Liver Metastases

In­for­ma­ti­on about the De­ve­lop­ment, Dia­gno­sis, Tre­at­ment

Dear Patients,

On the following pages we would like to inform you about the possible treatment modalities of liver metastases offered at our institution.

Ad­di­tio­nal in­for­ma­ti­on for our Pa­ti­ents and Re­fer­ring:

Liver metastases means spread of cancer cells from other primary cancer in the liver, for e.g. from intestinal cancer, breast cancer through blood vessels or lymphatic tracts. Characteristically the clinical symptoms of liver metastases appear very late and these are: feeling of fullness or dull pain due to lesion near the liver capsule, jaundice when the metastases infiltrate or compress the hepatic ducts.
The diagnosis of liver metastases is done by cross sectional imaging like ultrasound, computer tomography (CT) or most optimally through magnetic resonance imaging (MRI).
The treatment and likewise the prognosis is dependent from the number and size of the metastases, from the type and extension of the primary tumor and from the general condition of the patient. In the following paragraphs are few important information about liver metastases.
One must differentiate the liver metastases from the primary liver tumors like the hepatocellular carcinoma (HCC) and the cancer of hepatic ducts also known as cholangiocellular carcinoma (CCC). The primary malignant liver cancer arise from the liver cells while the liver metastases arise from the cells of the primary tumor located elsewhere in the body. These malignant cells which do not arise from the liver cells are called metastases or anaplastic cells. The most important criteria for malignancy is the ability of these anaplastic/metastatic lesions to multiply.
About one third of all malignant tumors finally metastasize to the liver. In the next page you will find the lists of tumors which are usually associated with liver metastases.

1. Tumors of the large intestine and rectum (colorectal carcinoma)
2. Carcinoma of pancreas
3. Carcinoma of stomach
4. Lung cancer
5. Breasts cancer
6. Eosophagus carcinoma
7. Thyroid carcinoma
8. Ovarial carcinoma
9. Carcinoma of uterus
10. Skin cancer ( malignant melanoma )
11. Sarcoma of soft tissues

Symptoms

Early symptoms of tumors in the liver are usually unspecific. The following symptoms are possible:

1. Loss of weight
2. Loss of appetite
3. Nocturnal sweats
4. Nausea
5. Dull pain in mid abdomen
6. Jaundice
7. Diarrhoea

Diagnosis

Diagnosis means also the early detection of liver metastasis by means of regular follow-up with ultrasonography, computer tomography (CT) or optimally with magnetic resonance imaging (MRI). In case a new lesion is detected in the liver when compared to previous normal examination, we are probably dealing with a newly developed liver metastasis. It is then important to obtain a biopsy from this lesion for histological examination which can be most accurately done by CT-guided biopsy where the lesion is reached step by step.

Treatment of Liver Metastases

1. Systemic chemotherapy with different cytostatic drugs
2. Operative resection
3. Interventional therapy with laser-induced thermotherapy (LITT),
4. Local chemotherapy, with one of the following catheters introduced from the inguinal region (femoral artery).

Which therapy?

An individual therapy concept needs to be conceived for every therapy decision. Chances of success are evaluated according to the extent of involvement of liver and the lung.

Requirements and Criteria:

In order to obtain a sinful therapy of liver and lung metastases a previous radical operation or resection of the primary tumor is necessary.
The general health condition of the patient must be stable enough inorder to be able to tolerate the planned therapy.

Depending on this, one can decide whether a surgical or minimal invasive method is to be chosen for the patient.

Following combination therapies are possible

1. Systemic chemotherapy: the cytostatic medication are injected through the arm vein or a port catheter. Regional Chemotherapy: the cytostatic medications are administered through a port system through a catheter direct into the liver.
2. Operation plus chemotherapy agains liver and lung metastases:
3. Laser therapy against metastases ( LITT )

The inclusion criteria are as follows:

• Up to 5 metastases with a maximal diameter of 8 cm,
• Recurrence of metastases after operative removal of previous metastases,
• When metastases tend to grow further despite chemotherapy,
• When both lobes of liver are affected,
• When an operation or chemotherapy is not possible.

About 1 to 2 metastases are treated at each LITT-sitting.
Each sitting lasts about 1 hour and can be done on an outpatient basis.
More than 5000 patients have been treated worldwide with LITT, at the University Hospital Frankfurt alone about 1300 patients have been treated with this method.

Prognosis

The life expectancy of a patient with liver metastases depends upon:

1. Stage of the tumor
2. Size of metastases
3. Number of metastases
4. Optimal therapy