Metastatic Liver Tumors

The liver is like a filter for the blood, and it a common site to which all different types of cancer can spread. Because of the liver’s special role in processing the nutrients from the food we eat, our bodies are designed so that all of the blood that drains from the organs in our abdomen passes through the liver before returning to the heart. Therefore, unlike common cancers like breast or lung cancer in which the liver may be one of many sites of spread, cancers that start in abdominal organs, most notably the colon, may spread to the liver yet be contained there so that cure by surgery is still possible.

  • Colon cancer: Colon cancer is the third most common cancer in the U.S.; in 15 percent of cases the cancer has spread to the liver when it is first discovered, and another 15 percent will develop spread to the liver at a later date. Even though spread to the liver in considered Stage 4, surgery to remove the liver tumors can result in long-term survival. Chemotherapy for colon cancer has improved greatly over recent years; while chemotherapy still does not have the power to cure colon cancer once it has spread, combining surgery to remove the tumors that we can see with chemotherapy to kill microscopic cells that can’t be seen raises the chances for survival even higher. In cases where the liver tumors are found at the same time as the colon tumor it is often possible to remove both at the same time. We use a wide array of advanced surgical techniques, including many borrowed from liver transplantation, to remove liver tumors that in the past or at other centers are considered not removable, and in cases where resection is impossible at the outset we work with our oncologists to shrink or “down-stage” the cancer to where surgery can be done.

  • Neuroendocrine tumors: This group of related tumors shares the characteristic of being able to produce protein hormones that are capable of causing a wide variety of effects throughout the body. The ones that arise in the small intestine or appendix are called carcinoids and produce substances that can cause episodes of flushing called carcinoid syndrome. Neuroendocrine tumors that arise in the pancreas may produce a variety of hormones including insulin that caused low blood sugar, gastrin that causes ulcers, and chromogranin, a hormone precursor that does not cause symptoms but which serves as a useful marker of tumor activity. As a group, neuroendocrine tumors are slow-growing. The liver is the most common site of spread, and it is not unusual for a small primary tumor to result in many large liver metastases. This is one sort of cancer where “debulking”—removing > 90-95 percent of the cancer—has been shown to prolong survival. Debulking is particularly useful in cases where liver tumors are producing large amounts of substances that cause flushing or other symptoms, often resulting in lasting relief. Mount Sinai is an internationally-recognized Center for patients with these tumors, with extensive experience in aggressive surgery as well as a large program of radioembolization for unremovable liver metastases and an array of clinical trials employing new drugs and other innovative strategies. This is one of the few types of metastatic cancer for which liver transplant has a role; we have transplanted 16 patients at Mount Sinai for whom all other options have been exhausted, with excellent results.