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Secondary liver cancer

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synonym Metastatic liver cancer (Metastatic liver cancer) generally refers to secondary liver cancer

This entry is made by Good Doctor Online Provide content and participate in editing.

Huang Lei

(Deputy Chief Physician)

Peking University People's Hepatobiliary Surgery Department

secondary liver cancer Also known as metastatic liver cancer, malignant tumors occurring in various parts of the body can be transferred to the liver through the blood or lymphatic system, and tumors in adjacent organs can directly infiltrate the liver to form secondary liver cancer. In this case, the liver is often an innocent victim. It has nothing wrong with itself, but is only involved by other tumors. Most patients with primary liver cancer have hepatitis or cirrhosis Liver cancer is only the result of long-term liver disease. The occurrence of liver metastasis means the spread of the primary tumor, which is a dangerous signal, but the progress of modern science and technology has changed this situation.

Western medicine name: Secondary liver cancer
Alias: Metastatic liver cancer
Department: Surgery - Liver Surgery
Common location: liver

common symptom: Early manifestations are often mild ， Emaciation, fatigue and liver pain in late stage
Common causes: Tumor metastasis in other parts
Multiple population: Patients with malignant tumor
infectivity: Non infectious

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Pathogenesis

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Cancer cells invade the liver mainly through the blood circulation system. The liver is an organ with large blood flow, and there are two sets of blood supply systems for the liver in the human body. One is the portal vein system. The venous blood of all organs in the abdominal cavity, including the stomach, small intestine, colorectal, pancreas, and spleen, should be collected into the portal vein, and then returned to the liver. The absorbed nutrients will be sent to the liver to synthesize various substances necessary for the human body, and the toxins generated by human metabolism will be detoxified by the liver. At the same time, the primary malignant tumor cells of these organs can also flow directly to the liver through this way, 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 through the aorta, celiac artery, common hepatic artery, and proper hepatic artery. Primary malignant tumor cells in extraperitoneal organs such as lung, breast, kidney, ovary, etc. generally return to the heart and transfer to the liver through the arterial system.

In addition, such organs as gallbladder, stomach, adrenal gland and bile duct are close to the liver, but Primary malignant tumor When it grows to a certain extent, it is easy to spread directly to the "old neighbor" of the liver, forming the so-called invasion and metastasis.

When a malignant tumor grows to a diameter of more than 2 cm, it can release a large number of cancer cells into the blood circulation every day. These cancer cells can eventually reach the liver by "drifting with the tide". The structure of the liver is like a thick sponge full of blood. The blood perfusion flow is large and the flow rate is slow. The tumor cells are easy to enter the liver parenchyma and stay. Among them, the malignant degree reaching the liver is relatively high tumor cell It can secrete some growth factors to promote the proliferation of its own tumor cells and stimulate the growth of surrounding new capillaries, so it gradually forms independent tumor cell clusters, and it will not take a long time to form tumor metastasis lesions that are visible to the naked eye.^[1]

clinical manifestation

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Generally speaking, secondary liver cancer The clinical manifestation is usually mild and the course of disease is concealed. When the number of cancerous tumors is small and the volume is small, secondary liver cancer The symptoms caused by primary cancer of other organs are the main manifestations, such as colorectal cancer Of Hematochezia 、 Emaciation 、 abdominal distention 、 intestinal obstruction ， pancreatic cancer Of jaundice 、 abdominal pain Or back pain, mammary cancer Breast lumps, gastric cancer Abdominal pain and black stool, lung cancer Of cough 、 hemoptysis , chest pain, etc. However, when the metastatic focus of the liver grows gradually, the patient may also suffer from emaciation, fatigue, pain in the liver area, tumor in the liver area, even ascites jaundice Similar to primary liver cancer Performance. It is rare that some extrahepatic tumors with high malignancy may be small in size and have no obvious symptoms, but have diffuse metastasis of the liver. The liver is obviously enlarged, the liver area is swollen, and sometimes Primary liver cancer Difficult to identify.^[1]

Diagnostic differentiation

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Supplementary Examination

1. Because most patients have no obvious symptoms of the liver, they often find metastatic lesions of the liver during routine abdominal examination after finding tumors in other parts. Or the extrahepatic malignant tumor has been surgically removed, and the patient finds liver metastasis in the regular review every few months in the outpatient department. Examination means are mainly color ultrasound and enhancement of abdomen CT or magnetic resonance Examination, especially the latter two examinations, can directly find the liver mass, and determine the number and size of metastatic tumors.

2. There may not be any specific findings in the physical examination, unless there are many large metastatic tumors, the doctor may feel the swollen liver and have tenderness in the liver area.

3. Sometimes it is impossible to judge the nature of the liver tumor, or it is suspected that there is metastasis in other parts, or in order to find the cause of metastasis liver cancer The concealed primary malignant tumor of PET-CT Do a full body scan.

4. In order to understand the function of the liver and provide necessary data for the next possible liver surgery hematuria Routine stool examination, blood coagulation function and liver function (mainly bilirubin, albumin and transaminase). In order to differentiate from primary liver cancer, it is also necessary to carry out virological tests for alpha fetoprotein, hepatitis B or hepatitis C.

differential diagnosis

1. Mainly differentiate from primary liver cancer

Secondary liver cancer generally has no symptoms of serious liver disease, and even when the liver is significantly enlarged, the liver function may still be normal. Compared with primary liver cancer, secondary liver cancer develops relatively slowly with mild symptoms and often presents multiple nodular lesions. The main method of differentiation is to check whether there are primary cancer lesions in organs other than the liver. Alpha fetoprotein is generally negative. When it is really difficult to differentiate, it is only considered to do the puncture biopsy of the tumor for pathological examination

2. Find the primary cancer focus

Secondary liver cancer gastric cancer Metastasis is the most common, followed by lung, colon, pancreas, breast, etc., so the first step is to examine the abdomen. Enhanced CT or MRI of the abdomen is an important means of differentiation. Chest CT can quickly detect lung tumors, breast masses can generally be felt, and pelvic CT can detect rectal, ovarian, and uterine lesions. All tumor markers in blood have complete sets of inspection items, which are simple and fast, and are auxiliary tools for imaging inspection. If it is really difficult to find, although PET-CT is more expensive, it can indeed provide valuable clues.^[1-2]

Disease treatment

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Secondary liver cancer may be a single nodule, but most of them are multiple nodules, and the lesions have already metastasized to the liver, indicating that the primary cancer is in an advanced stage. The previous view is that it can not be removed by surgery, and there is no special treatment. With the development of modern medical level, surgical technology, adjuvant chemotherapy drugs, post-operative critical care support treatment methods and other aspects have made rapid progress, and our doctors' treatment philosophy has also changed greatly. At present, many metastatic liver cancer has become treatable diseases. We use a very common knot rectal cancer As a representative example of liver metastasis, let's talk about the treatment characteristics of metastatic liver cancer in detail

（1） Knot rectal cancer Liver metastasis of

junction rectal cancer （ Colorectal cancer ）It is a malignant tumor with a high incidence in China gastric cancer 、 esophageal cancer It is also one of the "four killers" of digestive system malignant tumors. Recent achievements rectal cancer Radical surgery has become more and more standardized and refined with the efforts of surgeons, but only about 60% of patients can survive for more than 5 years after surgery. Liver metastasis is the main problem affecting the long-term survival of colorectal cancer patients. Indeed, half of the patients will have liver metastasis sooner or later after surgery, which is a high proportion. Because the blood in the gastrointestinal tract flows to the liver, if the tumor penetrates the blood vessel wall during the growth process, there will be cancer cells with the blood flow to the liver to be planted, which is easy to form metastatic cancer in the liver. But fortunately Colorectal cancer The growth rate of liver metastases is relatively slow, and only isolated metastases usually form in the liver, and rarely continue to spread in the liver, which creates conditions for surgical resection. First case since 1940 rectal cancer Liver metastasis resection has a history of 70 years, and the actual efficacy has proved that surgical resection is still the most effective method for the treatment of colorectal cancer with liver metastasis, and it is also the only way to truly cure the tumor. 40~50% of patients with liver metastases that can be removed surgically can achieve long-term survival. let me put it another way, Colorectal cancer The patient's liver metastasis does not mean the end of the world or the countdown of life. On the contrary, through active, scientific and targeted treatment, it is completely possible for us to overcome it with our joint efforts Colorectal cancer This is very sick.

Over the past 70 years, thanks to the great progress of surgical technology and the accumulation of experience of our professional doctors in hepatobiliary surgery, Metastatic carcinoma of liver The size, number, and growth site in the liver are no longer factors that affect whether patients can operate, and many of the previously prohibited areas have been broken through. It can be said that as long as enough liver can be preserved after surgery (generally more than 30%), most liver metastases can be removed. If there is metastasis outside the liver, those who can be resected can also be resected at the same time, such as lung metastasis, intraperitoneal implant metastasis, lymph node metastasis in the liver hilum, etc. Some patients are found to have colorectal cancer and liver metastasis at the same time, which should be treated according to the situation. If the patient's liver function and physical condition permit, according to the current technical level, it can be removed at the same time with one operation. If emergency surgery is needed because the tumor has blocked the intestinal tract, we do not recommend simultaneous resection of metastatic cancer due to the lack of complete preoperative examination data and the high chance of surgical infection. Priority should be given to ensuring the smooth resection of primary colorectal cancer and the rapid recovery of patients. Within 2 years after resection of liver metastases, 60% of cases may recur, and about 1/3 of them still occur in the liver. Don't lose heart and don't be afraid. As long as conditions permit, it can be reoperated, and the overall survival period after resection is similar to that of the first hepatectomy.

Of course, surgery is not omnipotent. In the face of tough enemies, our surgeons also need reinforcements, that is, comprehensive treatment involving multiple disciplines. For example, for preoperative and postoperative radiotherapy and chemotherapy, different schemes are selected for different patients. For those patients who cannot be operated on, radiofrequency or microwave ablation with less trauma can also be used. With a long needle in vitro (without open surgery), small liver metastases in some parts can be eliminated. Therefore, when colorectal cancer patients have liver metastasis, do not despair and pessimism, knowing that this is a disease that has a chance to be cured. What we should do is not to rush to the doctor when we are ill and look for secret prescriptions everywhere. Instead, we should go to a regular professional hepatobiliary surgeon in time to seek treatment opportunities.

(II) mammary cancer Liver metastasis of

mammary cancer It is a systemic disease. In recent years, the incidence has increased, and the peak age has moved forward. Generally, comprehensive treatment based on surgery is adopted, but due to various factors, mammary cancer Recurrence often occurs after operation, and distant metastasis occurs in mammary cancer It is also quite common in patients, and the liver is one of the main organs of breast cancer metastasis. The survival period after liver metastasis is significantly shortened, and the 3-year survival rate is only 30%. Therefore, the treatment effect of liver metastasis after breast cancer surgery directly affects the overall treatment of breast cancer.

However, breast cancer is also one of the most effective tumors in solid tumors with systemic chemotherapy. Effective systemic chemotherapy is still the preferred treatment for liver metastasis of breast cancer. Conventional drugs include anthracycline antibiotics, paclitaxel, 5-fluorouracil and vinorelbine. Taxus in particular is the most important anti breast cancer chemotherapy drug developed after the 20th century. Its single use has a high efficacy, so it is necessary to effectively combine it with other drugs to treat advanced breast cancer. If the tumor is gradually limited and the liver function is good after chemotherapy, surgical resection or ablation can still be considered to destroy the tumor.

(III) oophoroma Liver metastasis of

oophoroma The occurrence of liver metastasis usually indicates that the disease has progressed to an advanced stage, especially when the liver metastasis is multiple and chemotherapy is not sensitive, the treatment will be very difficult. Fortunately, most of them oophoroma It is sensitive to chemotherapy drugs. With the help of chemotherapy, the removal of liver metastases becomes meaningful. Clinical practice has also proved that active surgery can significantly prolong the survival time of patients with resectable liver metastases. Therefore, if there is a chance of radical resection, staged surgery is still recommended, and the survival rate can be increased from 10% in the past to 90%, of which immature Teratoma Although the rate of recurrence and metastasis is high, it is found that the immature tumor tissue has the characteristics of transforming to maturity through multiple operations after recurrence, that is, the reversal of malignancy. Therefore, for such patients, we should cherish the opportunity of surgery and consider active surgical treatment.

(IV) Neuroendocrine carcinoma Liver metastasis of

This type of tumor has a low degree of malignancy, including Carcinoid , malignant islet cell tumor of the pancreas (the tumor of Apple's religious leader Steve Jobs), etc. Gastrointestinal Carcinoid For example, the tumor itself grows slowly, is less invasive, and has low malignancy. Surgical resection is the main treatment. If liver metastasis has occurred, lobectomy can be performed at the same time, or absolute alcohol can be injected into the tumor. The degree of radical resection affects the survival time after surgery, but even palliative resection (partial or partial tumor resection) can significantly improve the symptoms of patients and improve the quality of life. Carcinoid The tissue contains a large number of somatostatin receptors. For those who cannot be radically resected, the use of somatostatin analogues has good efficacy and can be used as first-line treatment drugs.

(V) lung cancer Liver metastasis of

Liver metastasis Yes lung cancer The most common site of blood metastasis, lung cancer After liver metastasis occurs, the patient's condition often progresses rapidly. Liver metastasis occurs mostly in lung cancer Within 12 months after the diagnosis, few patients are suitable for surgery. Chemotherapy is the main method, and radiotherapy technology is advancing rapidly, which also plays an increasingly important role in the treatment of liver metastases. Bronchial artery infusion chemotherapy through femoral artery puncture to treat the primary focus and hepatic artery infusion can prolong the survival time, so it is an effective treatment method at present, especially arterial chemotherapy has small adverse reactions, definite effects and is easily accepted by patients. But the key to reduce the incidence of liver metastasis is the early detection, early diagnosis and early comprehensive treatment of lung cancer.^[1-3]

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