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liver metastases
Epidemiology:
- metastatic disease is the most common cause of malignancy in the liver
- 20-50 times more common than primary liver cancer
- 1/3 of patients who die with a malignancy have liver metastases
Pathology:
- most common malignancies metastazising to the liver
- colorectal carcinoma
- gastric cancer
- pancreatic cancer
- breast cancer
- most gastrointestinal cancer is spread through the portal venous system
- other malignancies are spread through the hepatic arterial system
- most small (< 1-1.5 cm) liver lesions, even in patients with known malignancy, are not malignant, especially if there are fewer than 5 lesions
Management:
- surgical resection of a few isolated metastatic lesions may be curative [2]
- radiologic evidence of metastatic recurrence precludes need for needle biopsy
- a negative needle biopsy would not change management
- resection is 1st line therapy if feasible [2]*
- conversion chemotherapy may facilitate a cure in 16% of patients with initially unresectable colorectal cancer liver metastases [3]
* consider recommendation in the light that most small liver lesions in patients with known malignancies are not malignant (not surprising that many cases are curable)
Related
liver
liver cancer; hepatobiliary carcinoma
General
metastasis
References
- Johnston FM, Mavros MN, Herman JM, Pawlik TM.
Local therapies for hepatic metastases.
J Natl Compr Canc Netw. 2013 Feb 1;11(2):153-60
PMID: 23411382
- Medical Knowledge Self Assessment Program (MKSAP) 17,
American College of Physicians, Philadelphia 2015
- Adam R, Wicherts DA, de Haas RJ et al
Patients with initially unresectable colorectal liver
metastases: is there a possibility of cure?
J Clin Oncol. 2009 Apr 10;27(11):1829-35.
PMID: 19273699