Metastatic liver disease

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Metastatic liver disease
Axial CT of the abdomen showing multiple liver metastases
Classification and external resources
ICD-10 Xxx.x
ICD-9-CM xxx

A liver metastasis is a malignant tumor in the liver that has spread from another organ affected by cancer. The liver is a common site for metastatic disease because of its rich, dual blood supply (the liver receives blood via the hepatic artery and portal vein). Metastatic tumors in the liver are 20 times more common than primary tumors. In 50% of all cases the primary tumor is of the gastrointestinal tract, other common sites include the breast, ovaries, bronchus and kidney.

Tumor emboli entering the sinusoids through the liver blood supply appear to be physically obstructed by the Kupffer cells, but if tumor emboli are larger, they tend to become lodged in the portal venous branches.




Treatment can consist of surgery (hepatectomy), chemotherapy and/or therapies specifically aimed at the liver like: radiofrequency ablation, transcatheter arterial chemoembolization, selective internal radiation therapy and irreversible electroporation). For most patients no effective treatment exists --- because both lobes usually involved --- making surgical resection impossible. Younger patients with metastases from colorectal cancer, confined to one lobe of liver and up to 4 in number, may be treated by partial hepatectomy. In selected cases, chemotherapy may be given systematically or via hepatic artery.

In some tumors, notably arising from the colon and rectum, apparently solitary metastases/metastases to one or other lobes --- may be resected. Careful search for other metastases is required, including local recurrence of original primary tumor (e.g.:colonoscopy) and dissemination elsewhere (e.g.:CT of thorax) --- 5 year survival rates of 30-40% have been reported following resection.


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