Liver metastasis develops due to the spread of malignant tumors from their primary sites in the gastrointestinal tract, breast, lung, and pancreas. The extension of melanomas and neuroendocrine tumors may also result in this disease. Clinical manifestations can be non-specific and imaging studies like ultrasonography, computed tomograms, and magnetic resonance imaging are required to detect the disease while biopsy with histopathology is necessary to confirm the diagnosis.
Liver metastasis occurs secondary to the spread of melanomas, renal cell carcinoma, neuroendocrine tumors and the primary cancers involving various sites of the body. Of these, the commonest is the colon, followed by non-colorectal locations such as breast, lungs, pancreas, etc. . 95% of uveal melanomas metastasize to the liver versus 15% of cutaneous melanomas     and liver metastasis has been reported in approximately 44% of neuroendocrine tumors   .
In a majority of the patients, the metastases are multiple with concomitant spread to other sites   while a small percentage of patients develop solitary lesions. 75% of the patients have involvement of bilateral lobes of the liver. The incidence and pattern of the metastases depend on the age, sex, primary site of the tumor, duration, and histopathology. Primary liver cancer is less common as compared to liver metastasis.
In the initial stages of the disease, patients with liver metastasis are asymptomatic. Subsequently, they develop non-specific symptoms like anorexia, weight loss, fever, night sweats, cachexia and right upper quadrant pain. On palpation, hard, tender hepatomegaly may be noted. Jaundice is rare in the early stages and is typically seen in the presence of bile duct obstruction. Ascites develops with peritoneal seeding of the tumor and in advanced stages, there is hyperbilirubinemia with hepatic encephalopathy.
Entire Body System
- Weight Loss
Liver metastases are suspected in patients with weight loss and hepatomegaly or with primary tumors likely to spread to the liver. [msdmanuals.com]
When this happens, the following symptoms may occur: loss of appetite weight loss dark-colored urine abdominal swelling or bloating jaundice, a yellowing of the skin or the whites of the eyes pain in the right shoulder pain in the upper right abdomen [healthline.com]
Patients with a primary cancer are suspected of having liver metastasis if they present with weight loss and a palpable, enlarged and hard liver. [symptoma.com]
- Abdominal Pain
A 50-year-old woman complained of abdominal pain beneath the xiphoid process for 1 day. Physical checkup revealed tenderness at the right upper abdomen. A fecal occult blood test was positive. [ncbi.nlm.nih.gov]
A 72-year-old man was referred to our hospital complaining of abdominal discomfort, diarrhea, and weakness over the last month. Colorectal liver metastases concurrent intrahepatic cholangiocarcinoma (ICC). [ncbi.nlm.nih.gov]
My feeling is that the chemo can be very harmful, but theoretically less harmful than the cancer, so the diarrhea shouldn't be a surprise. [cancercompass.com]
However, in our patient when paclitaxel 100 mg weekly had been used with pegylated adriamycin as a third line chemotherapy, patient develop severe grade IV diarrhea and his performance status deteriorated very fast from which he could not recover. [npplweb.com]
Side effects, which can be severe, include fatigue and diarrhea. Hormonal therapy Hormonal therapy can slow or stop the growth of certain types of tumors that rely on hormones to grow, such as breast and prostate cancer. [healthline.com]
Liver, Gall & Pancreas
- Liver Mass
The histopathological analysis after operation confirmed the gastric mass to be MANEC, whereas the liver mass was actually the metastatic neuroendocrine component of the gastric MANEC. [ncbi.nlm.nih.gov]
Most liver masses in are not biopsied... as a primary lesion is evident.  Dependent on the extent of disease, CRC metastatic to the liver may be curable with a liver resection. [librepathology.org]
[…] technique in the diagnosis of liver metastases Most liver tumors, benign or malignant, appear as hypo intense lesions on T1-weighted images and hyper intense lesions on T2-weighted images Gadolinium-enhanced MRI improves both the detection of focal liver [learningradiology.com]
MRI is usually used as a as problem-solving rather than a primary technique in the diagnosis of liver metastases Gadolinium-enhanced MRI improves both the detection of focal liver masses and the differentiation of benign from malignant lesions.Hepatobiliary [slideshare.net]
The bypass circuit is composed of a venous Delcath 16F polyethylene catheter with one large fenestrated lumen and 3 accessory lumens, flushed bypass tubing, 2 filters, and the internal jugular central venous return line. [hrjournal.net]
These hormones could cause characteristic patterns of symptoms, like flushing, diarrhea, and palpitation. NETs are comparatively uncommon, with an incidence range from 2.5 to 5.3 per 100,000 ( 1 ). [atm.amegroups.com]
Primary meningeal melanocytic tumors have genetic similarities with uveal melanomas, including GNAQ or GNA11 mutations. [ncbi.nlm.nih.gov]
- Personality Change
Breast cancer cells that have spread to the brain cause persistent, progressively worsening headache, visual changes, seizures, nausea, vomiting, vertigo, behavioral and personality changes and increased intracranial pressure. [breast-cancer.ca]
Patients with a primary cancer are suspected of having liver metastasis if they present with weight loss and a palpable, enlarged and hard liver. Routine laboratory tests like a complete blood count and liver function tests may be inconclusive in the early stages although alkaline phosphatase, gamma-glutamyl transpeptidase, and lactate dehydrogenase levels may be elevated.
Plain X-ray chest is performed as a routine in patients with a known primary cancer to exclude pulmonary lesions.
Radiological tests such as ultrasonography, computed tomogram (CT) and magnetic resonance imaging (MRI) are required to detect the metastasis. CT with contrast is the study of choice to diagnose the disease with MRI being more sensitive as compared to CT and positron emission tomography (PET) . However, Kinkel et al, have reported that fluorodeoxyglucose (FDG) PET scan is the most sensitive imaging modality to detect liver metastases, especially if the primary tumor is located in the colon, and upper gastrointestinal tract . Liver angiography is indicated in vascular metastasis, especially if, embolization is being considered as a therapeutic modality.
Histopathological evaluation of a liver biopsy specimen obtained under image guidance is usually required for confirmation of the diagnosis.
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