Liver metastases are tumors that have spread to the liver but originate from other organs in the body.
Tumor cells found in a liver metastasis are not true liver cells. They are cells from the part of the body where the primary tumor begins.
Most often, liver cancer is secondary.
Usually, the cells from the metastases under the microscope have the same appearance as the original cancer cells. In addition, the metastatic tumor cells and the original cancer cells have common characteristics such as the presence of some proteins or special chromosomal changes.
Statistics on liver metastases
The liver is the second most common organ with metastases (cancer spread) after the lymph nodes. Liver metastases have been found in 30-70% of patients who have died of cancer.
In the Western world, liver metastases are more common than primary liver cancer.
Liver metastases are most often observed in the elderly at the age of 50 and 70 years.
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Tumors that spread to the liver
Liver metastases develop only when a person is already sick with cancer. Some cancers, such as gastrointestinal cancer, are more likely than others to spread to the liver. Tumors that can spread to the liver originate from:
- Pancreas
- Breast
- Gallbladder and bile duct
- Intestine (colorectal carcinoma)
- Stomach
- Esophagus (esophagus)
- Lung
- Skin (melanoma)
- Ovary (ovarian carcinoma)
- Eye
- neuroendocrine tumors
Brain tumors are the only ones that do not form liver metastases.
Cancer usually spreads to the liver because it provides a suitable environment for tumor cells to grow.
Openings in the walls of the blood vessels in the liver allow the tumor cells to approach the functional cells of the liver (hepatocytes).
The liver has a strong blood flow and supplies the tumor cells with nutrients and oxygen that promote growth.
Organs in which metastases most often form are:
- Liver
- Lungs
- Bone.
Course of liver metastases
Liver metastases consist of foreign tissue that grows inside the liver.
These formations can grow in size or infiltrate other organs (spread through the surrounding tissues).
Metastases grow and compress the surrounding liver tissue.
As a rule, a band of connective tissue forms around the metastases and the surrounding tissue is broken down.
Large metastases can compress branches of the portal vein.
Since liver metastases grow rapidly, they become too large for nutrition by the blood supply, so cell death occurs inside the tissue.
Some metastases can provoke calcifications, which are easily detected by an X-ray.
Causes of death from metastases are:
- compression of the vena cava (blocks the blood flowing back to the heart),
- Blockage of blood outflow.
Symptoms of liver metastases
Many patients with liver metastases have no or non-specific symptoms that may indicate various diseases.
When symptoms appear, these are:
- General feeling of weakness or lack of health
- Loss of appetite
- Weight loss
- Fever
- Fatigue
- Bloated abdomen
- Ascites
- Itch
- Swollen feet and legs
- Abdominal pain or discomfort
- Backache
- Liver pain
- Jaundice (yellow-colored skin and eyes)
- In advanced phases, a hepatic coma can occur
Diagnosis of liver metastases
Examinations for the diagnosis of liver metastases:
- CT or MRI (magnetic resonance imaging)
- Liver function tests: direct and indirect bilirubin, enzymes (AST/ALT, alkaline phosphatase, γ-GT, LDH), plasma proteins (albumins and globulins)
- Ultrasound of the liver
- Liver biopsy
Treatment of liver metastases
Chemotherapy
Chemotherapy is a treatment based on anti-cancer drugs that circulate throughout the body and destroy tumor cells. Chemotherapy can help reduce liver metastases and reduce symptoms.
It is the preferred therapy for advanced cancer.
Chemotherapy is used for liver metastases when:
- the primary cancer can respond positively to the therapy (e.g. breast cancer and colon cancer),
- not all liver metastases can be surgically removed,
- there are quite a lot of metastases in the liver,
- the patient cannot survive surgery,
- the cancer has spread to other organs outside the liver.
Radiotherapy
Radiation therapy uses high-energy radiation to destroy the tumor cells.
For the treatment of liver metastases, radiation therapy is not often used because the healthy liver tissue does not tolerate radiation.
The type of radiation therapy used for liver metastases is external radiation. Radiation therapy is primarily used to:
- to keep the growth of liver metastases under control,
- alleviate the symptoms such as pain and thus improve the patient’s quality of life.
Radiofrequency ablation
Radiofrequency ablation uses a high-frequency electric current (also called hyperthermia) to destroy the tumor cells. Ablation can be performed to control the inoperable metastases in the liver.
Usually, this treatment is used only for small tumors (smaller than 5 cm).
Radiofrequency ablation is sometimes performed along with surgery.
The procedure consists of an electrical current in the liver metastases by means of a thin probe that can be inserted through the skin and controlled by ultrasound or a CT scan.
The probe is inserted into the liver, and some very small needles penetrate the tumor mass.
The needles are connected to two electrodes that transmit the electric current to heat the tumor tissue and destroy the cells.
A cell can withstand temperatures of more than 43/44 degrees for 20-25 minutes, beyond which they die.
Cryosurgery
Cryosurgery destroys cells or tumor tissue by freezing.
Cryosurgery can be used for:
- liver metastases that cannot be surgically removed,
- multiple metastases,
- Metastases in both lobes of the liver.
Cryosurgery uses a metal probe to bring extremely cold liquid or gas into contact with the liver tissue.
Ablation with ethyl alcohol
An ablation with ethyl alcohol is a procedure in which ethanol is injected through the skin (percutaneous injection) directly into the liver tumor. The alcohol kills the tumor cells and thereby reduces the size of the tumor.
Chemoembolization
Chemoembolization is done by injecting a chemotherapy drug into an artery.
Often the medication is mixed with an oily liquid (for example, Lipiodol) or gelfoam (an absorbent gelatin sponge or powder used to control bleeding).
A catheter is inserted into a large artery of the arm or leg.
The catheter is directed into the main artery that carries blood to the liver (hepatic artery).
The mixture is inserted through the catheter and cuts off most of the blood flow to the liver
In this way, the tumor is deprived of oxygen and nutrients that it needs to grow.
Surgical intervention to remove the tumor can be done in the traditional way or in minimally invasive laparoscopy.
Diet and nutrition for liver metastases
Among alternative therapies, diet can help prevent the growth and recurrence of the cancer.
In addition, it is important to eat enough, since the disease leads to weight loss due to the increased calorie consumption of tumor cells.
The dietary guidelines for tumors are based on a few specific types of foods:
- Fruit and vegetables
- Pulses
- Nuts, dried fruit and seeds
Foods to avoid are meat (especially red), sugary drinks and desserts with a high sugar content.
In my experience, the most effective diets are: The natural hygiene according to Shelton – Lezaeta and the blood group diet according to Dr. D’Adamo/Mozzi.
Both diets advise against milk, dairy products and grains; cereals containing gluten in particular are responsible for many diseases according to the blood group diet.
There are big differences between these two theories, Shelton and Lezaeta recommend a diet low in protein but rich in seasonal fruits and vegetables, legumes, nuts and seeds. Fasting in specialized clinics can cure a tumor if it is not already too advanced.
D’Adamo and Mozzi recommend a diet high in protein: fish, meat, eggs, legumes. Depending on the blood type, certain foods are allowed to avoid others, but the main cause of liver problems is considered to be cereals, desserts and dairy products.
Life expectancy
Life expectancy depends on the original location of the carcinoma and how far it has spread to the liver and other organs.
Rarely, surgical intervention is performed to remove liver tumors.
The operation is indicated only in patients with a certain type of tumor (for example, colon and rectal cancer) and when there are a limited number of tumors in the liver.
In most cases, cancer that has spread to the liver is not curable, so it is in the final stages.
Usually, patients with liver metastases die from this cancer.
However, treatment can help shrink the tumors, improve life expectancy, and alleviate symptoms.
How long can you live with liver metastases? Prognosis
The prognosis for patients with liver metastases is about 18 months from the first onset of symptoms in solitary metastasis, but only 3 months with extensive liver involvement.
Cases of patients with histologically proven liver metastases who lived for more than 5 years have been recorded. (The prognosis for carcinomas can be 10-15 years.)
The median survival time in individuals who have stage 4 non-small cell lung cancer (metastatic) is about 8 months, although some cases of long-term survival have been reported in patients with lung cancer and liver metastases.
The median survival time in individuals with advanced small cell lung cancer (metastatic) is 2-4 months without treatment and 6-12 months with therapy.
It is possible for life expectancy to improve with a liver transplant and the 5-year survival rate is 75% of patients.
However, liver cancer must be diagnosed at an early stage.
Liver transplantation is also a possibility when a person receives the early diagnosis of a tumor with liver metastases.
If it is a secondary carcinoma, sooner or later the cancer cells will attack the newly implanted liver.
Survival rates are also low with a transplant. Surgical resection can improve the possibility of survival, but this possibility is only possible if the tumors are located in the area of the liver or are stable there.
Life expectancy increases significantly in cases where surgery is possible.
There is a 75% chance that a person will survive 1 year longer, 50% that they will survive another 3 years and 30% at least 5 years.
In addition, chemotherapy and liver transplantation can increase the survival rate.
There is a 15% chance that life expectancy will be increased by one year due to chemotherapy, and by 3 years in 3%.
