he liver is the largest organ in the human body , being located in the upper right part of the abdomen. The liver performs numerous functions in the regulation of the organism, in the detoxification of the blood, in the defense against infections, in the deposit of energy and in the production of bile that will assist in the digestive process.
Hepatic metastases: introduction
For better understanding, benign liver tumors are presented in a separate session.
Malignant liver tumors can be divided into: primary cancer (originating in the liver itself) and secondary or metastatic cancer of the liver (originating in other organs and affecting the liver secondarily).
Among primary liver tumors, the most common is hepatocarcinoma or hepatocellular carcinoma. Other types of primary liver cancer include cholangiocarcinoma originating in the bile ducts, and other rare types such as angiosarcoma (cancer originating in the blood vessels), fibrolamellar carcinoma, lymphoma and hepatoblastoma.
Due to its functions, strategic position and the way it receives blood from the entire digestive system and also from other regions of the body, the liver is the organ most commonly affected by malignant tumors from other organs, which is called liver metastases . The primary primary tumor sites that will be metastatic to the liver are the large intestine (colon and rectum, colorectal tumors), pancreas, stomach, esophagus, skin, prostate, breast, ovary, lungs, uterus, bladder and kidneys.
Estimates of new cases in Brazil: 6995
Number of annual deaths in Brazil: 3940
Frequency: It is the most common cancer in the world.
Prevention and risk factors for liver metastases
Unlike primary liver tumors that present liver disease (cirrhosis and viral hepatitis) as a major risk factor, liver metastases occur in livers without previous disease. The risk factors are common to the primary site and prevention also depends on the location of the tumor.
Early detection of liver metastases
By definition, the presence of liver metastasis, regardless of the site of the primary tumor, indicates advanced cancer. Unlike some tumors (colorectal, hepatocarcinoma, breast, prostate) that have well-established programs for early detection, metastases do not have an early detection program.
Symptoms of liver metastases
– About 40% of people may have no symptoms
– Abdominal pain, feeling of distension and heaviness in the belly are the most common signs and symptoms
– Unexplained weight loss, loss of appetite, malaise, tiredness, jaundice (yellowish hue in the skin and eyes) and ascites (accumulation of fluid in the abdomen) can also occur.
Diagnosis of liver metastases
Liver metastases are usually found during:
– Routine examinations for nonspecific symptoms or other diseases often unrelated to the primary tumor (before the identification of the primary tumor).
– The staging of a primary tumor (before or during surgery).
– Follow-up of patients with tumors that have been treated.
– More rarely, because they cause symptoms of liver disease.
Suspicion of an experienced doctor is of fundamental importance for diagnosis. The reporting of symptoms and the examination of the patient are associated with some blood and imaging tests. These can also confirm or not the suspicion of liver cirrhosis (link). Blood tests will be used to check the overall health of patients, as well as test the liver, kidneys and check for bile obstruction. Tumor markers can assist in finding the primary tumor and also assist in post-treatment follow-up.
The diagnosis is made by computed tomography or Nuclear Magnetic Resonance (MRI). Liver biopsy may be necessary for diagnostic confirmation in some cases.
Staging of liver metastasis
The diagnosis of liver metastasis establishes that the primary tumor is at an advanced stage. However, it is necessary to complete the staging of the primary tumor in order to understand whether there is involvement of other organs (lung, brain and bones), in addition to the liver. Finally, it is necessary to understand in detail the size, number and location of liver metastases so that the most effective treatment can be planned.
Treatment of liver metastases
In addition to the factors described in the liver metastasis staging session, information about the primary tumor is essential to guide the treatment of liver metastases.
Thus, the location, if treatment has already been carried out (and also type, time and response to treatment), characteristics of the patient, findings of blood and image tests (size, involvement of other organs and lymph nodes) and pathology (tests in the microscope of part or all of the tumor by a specialized doctor) of the primary tumor will be the main information that will define how best to treat liver metastases. The main condition for the indication of a surgical resection of a liver metastasis is the complete elimination of the primary tumor and the affected ganglia. Depending on the type of primary tumor, this can be done before, after or at the same time as the treatment of liver metastases.
Generally, liver metastasis of primary tumors of the esophagus, stomach, pancreas, ovaries, uterus, bladder, prostate, kidneys and lungs contraindicate removal through surgery with treatment being restricted to chemotherapy and / or radiation therapy. Primary breast tumor may have liver metastases treated through surgery in sporadic cases. Liver metastases from primary carcinoid or neuroendocrine tumors can be treated by surgery or in selected cases of liver transplantation.
Those patients with liver metastasis from colorectal cancer are those who have greater treatment options that enable cure. These options include surgery (called hepatectomy) associated with radiotherapy and / or chemotherapy (before and / or after surgery), locoregional percutaneous treatments (which are carried through the skin under sedation with the purpose of reducing the tumo r to facilitate or enable the surgery).
Surgery, called hepatectomy, usually finds size, location, number of metastases as the main limitation so that part of the liver can be removed without changing liver function. Today, in some cases, laparoscopy can be used for these types of surgery (laparoscopic hepatectomy) so that the patient can benefit from minimally invasive surgery (Learn more about laparoscopy and minimally invasive surgery).
Results of the treatment of liver metastases
Best results are obtained with the simultaneous use of various forms of treatment of liver metastasis, combining surgery, local or systemic chemotherapy, percutaneous procedures (with sedation and guided by image through the skin), radiotherapy, radiofrequency and involving multiple specialists who combine their experience to greater risk of liver metastasis.