What Factors Affect Secondary Liver Cancer Prognosis?

Cancer cells invade the liver mainly through the blood circulation system. The liver is an organ with a large blood flow. There are two systems in the human body that supply blood to the liver. The first is the portal vein system. All the organs in the abdominal cavity, including the stomach, small intestine, colorectum, pancreas, and spleen, must be collected into the portal vein, and then returned to the liver, and the absorbed nutrients are sent to the liver to synthesize all kinds of human body. Substances that detoxify the body's metabolism toxins produced by the liver. At the same time, the primary malignant tumor cells of these organs can also directly flow to the liver through this pathway, and then stay in the liver to form metastatic tumors. The second blood supply system of the liver is the hepatic artery system. Fresh oxygen-rich blood supplied from the heart flows into the liver via the aorta, the celiac artery, the common hepatic artery, and the hepatic artery. Organs outside the abdominal cavity, such as lung, breast, kidney, ovary and other primary malignant tumor cells, usually return to the heart and metastasize to the liver through the arterial system.

Huang Lei

(Deputy Chief Physician)

Peking University People's Hepatobiliary Surgery

Secondary liver cancer is also called metastatic liver cancer. Malignant tumors that occur in various parts of the human body can be transferred to the liver through the blood or lymphatic system. Tumors in adjacent organs can directly infiltrate the liver to form secondary liver cancer. In this case, the liver is often an innocent victim. There is nothing wrong with it, but it is only affected by other tumors. The liver of patients with primary liver cancer mostly has the basis of hepatitis or cirrhosis, and liver cancer is only the result of long-term liver disease. The presence of liver metastases means that the spread of the primary tumor is a dangerous signal, but advances in modern technology have changed this situation.

Western Medicine Name: Secondary liver cancer
Other name: Metastatic liver cancer
Affiliated Department: Surgery-Liver Surgery
Disease site: liver

The main symptoms: Early manifestations are usually mild, late stages are wasting, fatigue, and pain in the liver
Main cause: Tumor metastasis elsewhere
Multiple groups: Patients with malignant tumors
Contagious: Non-contagious

Causes of secondary liver cancer

In addition, organs such as the gallbladder, stomach, adrenal glands, and bile ducts are close to the liver and closely related organs. However, after the primary malignant tumor grows to a certain extent, it can easily spread directly to the "old neighbor" of the liver, forming the so-called infiltration and metastasis. .

When the malignant tumor grows to a diameter of more than 2 cm, a large number of cancer cells can be released into the blood circulation every day. These cancer cells can eventually reach the liver by following the flow. The structure of the liver is like a thick blood-soaked sponge. The blood perfusion flow is large and the flow velocity is slow. Tumor cells easily enter the liver parenchyma and stay. Among them, tumor cells with a high degree of malignancy reaching the liver can secrete certain growth factors to promote the proliferation of their own tumor cells and stimulate the growth of new capillaries around them. Therefore, independent tumor cell masses are gradually formed, and it can take a long time. A tumor metastasis of the size visible to the naked eye has formed. ^[1]

Clinical manifestations of secondary liver cancer

Generally speaking, the clinical manifestations of secondary liver cancer are usually mild, and the course of the disease is relatively hidden. When the number of cancers is small and the volume is small, secondary liver cancer is often manifested by symptoms caused by primary cancers of other organs, such as blood in the stool, weight loss, abdominal distension, intestinal obstruction, and pancreas of colorectal cancer. Cancer jaundice, abdominal pain or lower back pain, breast lumps in breast cancer, abdominal pain in gastric cancer, melena, cough in lung cancer, hemoptysis, chest pain, etc. However, as the metastatic lesions of the liver gradually grow up, the patient may also exhibit symptoms similar to primary liver cancer, such as weight loss, fatigue, pain in the liver area, liver mass, and even ascites and jaundice. Rarely, some extra-hepatic tumors with a high degree of malignancy may not be large in size and the symptoms are not obvious, but diffuse metastases of the liver appear, the liver is significantly enlarged, the liver area is full, and sometimes it is difficult to treat with primary liver cancer Identification. ^[1]

Diagnosis and identification of secondary liver cancer

Auxiliary examination of secondary liver cancer

1. Because most patients do not have obvious symptoms of the liver, they often discover metastatic lesions of the liver when performing routine abdominal examination after finding tumors in other parts. Or the extrahepatic malignant tumor has been surgically removed, and the patient found liver metastases in the outpatient regular periodic review every few months. The examination methods are mainly color Doppler ultrasound, enhanced CT or magnetic resonance examination of the abdomen, especially the latter two examinations can directly find a liver mass, and definite the number and size of metastases.

2. There may not be any specific findings during the physical examination, unless the metastasis is very large, the doctor may feel the enlarged liver and have tenderness in the liver area.

3. Sometimes due to the inability to determine the nature of liver tumors, or the existence of metastatic tumors in other parts, or to find hidden primary malignant tumors that cause metastatic liver cancer, PET-CT can be performed as a whole body scan.

4. In order to understand the function of the liver and provide the necessary data for the next possible liver surgery, a routine hematuria, coagulation function, and liver function (mainly bilirubin, albumin, and transaminase) should be checked. In order to distinguish it from primary liver cancer, virological examination of alpha-fetoprotein, hepatitis B or hepatitis C is also necessary.

Differential diagnosis of secondary liver cancer

1. Differentiation from primary liver cancer

Secondary liver cancer generally does not have symptoms of severe liver disease, and liver function tests may be normal even when the liver is significantly enlarged. Compared with primary liver cancer, the development of secondary liver cancer is relatively slow, and the symptoms are mild. It often manifests as multiple nodular lesions. The main method of identification is to check whether there is a primary cancerous tumor in organs other than the liver. Protein is generally negative. When it is really difficult to identify, consider taking a biopsy of the tumor for pathological examination

2. Find the primary cancer

Gastric cancer metastases the most in secondary liver cancer, followed by lung, colon, pancreas, breast, etc., so it is usually checked from the abdomen first. Enhanced CT or magnetic resonance imaging of the abdomen is an important means of identification. Chest CT can quickly find lung tumors Breast masses can generally be felt, and pelvic CT can detect rectal, ovarian, and uterine lesions. Blood tumor markers have a complete set of inspection items, which is simple and fast, and is an auxiliary tool for imaging studies. If it is difficult to find, although PET-CT is more expensive, it can indeed provide valuable clues. ^[1] ^[2]

Treatment of secondary liver cancer disease

Secondary liver cancer may be a single nodule, but most of them are multiple nodules, and the lesion has metastasized to the liver, indicating that the primary cancer is advanced, and the previous view is that it cannot be surgically removed and there is no special treatment. With the development of modern medical standards, surgical techniques, adjuvant chemotherapy drugs, and postoperative severe supportive treatment methods have made rapid progress, and our doctors' treatment concepts have also changed greatly. At present, many metastatic liver cancers are already treatable diseases. We take the very common colorectal cancer liver metastasis as a representative example, and explain in detail the treatment characteristics of metastatic liver cancer

(A) liver metastases from colorectal cancer

Colorectal cancer (colorectal cancer) is a malignant tumor with a high incidence in China. It is tied with gastric cancer, esophageal cancer, and liver cancer as the "four killers" of digestive system malignancies. In recent years, radical surgery for colorectal cancer has been done more and more standardized and improved with the efforts of surgeons. However, only about 60% of patients who can survive more than 5 years after surgery have liver metastasis. The main problem of survival. Indeed, half of the patients will develop liver metastases sooner or later after surgery, a high proportion. Because blood from the gastrointestinal tract flows to the liver, if the tumor penetrates the wall of the blood vessel during growth, cancer cells will run to the liver and grow along with the blood flow, which easily forms metastatic cancer in the liver. Fortunately, the growth rate of colorectal cancer liver metastases is relatively slow, and generally only isolated metastatic lesions are formed in the liver, and rarely continue to spread in the liver, which creates conditions for surgical resection. It has been 70 years since the first rectal cancer liver metastasis surgery in 1940. The actual curative effect proves that surgical resection is still the most effective method for treating liver metastases of colorectal cancer, and it is also the only method that can truly cure tumors. Long-term survival can be achieved in 40-50% of patients with liver metastases that can be surgically removed. In other words, the occurrence of liver metastases in patients with colorectal cancer does not mean the end of the world, nor does it start the countdown of life. On the contrary, through positive and scientific targeted treatment, we can work together with everyone to completely defeat the disease of colorectal cancer.

In the past 70 years, due to the long-term progress of surgical technology and the accumulation of experience of our professional hepatobiliary surgeons, the size, number and growth site of liver metastases are no longer factors that affect patients' ability to undergo surgery. Break through one by one. It can be said that as long as sufficient liver can be retained after surgery (generally 30% or more), most liver metastatic cancers can be removed. If there is metastasis outside the liver, those who can be resected can also be removed together. For example, lung metastases, abdominal metastases, and hilar metastases can be removed. Some patients are found to have liver metastases at the same time as they develop colorectal cancer, which should be treated separately according to the situation. If the patient's liver function and physical condition allow, according to the current technical level, it can be completely removed in one operation at the same time. If emergency surgery is needed due to tumor clogging of the intestine, due to lack of complete preoperative examination data and a high chance of surgical infection, we do not recommend simultaneous resection of metastatic cancer. Priority should be given to ensuring the smooth removal of primary colorectal cancer And the patient's rapid recovery. Within 2 years after resection of liver metastatic cancer, 60% of cases may recur, and about 1/3 still appear in the liver. Don't be discouraged or scared, as long as conditions permit, you can still be treated again, and the overall survival after resection is similar to the first liver resection.

Of course, surgery is not a panacea. In the face of powerful enemies, surgeons also need reinforcements, that is, comprehensive treatment involving multiple disciplines. For example, preoperative and postoperative radiotherapy and chemotherapy, choose different schemes for different patients. For those patients who cannot be operated on, a less invasive radiofrequency or microwave ablation method can be used. A long needle outside the body (without laparotomy) can eliminate smaller liver metastases in some areas. Therefore, when colorectal cancer patients have liver metastases, don't despair and pessimism, you must know that this is a disease that has a chance to cure. What you need to do is not to go to the doctor for medical treatment and find recipes for your recipes everywhere, but to go to a regular professional liver and gallbladder surgeon in time to actively seek treatment opportunities.

(B) liver metastases from breast cancer

Breast cancer is a systemic disease. In recent years, the incidence rate has increased, and the peak age of the disease has moved forward. Generally, surgery-based comprehensive treatment is generally used. However, due to various factors, breast cancer often recurs after surgery. Metastasis is also quite common in breast cancer patients, and the liver is one of the main organs of breast cancer metastasis. The survival time after liver metastasis is significantly shortened, and the 3-year survival rate is only 30%. The effect directly affects the overall treatment of breast cancer.

However, breast cancer is one of the most effective tumors for systemic chemotherapy in solid tumors. Effective systemic chemotherapy is still the preferred treatment for liver metastases in breast cancer. Conventional medications include anthracycline antibiotics, paclitaxel, 5-fluorouracil, and vinorelide. Bin and so on. In particular, taxanes are the most important anti-breast cancer chemotherapy drugs developed after the 20th century. Fruit alone has a high curative effect, and it is necessary to effectively combine it with other drugs for the treatment of advanced breast cancer. After chemotherapy, if the tumor is gradually confined and the liver function is better, surgical resection or ablation treatment can still be considered to destroy the tumor.

(C) liver metastases from ovarian cancer

The occurrence of liver metastases in ovarian cancer usually indicates that the disease has progressed to advanced stages, especially when liver metastases are multiple and chemotherapy is not sensitive, treatment will be very difficult. Fortunately, most ovarian cancers are sensitive to chemotherapeutic drugs. With the help of chemotherapy, the resection of liver metastases becomes meaningful. Clinical practice has also proven that active surgery can significantly prolong the resectable liver metastases. Patient survival time. Therefore, if there is a chance of radical resection, staged surgery is still recommended, and the survival rate can be increased from 10% to 90% in the past. Although the recurrence and metastasis rate of immature teratoma is high, it has passed multiple operations after recurrence. It was found that immature tumor tissue has the characteristics of transformation to maturity, that is, the reversal of malignancy. Therefore, for such patients, the opportunity for surgery should be cherished, and active surgery should be considered.

(IV) Liver metastasis of neuroendocrine cancer

These tumors are less malignant, including carcinoids, malignant islet cell tumors of the pancreas (tumours caused by Steve Jobs). Taking the gastrointestinal carcinoid as an example, the tumor itself grows slowly, is less invasive, and less malignant. Surgical resection is the main treatment. If liver metastases have occurred, hepatic lobe resection can be performed at the same time, or the mass can be injected with absolute alcohol. The degree of radical resection affects the survival time after surgery, but even palliative resection (partial or partial resection of the tumor) can still significantly improve the symptoms and quality of life of patients. Carcinoid tissues contain a large number of somatostatin receptors. For those who cannot be radically resected, the use of somatostatin analogues has better efficacy and can be used as first-line treatment drugs.

(E) Liver metastases from lung cancer

Liver metastasis is the most common site of blood metastasis of lung cancer. After liver metastasis of lung cancer, patients' disease often progresses rapidly. Most of the liver metastases occur within 12 months after the diagnosis of lung cancer, and it is rare for patients who are suitable for surgery. Chemotherapy is the main method and rapid advances in radiotherapy have also played an increasingly important role in the treatment of liver metastases. Transbronchial arterial infusion chemotherapy through femoral artery puncture, treatment of primary lesions and hepatic arterial infusion, can prolong survival time, so it is a more effective treatment method, especially arterial chemotherapy has small adverse reactions, accurate effect, and easy to accept. But the key to reducing the incidence of liver metastasis lies in the early detection, early diagnosis and comprehensive treatment of lung cancer. ^[1] ^[2] ^[3]