One third of cancer causes metastases in the liver. This complication accompanies every second oncology of the abdominal organs. Malignant lesions of the gland with metastases are called metastatic cancer. Previously, this oncology was considered a harbinger of the imminent death of the patient. With the development of medicine, the diagnosis ceased to be a sentence. Depending on the type of metastases, their number and degree of malignancy, doctors select the therapy, and the patient has a chance to live.
Why does the tumor migrate to the liver
Primary malignant tumors have a different shape, structure, develop from cells of different types. Their adverse characteristics combine – the ability to grow, invade into healthy tissues, and provoke their death. Another “poor” ability is that tumor cells are able to disconnect from the “mother” structure, enter the blood and lymph circulation, and spread throughout the body. Most of these cells are eliminated through immunity. Some settle in organs, attach other circulating atypical cells to themselves.
Malignant cells multiply. So metastases increase in size. Cells secrete a special growth factor. Its function is to stimulate the formation of blood vessels for additional nutrition of the tumor. Under the influence of growth factors, the tumor grows faster. Large metastases worsen the prognosis for the patient.
The frequent appearance of metastases in the liver is due to its anatomical location and active blood supply. From almost all organs of the abdominal cavity, blood enters the liver through the portal vein. Due to the structure of blood vessels, blood is retained in the gland, mixing with the arterial. Cancer cells have more time to “cling” to parenchymal tissue and form a secondary tumor. Another predisposing factor is the proximity of large lymph nodes.
More often, the cancer affects the malignant cells against the background of cancer:
- small intestine.
More rarely, metastatic liver damage develops from the lungs, mammary glands, and melanoma. The likelihood of metastasis to the liver is reduced in cancer of the ovaries, uterus and kidneys. Metastatic cancer of the liver against the background of primary damage to the brain, oral mucosa and larynx practically does not occur.
The relationship of symptoms and degree of liver damage
The intensity of the symptoms, their specificity and duration depends on factors:
- the number of metastases;
- tumor sizes;
- localization (in-depth or surface);
- proximity to large vessels;
- proximity to the bile ducts.
In the early stages of metastases, there are no symptoms. Hence the high probability of diagnosing cancer when it becomes inoperable. As the tumor grows and toxins are released, non-specific signs of oncopathology appear:
- fast fatiguability;
- decreased appetite;
Further progression of metastases increases the intensity of the symptoms. To the listed symptoms, persistent nausea, periodic vomiting (often with impurities of bile or blood) is added. An alarming signal is vomiting more than 2 times a day. The phenomenon accompanies the accelerated growth of metastases. The patient’s appetite is completely absent, body weight is significantly reduced. Signs of cachexia develop – depletion of the body. Periodically, the patient feels aching pain or pressure under the right costal arch. Digestion is somewhat impaired – often there is heaviness in the stomach, flatulence, upset stools.
With large metastases, blood circulation in the gland, outflow of bile are disturbed. Specific symptoms of liver cancer appear:
- pain in the area of the projection of the gland;
- vascular pattern in the umbilical region (“jellyfish head”);
- symptoms of intoxication (prolonged nausea and frequent vomiting);
- obstructive jaundice (yellowing of the skin, mucous membranes, feces discoloration, dark urine);
- digestive disorders (heartburn, vomiting after eating, cramping in the abdomen, persistent constipation or prolonged diarrhea);
- fever (manifests itself in waves, accompanied by chills, night sweats, increased salivation);
- severe hepatomegaly (the liver protrudes from under the costal arch by 5 cm or more, is easily felt by the patient himself);
- a change in the structure of the liver (with palpation on the surface of the organ, tubercles, nodules, uncharacteristic hardness of the tissues are detected).
In the absence of therapy, the liver fails. As a rule, patients do not live up to this point. Mortality with metastatic lesions of the gland is associated with a high risk of seeding with metastases of the abdominal cavity with the development of new foci of oncology. As a result, malignant peritonitis with a reactive course develops. In other cases, the patient dies from internal hemorrhage, when metastases destroy large blood vessels.
Often, malignant liver damage is detected during a preventive examination. After clarifying the diagnosis, the search for primary cancer begins. The main tumor may remain undiagnosed for a long time if metastases develop slowly and deeply in the parenchyma.
Methods of treatment and forecasts
Metastatic cancer is better treated with early diagnosis. The effectiveness of therapy is affected by the number, size, and aggressiveness of the tumors. The classic treatment is liver resection. It is conducted with single metastases, up to 3 cm in diameter. During an operation, a segment, lobe, or a separate portion of an organ is removed. Mortality of surgical treatment is 5-6%. This is due to the sudden development of liver failure in the postoperative period.
After surgery, there is a risk of repeated metastasis, the development of an independent tumor. Crucial is the postoperative chemotherapeutic treatment, radiation therapy, adherence to the doctor’s recommendations during and after rehabilitation.
Relatively new methods of treating metastatic cancer are:
- transhepatic radiofrequency ablation;
Radiofrequency surgery provides aseptic internal destruction of single and multiple medium-sized tumors. An electrode is inserted into the liver through the skin. Due to the action of radio frequencies, tumor cells are necrotic, after which they are lysed.
With embolization of the vessels supplying the tumor, their trophism is impaired and growth is slowed down. Sometimes this method is used in the preoperative period. Chemoembolization involves the closure of the lumen of blood vessels, the introduction of special particles that secrete a chemotherapy drug. As a result, metastases atrophy, collapse under the influence of the drug. A similar effect is obtained by the introduction of chemotherapeutic agents into the vessels supplying the tumor.
When assessing the condition during metastatic liver damage, a biochemical blood test is important. According to its results, the number of functioning liver cells, the stage of damage, the risk of general exhaustion of the body is established.
For small tumors, cryodestruction is used – the effect on metastases at lower temperatures. Targeted and radiation therapy is actively used to treat liver cancer.
The choice of methods and the procedure for their implementation is carried out by an oncologist. With the right selection of techniques that inhibit growth, large metastases become operable, which improves the prognosis for the patient.
The most favorable prognoses are characteristic for the location of the primary tumor in the colon. Timely treatment of such patients provides a full 5-year survival. Resection of the liver to remove metastases reduces the rate to 40%. If several metastases are removed, only 1/3 of the patients have a chance to live longer than 5 years. Chemotherapy for inoperable tumors provides life to the patient for 15-22 months. With timely embolization and chemoembolization, the mortality rate does not reach 1%.
Even after successful treatment, the patient must control his/her condition. Preventive examinations are shown quarterly in the first year after treatment. Further diagnostics are carried out every six months. After 2 years or more, the liver condition is monitored once a year, and the patient is considered completely cured.
If time is lost, and the use of any treatment methods is impossible, the patient is prescribed symptomatic treatment. Life expectancy is 4-16 months, and with diffuse organ damage by metastases – several weeks.