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词条 Metastatic liver disease
释义

  1. Presentation

  2. Diagnosis

  3. Treatment

  4. References

  5. External links

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A liver metastasis is a malignant tumor in the liver that has spread from another organ affected by cancer. The liver is a common site for metastatic disease because of its rich, dual blood supply (the liver receives blood via the hepatic artery and portal vein). Metastatic tumors in the liver are 20 times more common than primary tumors. In 50% of all cases the primary tumor is of the gastrointestinal tract, other common sites include the breast, ovaries, bronchus and kidney.

Tumor emboli entering the sinusoids through the liver blood supply appear to be physically obstructed by the Kupffer cells, but if tumor emboli are larger, they tend to become lodged in the portal venous branches.

Presentation

  • Hepatomegaly - with a nodular free edge of liver
  • Tenderness
  • Cachexic
  • Ascites
  • Jaundice
  • Pyrexia - up to 10% of patients
  • Alkaline Phosphatase (ALP) and gamma glutamyl transpeptidase (GGT) elevated
  • Ultrasound scan and CT scan - multiple filling defects.

Diagnosis

  • Hemoglobin decrease
  • Liver function test: ALP elevated, bilirubin elevated, albumin decrease
  • Carcinoembryonic antigen for colorectal secondaries
  • Ultrasound scan
  • CT scan
  • Biopsy under ultrasound control

Treatment

Treatment can consist of surgery (hepatectomy), chemotherapy and/or therapies specifically aimed at the liver like radiofrequency ablation, transcatheter arterial chemoembolization, selective internal radiation therapy and irreversible electroporation. For most patients no effective treatment exists because both lobes are usually involved, making surgical resection impossible. Younger patients with metastases from colorectal cancer confined to one lobe of the liver and up to 4 in number may be treated by partial hepatectomy. In selected cases, chemotherapy may be given systemically or via hepatic artery.

In some tumors, notably those arising from the colon and rectum, apparently solitary metastases

or metastases to one or other lobes may be resected. A careful search for other metastases is required, including local recurrence of the original primary tumor (e.g., via colonoscopy) and dissemination elsewhere (e.g., via CT of the thorax). 5 year survival rates of 30-40% have been reported following resection. {{citation needed|date=June 2017}}

References

[2][3][4]

[5] {{dead link|date=August 2017}}

[6][7][8]
1. ^List of included entries and references is found on main image page in Commons: File:Metastasis sites for common cancers.svg#Summary
2. ^Metastatic Liver Cancer: Tumors of the Liver: Merck Manual Home Health Handbook
3. ^Treatment of metastatic liver cancer and colorectal cancer
4. ^http://www.c2i2.org/winter2003/imaging_update_in_metastatic_abstract.asp
5. ^http://www.healthcare.com/topic/metastatic-liver-disease
6. ^en.diagnosispro.com/disease_information-for/metastatic-liver-disease/16554.html
7. ^{{cite journal | pmid = 16586537 | volume=12 | title=Assessment of metastatic liver disease in patients with primary extrahepatic tumors by contrast-enhanced sonography versus CT and MRI | pmc=4124343 | author=Dietrich CF, Kratzer W, Strobe D, Danse E, Fessl R, Bunk A, Vossas U, Hauenstein K, Koch W, Blank W, Oudkerk M, Hahn D, Greis C | journal=World J Gastroenterol | pages=1699–705 | doi=10.3748/wjg.v12.i11.1699}}
8. ^{{cite web |url=http://www.ist-world.org/ResultPublicationDetails.aspx?ResultPublicationId=3fb68dcc8b7142b6afc25183a9aa2786 |title=Archived copy |accessdate=2014-01-03 |deadurl=yes |archiveurl=https://archive.is/20140103073809/http://www.ist-world.org/ResultPublicationDetails.aspx?ResultPublicationId=3fb68dcc8b7142b6afc25183a9aa2786 |archivedate=2014-01-03 |df= }}

External links

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2 : Hepatology|Digestive system neoplasia

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