Liver Metastases

Liver metastases (Secondary liver cancer)

Liver metastases are tumour cells which have spread to the liver from another part of the body. This can appear at the same time of diagnosis of the primary tumour, or after completion of treatment of the primary tumour.

Most liver metastases can start in the rectum or colon. As many as 70% of patients with colorectal cancer will develop liver metastases. The reason that this happens is because the blood supply from the intestines will flow into the liver through a large blood vessel called the portal vein.

Other cancers which can spread to the liver include: lung cancer, breast cancer, kidney cancer, pancreatic cancer, and breast cancer.

The reality is that secondary liver cancer is much more common than primary liver cancer, which starts in the liver.

Symptoms

The symptoms of liver metastases are very often silent, and hard to identify. Many patients who have liver metastases will not notice anything unusual to indicate the development of liver metastases.

The following signs or symptoms may suggest the presence of liver metastases:

Weakness and poor health
Weight loss
Loss of appetite
Lethargy
Abdominal bloating
Jaundice (yellowing of the skin)

Diagnosis and staging

The diagnosis of secondary liver cancer, and to ascertain extent of spread, will require the following tests:

Blood tests (tumour markers, and liver enzyme levels)
Imaging testsThis can include CT scan, MRI scan, or PET scan as appropriate. PET scan is typically done with injection of tracer sugar to determine extent of spread. As cancer cells absorb sugar faster than normal cells, these will be highlighted on the PET scan.
Liver biopsy
Biopsy is an important part of the diagnosis, as this will determine the extent of tumour and the tumour cell type, which will impact treatment plans.
Typically, a usual approach is for image-guided liver biopsy with a fine-needle. For this, a thin needle is inserted into the liver to obtain a small tissue sample for examination.
On occasion, laparoscopy (a minimally invasive procedure) may be recommended to obtain difficult to reach areas of the abdomen to obtain tissue samples.
With information on the genetic makeup of the tumour, we can advise patients on the most effective therapies for their tumour type. Next-generation sequencing can be performed on the tissue sample obtained during biopsy.

Treatment

Cancer staging is important to determine how advanced a cancer is. As liver metastases have spread to liver from another part of the body, these are labelled as Stage 4 cancer. This is the most advanced stage of a cancer.

As liver metastases have spread from another part of the body, these can be difficult to treat. However, with the right approach, remission or even cure can be possible for some patients.

The key is to formulate the most effective plan for patients, we will consider the latest surgical and interventional radiology techniques (which are minimally invasive) to minimize pain and time to recovery for patients.

No two tumours are the same, and no patients are the same. Our approach is to customize a treatment plan for our patients. We will determine the primary cancer location, size and number of liver metastases and overall health of patient.

Surgery for liver metastases

Many of the major abdominal blood vessels pass through or under the liver, and are all connected to the heart. Great care must be taken during surgery as the liver can bleed massively when injured. Surgery to remove liver metastases will usually present a number of challenges. Dr Victor has performed many such procedures, and has a special interest in this type of treatment.

Such procedures can much safer today due to improvement of imaging techniques, and better surgical techniques. Dr Victor has refined his surgical technique and works closely with other interventional colleagues to improve his clinical results, minimizing blood loss and improving patient recovery time.

Surgical techniques will include the following:

Open surgery
Laparoscopic surgery
Ablation
This is a technique to destroy tumours without surgical wounds. This is undertaken with delivering tumour-eliminating energy via a needle probe. This is inserted through the skin and guided into the tumour with imaging guidance.
The most common ablation methods will be the application of heat delivered by radiowaves (radiofrequency ablation), or microwaves (microwave ablation).
We will select the appropriate ablation therapy based on the size and location of the tumour. Increasingly, such procedures are performed in combination with liver surgery that other hospitals/doctors may consider inoperable. A typical example of this is when metastases develop on both sides of the liver.
Ablation can reduce the risk of cancer coming back when liver metastases cannot be completely removed. It can prolong survival for patients with recurrent metastases whom doctors have previously treated with surgery or chemotherapy. Also, it can be utilized for patients who are too unwell to undergo an operation.
Radioembolisation (TACE) or Selective internal radiation therapy (SIRT)
This procedure for patients who have liver metastases, or when the liver metastases are the main clinical problem. It is also used when tumours are getting bigger or are not responding to chemotherapy.
With treatment planning, such procedures can be utilized to downstage liver tumour size with the aim of eventual liver metastases surgery.
Radiation therapy
This is utilized when cancer cannot be removed by surgery, or the tumour in the liver are too large for ablation
- Stereotactic body radiation therapy (SBRT)This uses a highly focused radiation field to deliver larger doses of radiation in fewer treatments. Tiny markers may be used to guide radiation to the tumour.
- Intensity modulated radiation therapy (IMRT)This uses radiation beams of varying intensity that mold to the shape of the tumour. Software and 3D images from CT scans will enable the doctor to focus radiation on cancerous tissue more accurately.

Dr Victor Lee and Dr Ek Khoon Tan have more than 40 years of experience treating liver cancer, colorectal liver metastases, and other liver tumours. We believe that dedication, skill, and multidisciplinary care is key to achieving optimal outcomes.

For more information, call us at

6737 8878

Mount Elizabeth Orchard

6475 1488

Gleneagles Hospital

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