapeutic drugs directly to tumors in the liver. It involves implanting a small pump in the lower abdomen through which medication can be administered directly to the tumor via the hepatic artery—the main source of blood and nutrients to the liver. HAI has fewer potential side effects than standard chemotherapy and may improve survival rates.

Biologic Drugs

Biologic drugs are considered targeted therapy, although the presence of side effects associated with these agents demonstrates that the specificity for cancer cells is only partial.

Biologics typically are delivered intravenously or through an implanted vascular access device. They may be given in conjunction with chemotherapeutic drugs.

There are several types of biologics used to treat liver metastasis coming from colon cancer. The most commonly used ones are:

• Anti-angiogenesis drugs, Avastin (bevacizumab) halt the growth of blood vessels that feed tumors, causing them to shrink.
• Epidermal growth factor inhibitors, Erbitux (cetuximab), Vectibix (panitumumab) block a protein that helps to support the progression of cancer.

People who have a mutation of an oncogene called the KRAS gene cannot be successfully treated with Cetuximab. Therefore, oncologists routinely test for this mutation. A mutation of KRAS may be present in different types of cancer (colorectal, pancreas, lung).

Ablation

Ablation is the non-surgical removal or destruction of cancerous tissue. The objective is to leave as much healthy liver tissue intact as possible.

There are several types of ablation:

• Radiofrequency ablation (RFA). In this procedure, a needle is inserted through the skin and, with the help of computerized thermography (CT) or ultrasound, guided directly into a liver tumor. An electrical current is passed through the needle to generate heat that destroys the cancer cells.
• Microwave ablation uses microwaves to create heat.
• Cryoablation uses cold gas to freeze cancer cells.

Radiation Therapy

Two types of radiation therapy sometimes are used to treat liver metastasis that can't be removed surgically or with ablation:

• Intensity-modulated radiation therapy (IMRT) in which radiation molds to the tumor's shape with the help of an imaging technique such as CT
• Stereotactic body radiation therapy which administers concentrated amounts of radiation with fewer overall treatments

Selective Internal Radiation Therapy (SIRT)

Also known as radioembolization, SIRT combines radiation therapy with embolization. This treatment involves the injection of tiny radioactive particles into the hepatic artery in order to restrict the blood supply to tumors.

SIRT sometimes results in significant shrinkage of secondary liver tumors. Research shows that combining chemotherapy and SIRT may control the growth of tumors for a longer time.

Liver Transplant

A liver transplant is a procedure in which a diseased liver is removed from a person's body and replaced with a healthy liver from a donor.

It generally has been believed that a transplant is not feasible in cases of secondary liver cancer. There is some research, mostly out of Europe, to show that for a subset of patients with colorectal liver metastasis a transplant may be possible. However, it's an expensive procedure that in the United States is further stymied by the fact that are few donated livers available for transplantation.

Palliative Care

Palliative care focuses not on treating the cancer but rather on managing the symptoms it causes and/or side effects of medications and other treatments. It can be used at any time during treatment for secondary liver cancer.

Sometimes radiation or chemotherapy are used as part of palliative care: The goal is not to cure the cancer but to shrink tumors and prevent further metastases—which may relieve symptoms and prolong life. Other procedures, such paracentesis or abdominal tap, may be used to to drain fluid from the abdomen.

Palliative care that takes place in the last weeks or months of life is regarded as hospice or end-of-life care. It involves a team comprised of doctors, nurses, home care workers, and other supportive personnel. Hospice care not only helps a person be as comfortable as possible, it frees up their loved ones to be able to make the most of the time that's left.

A Word from VeryWell

A diagnosis of liver metastasis can be devastating whether you already have been battling colon cancer or another type of cancer or this is the first you're learning about the disease. Secondary liver cancer is regarded as stage 4 cancer, which means it's advanced and rarely curable. Oncologists have tools for treating this disease that can dramatically improve quality of life and even extend it. Your job is to learn all you can so that you're empowered to make decisions about your treatment and surround yourself with people who can help and support you.