Metastatic Liver Tumors
The spread of cancer cells from the place where they first formed to another part of the body is called metastasis. Our specialists have extensive training and experience in diagnosing and treating metastatic cancers, including colon cancer and neuroendocrine tumors (NETs).
The liver, acting as a filter for blood, can trap cancer cells, so all different types of cancer can spread to the liver. For cancers that start outside the abdomen, like breast or lung cancer, the liver is usually just one of many places to which the cancer spreads. Cancers that start in the abdomen, though, are different. All of the blood from the organs in our abdomen, including the colon, drains through the liver before returning to the heart. For this reason, these cancers often spread to the liver and nowhere else. In this case, surgery to remove the tumors from the liver can result in a cure.
Colon cancer is the fourth most common cancer in the United States. It is also the fourth most deadly one. At Mount Sinai, we take a team approach to developing a personalized treatment plan for patients with metastatic colon cancer. Our tumor board meets regularly to discuss all patients and treatment plans. Even though spread to the liver is considered stage IV cancer, a treatment program including surgery to remove the liver tumors along with chemotherapy before and/or after surgery can cure many patients.
Surgery: When we find colon cancer and liver metastases at the same time, our surgeons can often remove both in one operation. At Mount Sinai, we use a wide array of advanced surgical techniques that allow us to remove liver tumors that could not have been taken out before. We perform surgeries that are not possible at many other centers. In some cases, the tumors in the liver are too large or there are too many to remove safely. We can often shrink these tumors using chemotherapy so that surgery becomes possible.
Chemotherapy: In recent years, chemotherapy for colon cancer has improved greatly. While it cannot cure colon cancer on its own, chemotherapy can kill microscopic tumor cells that have begun to spread. Adding chemotherapy to surgery to remove liver metastases doubles the five-year life expectancy. We use genomic sequencing of the tumor to help us understand which treatments are likely to be most effective.
In addition to standard chemotherapy, Mount Sinai is one of a few hospitals that offers treatment of liver tumors with chemotherapy given directly into the liver. We implant a pump that holds a two-week supply of chemotherapy into the abdomen. The pump has a tube that leads into the artery that brings blood to the liver. We can refill the pump every two weeks. This pump lets us give a high dose of chemotherapy to the liver without all the side effects in the rest of the body. This approach can shrink and sometimes even destroy tumors when standard chemotherapy cannot.
Transplantation: Researchers at several medical centers, including Mount Sinai, are exploring whether liver transplants can help treat liver metastases from colon cancer. This approach works best if you are in good overall health, have had the original colon tumor removed, but cannot have the liver metastases removed. You would not qualify for priority on the transplant list, so you would need to have a friend or family member willing to donate part of a liver.
Neuroendocrine tumors (NETs) are a group of related tumors that can produce hormones that cause a wide variety of symptoms. NETs often start in the small intestine or the pancreas. The blood draining from these organs flows through the liver. For this reason, these cancers often spread to the liver. The liver tumors are often numerous and much larger than the tumor they came from.
Small intestine NETs, sometimes called carcinoids, can produce symptoms called carcinoid syndrome. The syndrome includes facial flushing, diarrhea, and thickening of heart valves that can lead to heart failure. Pancreatic NETs can produce a variety of hormones. These hormones include insulin, which causes low blood sugar; gastrin, which leads to ulcers; and chromogranin, which does not cause symptoms but can give us a sense of how your tumor is doing.
With most cancers, we need to remove all of the cancer or there is no benefit. NETs, though, are different. They tend to grow more slowly than other types of cancer. For this reason, surgery to remove most of the cancer is often effective. Removing 90 percent or more of the cancer can greatly prolong survival. This approach is called debulking. It is particularly useful for patients with carcinoid syndrome. Our team has a lot of experience with this kind of surgery, sometimes removing 20 or more tumors from the liver.
Patients from around the world come to Mount Sinai’s Center for Neuroendocrine and Carcinoid Tumors. We offer the latest options for diagnosis and treatment including gallium-68 DOTATATE positron emission tomography scanning and peptide receptor radionuclide therapy. NETs are one of the few types of metastatic cancer that can be helped by liver transplantation. When other options have not worked, liver transplants have provided excellent results for these patients.
Other Metastatic Cancers
Most types of cancer can spread to the liver. When cancers that start outside the abdomen spread to the liver, they usually have spread to other places as well. Often, chemotherapy is the only treatment for these patients. Sometimes, though, there are just a few tumors in the liver and nothing anywhere else. We can often treat these tumors with surgery, radiation, or ablation (American Journal of Surgery).