liver metastases
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Epidemiology
- metastatic disease is the most common cause of malignancy in the liver
- 20-50 times more common than primary liver cancer
- 1/3 of patients who die with a malignancy have liver metastases
Pathology
- most common malignancies metastazising to the liver
- most gastrointestinal cancer is spread through the portal venous system
- other malignancies are spread through the hepatic arterial system
- most small (< 1-1.5 cm) liver lesions, even in patients with known malignancy, are not malignant, especially if there are fewer than 5 lesions
Management
- surgical resection of a few isolated metastatic lesions may be curative[2]
- radiologic evidence of metastatic recurrence precludes need for needle biopsy
- a negative needle biopsy would not change management
- resection is 1st line therapy if feasible[2]*
- conversion chemotherapy may facilitate a cure in 16% of patients with initially unresectable colorectal cancer liver metastases[3]
* consider recommendation in the light that most small liver lesions in patients with known malignancies are not malignant (not surprising that many cases are curable)
More general terms
Additional terms
References
- ↑ Johnston FM, Mavros MN, Herman JM, Pawlik TM. Local therapies for hepatic metastases. J Natl Compr Canc Netw. 2013 Feb 1;11(2):153-60 PMID: https://www.ncbi.nlm.nih.gov/pubmed/23411382
- ↑ 2.0 2.1 2.2 Medical Knowledge Self Assessment Program (MKSAP) 17, American College of Physicians, Philadelphia 2015
- ↑ 3.0 3.1 Adam R, Wicherts DA, de Haas RJ et al Patients with initially unresectable colorectal liver metastases: is there a possibility of cure? J Clin Oncol. 2009 Apr 10;27(11):1829-35. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19273699