What Are Liver Metastases?

A cancer that moves away from the primary cancer site in the liver is called a liver metastasis (tumor). Because the liver receives dual blood supply from the hepatic artery and the portal vein, the blood flow is abnormally rich, and most of the malignant tumors of all organs in the body can be transferred to the liver. Malignant tumors of the digestive tract, pelvic cavity, etc. can all metastasize to the liver. Among them, the rate of metastasis of the digestive tract tumors is higher (in order, gallbladder cancer, colorectal cancer, gastric cancer, and pancreatic cancer), followed by chest tumors (lung cancer and esophagus) Cancer), breast cancer, hematological tumors, and some other types of tumors. ^[1]

Liver metastases

A cancer that moves away from the primary cancer site in the liver is called a liver metastasis (tumor). Because the liver receives dual blood supply from the hepatic artery and the portal vein, the blood flow is abnormally rich, and most of the malignant tumors of all organs in the body can be transferred to the liver. Malignant tumors of the digestive tract, pelvic cavity, etc. can all metastasize to the liver, among which the rate of metastasis to the digestive tract tumors is higher (in order, gallbladder cancer, colorectal cancer,

1. Portal vein metastasis All blood vessels that enter the venous system, such as the lower esophagus, stomach, small intestine, colorectum, pancreas, gallbladder, and spleen, can be metastasized to the liver through the portal vein. This is the spread of the primary cancer An important way to the liver. It has been reported that there is a shunt phenomenon in the portal vein blood flow, that is, the blood flow of the splenic vein and the sub mesenteric vein mainly enters the left liver, and the blood flow of the superior mesenteric vein mainly flows into the right liver. The tumors of the organs to which these portal veins belong may vary depending on the blood flow. The direction is transferred to the corresponding part of the liver. However, clinically, the shunt of this tumor metastasis is not obvious, and whole liver scattered metastasis is more common. Other cancers in the uterus, ovary, prostate, bladder, and retroperitoneal tissue can also be transferred to the liver through the anastomotic branch of the systemic vein or portal vein; it can also invade the organs of the portal vein system due to the growth of tumors in these sites and metastasize to The liver; or from the systemic veins to the lungs, and then from the lungs to the systemic circulation to the liver.

2. Hepatic arterial metastasis Any hematogenous cancer can be transferred to the liver through the hepatic arteries, such as lung, kidney, breast, adrenal gland, thyroid,

Treatment of liver metastases is different from primary liver cancer. Although the tumors are all grown on the liver, the biological activity of liver metastatic cancer is the same as that of the tumor in the primary site, but it is completely different from that of primary liver cancer. Therefore, we must first determine which organ or tissue is the source of the primary cancer (take the pathology), and then use systemic treatment (select the plan according to the pathology of the primary cancer) + local ablation treatment.

The main purpose of clinical staging of liver metastatic cancer is to facilitate the formulation of surgical treatment plans and the assessment of prognosis. Foreigner classification and Gennari staging methods are available abroad. Some scholars in China have proposed clinical staging of liver metastatic cancer to formulate surgical treatment plans and assess prognosis. This staging method roughly divides liver metastatic cancer into three phases: clinical phase I: complete resection can be obtained through hepatectomy in the half-hepatic range. Liver solitary or <3 multiple metastatic cancerous nodules. Radical hepatectomy can be performed at this stage, which has a greater chance of cure. Clinical stage II: can pass through two or more irregularities in the same liver lobe. Hepatectomy can obtain complete resection, limited multiple scattered liver metastases and> 3 multiple liver metastases, and can complete metastatic cancer resection by hepatectomy. The 5-year survival rate after this period can reach about 20%. . Clinical stage III (equivalent to advanced primary cancer): Regardless of single multiple and those with extrahepatic metastases, it is difficult to remove liver metastases from the liver by surgery. The median survival period is about six months.