The Treatment of Liver Metastases

Liver cancer, artwork
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Metastasis is the word used to describe a tumor that has spread outside of its primary site. In advanced colon cancer, tumor metastasis most frequently occurs in the lungs or the liver. These tumors may be found at the time you were diagnosed with colon cancer, as a recurrence, or if the cancer gains strength and continues to grow and spread.

Showing Signs of Metastasis

Occasionally, the symptoms of liver metastasis begin to show prior to any diagnostic tests confirming it. Although some of the symptoms can overlap with treatment side effects, the heralding symptoms of liver metastasis may include:

  • Extreme fatigue
  • Nausea and lack of appetite
  • Vomiting or diarrhea
  • Itchy skin
  • Yellow eyes or skin
  • Bloated stomach

Although these symptoms are not concrete, they may be reflective of liver injury. As tumors invade the liver, they decrease its ability to function properly. Your liver has many important roles including its life-sustaining ability to help your body use glucose and to recycle waste from the body.

As tumors grow inside the liver, symptoms can increase in severity. As the protein levels in your blood decrease, fluid can leak into the abdomen and cause the bloating and fluid retention associated with liver problems. The increased fluid in your belly can also cause swelling and discomfort in your ankles and feet, especially after standing or sitting for prolonged periods of time.

Confirming the Suspicion

Metastatic liver tumors are usually found through blood tests or confirmed by biopsy or abdominal computed tomography (CT) exams. The easiest test doctors use to confirm a suspicion of metastasis or growing cancer is a blood test. The blood is tested for specific tumor markers. A tumor marker may consist of a protein associated with a certain type of cancer. For colorectal cancers, the tumor marker the doctor looks for in your blood is a type of protein called carcinoembryonic antigen, or CEA. The tumor marker specific to liver cancers and metastasis is called alpha fetoprotein or AFP.

Watching tumor markers in the blood does not provide definitive proof of metastasis. Tumor markers can be elevated for a number of reasons—the most common being a response (or lack of) to a chemotherapy drug. As the chemotherapy kills the cancer cells, they can release this protein into your blood, causing a temporary spike in your tumor markers. Your doctor will watch these blood tests at intervals and pair the results with his or her clinical findings.

A CT of your abdomen may show liver metastasis, especially if a contrast agent is used. Contrast agents clarify the picture and allow the doctor to see more details, but they are not always necessary. If it's needed, a core needle biopsy (or alternatively, a fine needle aspiration) can be ordered at the same time as the abdominal CT test. Using a very thin, long needle, the doctor uses the CT to find and isolate the liver mass and withdraws a microscopic sample of cells. A pathologist looks at the cells under a microscope and determines if the cancer has spread from your colon or if the liver cancer is a new, independent cancer. This may affect your treatment options, prognosis, and the stage and grade of your cancer.

Exploring Treatment Options

There are a number of ways your doctor may approach treating the liver tumors. He or she may suggest surgery, ablation, or palliative treatment options. Your treatment plan depends on a couple factors, including:

  • The stage and grade of your cancer
  • Your age and current health
  • The number and location of tumors present in your liver
  • The health of your unaffected liver
  • If your veins or arteries are close to the tumors in your liver
  • The type of treatment you have already endured (chemotherapy, radiation, or surgery) to treat the primary cancerous tumors

The surgical removal of a liver tumor is called a resection. Most commonly, the doctor will only suggest surgery if the lesion is isolated and if it can be removed completely (one or two tumors with clearly defined borders).

Radiofrequency ablation (also called RFA) is a procedure sometimes used to destroy lesions in the liver if surgical resection is not an option. RFA can be completed through the skin (percutaneous) or during surgery. A needle or probe creates heat through radiofrequency, which in turn heats and destroys cancer cells.

Palliative Treatment Options

If your doctor has decided you are not a candidate for resection or RFA, he or she may encourage palliative treatment measures to increase your comfort and survival. Commonly, the fluid build-up and swelling in your abdomen can cause discomfort and can be drained using ultrasound-guided removal. The procedure, called a paracentesis or abdominal tap, requires a needle to drain the excess fluids. The fluid will re-accumulate, so the procedure may need to be repeated every few weeks or months.

Palliative radiation and chemotherapy can also be used to control the growth and spread of liver metastasis. The treatment is not intended to "cure" the cancer, only to reduce the discomfort associated with the liver tumors.

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Article Sources

  • American Cancer Society. (2006). American Cancer Society’s Complete Guide to Colorectal Cancer. Clifton Fields, NE: American Cancer Society.
  • American Cancer Society. (n.d.). How are Tumor Markers Used?
  • National Cancer Institute. (n.d.). Stage IV and Recurrent Colon Cancer.