Liver Metastasis

Liver Metastasis

About 50% of people diagnosed with metastatic breast cancer develop liver metastases, and 5% to 12% of these people develop liver metastases as the main site of breast cancer recurrence.

Liver metastasis symptoms and diagnosis

When breast cancer moves into the liver, it often doesn’t cause symptoms. Liver function tests may help doctors pick up on signs of liver metastasis. Also called a hepatic panel, liver function tests are blood tests that measure certain levels of enzymes and proteins in the blood. Abnormal levels can indicate liver disease or damage.

Sometimes liver metastasis does cause symptoms. Some of these symptoms are:

  • pain or discomfort in the mid-section

  • fatigue and weakness

  • weight loss or poor appetite

  • fever

  • bloating

  • swelling in the legs

  • a yellow tint to the skin or the whites of the eyes

In addition to liver function tests, doctors use imaging tests to diagnose liver metastases. These may include MRI, CT scan, ultrasound, or PET scan. Sometimes, doctors use a combined PET scan and CT scan.

Doctors also may order a biopsy to confirm liver metastasis. Using imaging tests as a guide, a doctor can insert a small needle through the skin and into the liver to remove a tissue sample. Some doctors also may recommend a procedure called laparoscopy. In a laparoscopy, a surgeon makes small incisions in the abdomen and uses specialized surgical instruments to remove a tissue sample that — after examination — can confirm a diagnosis of metastatic breast cancer.


Treatment for liver metastasis

Metastatic breast cancer in any part of the body is usually treated with systemic medications, which treat cancer throughout the entire body. For liver metastasis, local treatments that specifically target the liver, such as surgery or radiation, are sometimes recommended.

Chemotherapy to treat liver metastasis

Chemotherapy destroys or damages cancer cells as much as possible and, therefore, doctors recommend it as a treatment for metastatic breast cancer. Because chemotherapy medicines are systemic treatments — meaning they affect the entire body — doctors generally recommend chemotherapy if:

  • the cancer is growing despite other forms of treatment

  • there is a significant amount of cancer in organs such as the liver or lungs

  • the cancer is growing quickly

Doctors often combine chemotherapy with targeted therapies, which are medicines that target specific characteristics of cancer cells.

Each person’s chemotherapy treatment plan is different. But there are some general guidelines that doctors follow when using chemotherapy to treat metastatic breast cancer:

  • If you’ve had chemotherapy before, your doctor may recommend using only one chemotherapy medicine at a time to treat metastatic disease. This way you can get benefits with fewer possible side effects.

  • In general, doctors use most chemotherapy medicines to treat metastatic disease until side effects become a problem or the medicines stop being effective.

  • Some chemotherapy medicines seem to work better against cancer tumors when they are combined. Research has shown that combining treatments has contributed to a better overall prognosis for some metastatic cancers.

If breast cancer comes back after chemotherapy or doesn’t respond to chemotherapy medicines, you can try a different combination of medicines. There are many chemotherapy medicines, and if one medicine or combination of medicines doesn’t work, there is almost always something else you can try.

Local chemotherapy for liver metastasis

Localized chemotherapy directs chemotherapy medication into liver tumors, avoiding damage to surrounding healthy organs.

There are a couple of local chemotherapy options for liver metastasis:

  • Hepatic arterial infusion (HAI) chemotherapy: Unlike traditional chemotherapy, which travels throughout the entire body, this treatment delivers high doses of chemotherapy right into the liver through the hepatic artery (the main source of blood supply for liver tumors). HAI chemotherapy uses a small pump implanted under the skin in the lower abdomen to deliver the chemotherapy medicines directly to the liver. The pump can be refilled with medication over time.

  • Transarterial chemoembolization (TACE): TACE is another form of local chemotherapy. TACE delivers micro beads filled with chemotherapy medication directly into the liver tumors. With the help of imaging guidance, an interventional radiologist makes a small incision and guides a tiny tube, or catheter, into an artery that supplies blood to the liver and then injects the micro beads. The micro beads travel into the small blood vessels that feed the liver tumors and then deliver the chemotherapy. This procedure delivers higher drug concentrations to the tumor without damaging nearby healthy tissue.

Hormonal therapy to treat hormone receptor-positive liver metastasis

Hormonal therapy medicines — also called endocrine therapy or anti-estrogen therapy — are used to help shrink or slow the growth of hormone receptor-positive metastatic breast cancer.  Hormonal therapy medicines include:

  • tamoxifen

  • Arimidex (chemical name: anastrozole)

  • Aromasin (chemical name: exemestane)

  • Femara (chemical name: letrozole)

  • Faslodex (chemical name: fulvestrant)

Hormonal therapy does not work on hormone receptor-negative breast cancer.

Hormonal therapy medicines treat hormone receptor-positive breast cancers in two ways:

  • by lowering the amount of the hormone estrogen in the body

  • by blocking the action of estrogen in the body

You usually take hormonal therapy to treat metastatic hormone receptor-positive breast cancer for as long as it works. If the cancer stops responding to one hormonal therapy medicine, your doctor will usually recommend a different hormonal therapy medicine.

Targeted therapies to treat liver metastasis

Targeted therapies are treatments that target specific characteristics of cancer cells, such as a protein that allows the cancer cells to grow in a rapid or abnormal way. Targeted therapies are generally less likely than chemotherapy to harm normal, healthy cells. Some targeted therapies are antibodies that work like the antibodies made naturally by our immune systems. Because of this, they are sometimes called immune-targeted therapies.

Immunotherapy to treat liver metastasis

Cancer immunotherapy medicines work by helping your immune system work harder or more efficiently to fight cancer cells.

Your immune system is made up of a number of organs, tissues, and cells that work together to protect you from foreign invaders that can cause disease. When a disease- or infection-causing agent, such as a bacterium, virus, or fungus, gets into your body, your immune system reacts and works to kill the invaders. This self-defense system works to keep you from getting sick.

Immunotherapy uses substances — either made naturally by your body or man-made in a lab — to boost the immune system to:

  • stop or slow cancer cell growth

  • stop cancer cells from spreading to other parts of the body

  • be better at killing cancer cells

Local treatments for liver metastasis

Breast cancer spreads to the liver before it does to the bones, lungs, and brain in only between 5% and 12% of people. In this situation, for carefully selected people, some doctors may recommend surgery to remove the cancer. Doctors may recommend surgery and other local treatments if the cancer in the liver is causing persistent pain or serious problems with liver function.

Local treatments for liver metastasis can include surgery, SBRT, yttrium 90 (Y-90) radioembolization, ablation, and local chemotherapy.

Surgery for liver metastasis

Doctors usually recommend surgery only for people who are experiencing severe symptoms, such as pain, bleeding, or major blockages within the liver. However, some doctors may consider surgery if:

  • the liver is the only site of cancer spread

  • you have one or two lesions that can be completely removed (oligometastatic disease)

  • there were a few years of no evidence of cancer between initial, early-stage breast cancer, and diagnosis of metastasis

  • you’re generally in good health

  • the cancer is hormone receptor-positive, which suggests it may be easier to treat

Your oncologist or surgeon may order additional imaging scans of the liver, such as MRI or CT, to make sure that:

  • any areas of cancer can be removed completely

  • enough healthy tissue can be left behind to allow the liver to function

Right now, we don’t know if women who have surgery to remove metastatic breast cancer in the liver have better outcomes than women who don’t have surgery. So it makes sense to talk with your medical team about the benefits and risks of surgery. You also can discuss whether you’re a candidate for laparoscopic surgery, which is done through smaller incisions, or whether you need more traditional open surgery.

Stereotactic body radiation therapy for liver metastasis

SBRT (stereotactic body radiation therapy) precisely targets high-dose beams of radiation at the cancerous areas in the liver over a series of treatments. As with metastases to other parts of the body, the surgeon maps tumors in advance using imaging scans to deliver the radiation directly to the cancer’s exact location.

Yttrium 90 radioembolization for liver metastasis

Y-90 (yttrium 90) radioembolization is a procedure that delivers radiation therapy directly to the tumors in the liver.

With the help of imaging guidance, an interventional radiologist makes a small incision and guides a tiny tube (called a catheter) into the artery that supplies blood to the liver. The interventional radiologist then injects tiny beads containing the radioactive substance known as Y-90. The beads can travel into the small blood vessels that feed the liver tumors. Once inside, they destroy the tumor from within. This procedure minimizes any damage to nearby healthy tissue.

Ablation for liver metastasis

Doctors may recommend ablation to destroy tumors in the liver with heat, cold, or electrical currents that are delivered through a small probe. Ablation techniques for liver tumors include:

  • cryoablation, which uses extreme cold

  • RFA (radiofrequency ablation), which uses high-frequency electrical currents

  • NanoKnife, or irreversible electroporation, which delivers pulses of electrical currents to the tumor cells and leads to defects in their membranes (outer surfaces) and, eventually, cell death

— Last updated on August 16, 2022, 9:54 PM