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  • • Most common tumors of liver

    • 90% with extrahepatic metastases

    • 20% of patients with metastatic colon cancer have metastasis isolated to liver

    • Common site of metastasis for multiple tumor types; most common candidates for resection include colon, endocrine, melanoma, breast, sarcoma, lung, renal, and other GI tumors

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Symptoms and Signs

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  • • Weight loss

    • Fatigue

    • Fevers

    • Right upper quadrant pain

    • Ascites

    • Jaundice

    • Hepatomegaly

    • Portal hypertension

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Laboratory Findings

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  • • Anemia

    • Hyperbilirubinemia

    • Elevated alkaline phosphatase

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Imaging Findings

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  • • Masses in liver sometimes better visualized with CT by portography or use of MRI

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  • • Site of primary tumor

    • Time since resection of primary tumor

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Rule Out

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  • • Extrahepatic disease before consideration of resection

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  • • History and physical exam

    • Liver function tests

    • CBC

    • CT with portography

    • MRI if CT is nondiagnostic

    • Mesenteric angiogram if considering hepatic artery pump for metastatic colon cancer

    • Bone scan if markedly elevated alkaline phosphatase

    • Carcinoembryonic antigen (CEA), CA 125, CA 19-9, and alpha-fetoprotein (AFP) which aid in distinguishing primary from metastatic tumors

    • Intraoperative US if resection is planned

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Surgery

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  • • Resection

    • Hepatic artery chemotherapy pump (for metastatic colon cancer only)

    • Radiofrequency ablation (RFA) or cryotherapy for unresectable lesions

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Indications

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  • • No extrahepatic disease

    • Disease-free interval of 1 year or more for primary tumors, such as gastric and breast

    • Colon cancer metastasis not amenable to resection and no extrahepatic disease (hepatic artery chemotherapy pump)

    • Most common resectable tumors:

    • -Colon

      -Neuroendocrine

      -Melanoma

      -Breast

      -Sarcoma

      -Lung

      -Prostate

      -Renal

      -Other GI tumors (rarely)

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Contraindications

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  • • Extrahepatic disease

    • Minimal planned residual liver function

    • Multiple bilobar metastasis

    • Metastasis involving bilateral portal branches

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Medications

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  • • 5-fluorouracil for colon cancer

    • Other chemotherapy for specific tumor types

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Treatment Monitoring

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  • • CEA levels for colon cancer

    • CT scanning

    • Hormonal markers, eg, gastrin for metastatic endocrine tumors

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Complications

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  • • Liver failure

    • Hemorrhage

    • Recurrent disease

    • Biliary leak

    • Gastroduodenitis (hepatic artery pump)

    • Hepatic artery or pump thrombosis (hepatic artery pump)

    • Sclerosing cholangitis (hepatic artery pump)

    • Perihepatic abscess

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Prognosis

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  • Colon cancer: 25% 5-year survival with resection

    Other metastatic disease: 10-20% 5-year survival possible

    • Marked palliation for metastatic endocrine tumors

    • Hepatic artery chemotherapy (colon) increases 2-year survival when compared with systemic therapy

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References

Andres A et al: Improved long-term outcome of surgery for advanced colorectal liver metastases: reasons and implications for management on the basis of a severity score. Ann Surg Onc 2007;15:134....

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