Section 10. Liver and Gallbladder Disorders

Chapter 139. Liver Tumors

Topics: Introduction | Hemangioma | Hepatocellular Adenoma | Hepatoma | Other Primary Liver Cancers | Metastatic Liver Cancer

Metastatic Liver Cancer

Metastatic liver cancer is a cancer that has spread to the liver from elsewhere in the body.

Metastatic liver cancer most commonly originates in the lung, breast, large intestine, pancreas, or stomach. Leukemia (a cancer of white blood cells) and lymphoma (a cancer of the lymph system) may involve the liver. Sometimes the discovery of a metastatic liver cancer is the first indication that a person has cancer.

Symptoms

Often, the first symptoms include weight loss and poor appetite. Fever may be present. Typically, the liver is enlarged and hard and may be tender; often the liver feels lumpy as well. Occasionally the spleen is enlarged, especially if the cancer originated in the pancreas. At first, the person has mild or no jaundice (a yellowish discoloration of the skin and the whites of the eyes) unless the cancer is blocking the bile ducts. Later, the abdominal cavity may become swollen (distended) with fluid, a condition called ascites (see Section 10, Chapter 135). In the weeks before the person dies, jaundice progressively worsens. Also, the person may become confused and drowsy as toxins accumulate in the brain, a condition called liver encephalopathy (see Section 10, Chapter 135).

Diagnosis

The diagnosis is often difficult in the early stages of the disease but becomes fairly easy in the late stages. The tumors often damage the liver, causing it to malfunction and resulting in abnormal liver function test results. Ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI) of the liver may reveal the cancer, but these scans cannot always detect small tumors or distinguish a tumor from cirrhosis or other abnormalities.

A liver biopsy, in which a sample of liver tissue is removed with a needle for examination under a microscope (see Section 10, Chapter 134), confirms the diagnosis in only about 75% of cases. To improve the chances of obtaining cancerous tissue, a doctor sometimes uses ultrasound to guide the insertion of the biopsy needle. Alternatively, a biopsy specimen may be obtained while a doctor looks at the liver through a laparoscope (a flexible viewing tube that is inserted through the abdominal wall).

Treatment

Depending on the type of cancer, chemotherapy drugs may be used to temporarily shrink the tumor and prolong life, but they do not cure the cancer. Chemotherapy drugs may be injected into the liver's main artery (the hepatic artery), which then delivers a high concentration of the drugs directly to the cancer cells in the liver. Radiation therapy to the liver can sometimes reduce severe pain, but it has little other benefit.

If only a single tumor is found in the liver, it may be surgically removed, especially if it originated in the intestines. However, not all experts consider this surgery worthwhile. For most people with extensive cancer, all a doctor can do is relieve the symptoms (see Section 1, Chapter 8). A person may develop an advance directive (see Section 1, Chapter 9) to specify the type of care desired if he becomes unable to make decisions about care.