Why is the liver most often affected?
The liver receives blood from two sources: the hepatic artery and the portal vein, which collects blood from the stomach, intestines and pancreas. Tumor cells that enter the bloodstream from these organs are retained in the dense network of small vessels of the liver and can give rise to new lesions. A rich nutrient medium plays an additional role. Metastases are usually multiple and located in both lobes, but in some patients, especially with colon cancer, they are single, and then radical treatment is possible.
- Double blood supply to the liver
- Blood from the intestines passes through the liver
- Most common source is colon cancer
- Also cancer of the stomach, pancreas, breast, lung
- The lesions are often multiple, less often single
Symptoms
The liver has a large margin of safety, so small lesions do not disrupt its functioning and do not cause complaints. The first signs appear when the lesion is significant or when the bile ducts are compressed: heaviness and dull pain in the right hypochondrium, loss of appetite, nausea, unexplained weight loss, weakness. Later, jaundice, itching of the skin, darkening of urine, accumulation of fluid in the abdomen and swelling of the legs appear. Often metastases are found before complaints - during a routine examination of the main tumor.
- Heaviness and pain in the right hypochondrium
- Decreased appetite and nausea
- Weight loss and weakness
- Yellowness of the skin and sclera, itchy skin
- Enlarged abdomen due to fluid
- Swelling of the legs
- Increase in temperature for no apparent reason
Not every lesion in the liver is a metastasis
Benign liver tumors are very common and usually harmless. Simple cysts, hemangiomas and focal nodular hyperplasia have characteristic features with a properly performed contrast study and do not require treatment. In our region, it is important to remember about hydatid cysts. Therefore, a finding on a routine ultrasound is not a diagnosis, but a reason to perform a CT or MRI with contrast, and if doubts persist, a biopsy. There is no need to panic until clarification is made.
- Simple liver cyst
- Hemangioma is a benign vascular tumor
- Focal nodular hyperplasia
- Liver adenoma
- Hydatid cyst
- Liver abscess
- Primary liver cancer
Diagnostics
Ultrasound is the first available method, but to characterize the lesions, a CT or MRI with intravenous contrast is needed: by the way the lesion accumulates and releases contrast in different phases, the doctor distinguishes metastasis from hemangioma and other formations. Blood tests show the condition of the liver and the level of tumor markers, which help in monitoring. If the primary tumor is unknown, be sure to look for its source, including colonoscopy and gastroscopy, and if the picture is unclear, a biopsy of the lesion is performed under ultrasound or CT guidance.
- Ultrasound of the liver and gallbladder
- CT or MRI with contrast in several phases
- ALT, AST, bilirubin, alkaline phosphatase, albumin
- Tumor markers depending on the suspected source
- Colonoscopy and gastroscopy for unknown primary tumor
- Image-guided biopsy of the lesion
- PET-CT according to indications
Treatment
In most cases, the basis remains systemic therapy, selected according to the type of primary tumor: chemotherapy, targeted drugs, hormonal treatment or immunotherapy. A separate situation is single metastases in colon cancer: their surgical removal, sometimes after preliminary drug therapy, allows for long-term remission. Local methods are also used: radiofrequency or microwave ablation, embolization of tumor vessels. An important part of care remains supportive treatment - pain relief, nutrition, correction of jaundice.
- Systemic drug therapy
- Surgical removal of single lesions
- Ablation of small metastases
- Embolization of tumor vessels
- Bile duct drainage for jaundice
- Eating enough protein and avoiding alcohol
- Pain management and supportive care
- Regular monitoring of CT scans and tests
