Metastatic liver tumours - Tumours of the liver

Metastatic liver tumours

Definition

Secondary tumours in the liver are very common.

Aetiology

The most common sites of the primary tumour are bronchus, breast, bowel (stomach, colon) and pancreas. The liver is also an important site of growth for lymphomas and leukaemias.

Pathophysiology

Haematogenous spread via the portal vein or the hepatic artery. One or more tumours may develop. Large or multifocal tumours cause loss of liver parenchyma and liver impairment. Liver metastasis may be the first sign that there is a primary tumour present, or it may occur in a patient with known past or present malignant disease.

Clinical features

Insidious onset of fatigue, anorexia and weight loss occurs. Jaundice is a late sign. Pain and tenderness may be felt over the liver, which may be irregular, firm and enlarged.

Investigations

Liver function tests may be abnormal. Ultrasound or CT abdomen may demonstrate the tumours, guided biopsy may be required if the diagnosis is unclear or if the primary tumour is unknown.

Management

Treatment depends on the natural history of the primary tumour.

·        Chemotherapy may be effective in certain tumour types such as small cell lung carcinoma, lymphoma and breast cancer. Drugs can be infused through a catheter into the hepatic artery.

·        Rarely curative excision of a liver metastasis is performed, particularly for slow-growing tumours.

·        In most cases liver metastases indicate a poor prognosis and treatment of the liver tumour will not be curative. Patients should receive palliative care.

Prognosis

Depends on the primary tumour type. Obstructive jaundice is a poor prognostic factor.