- Liver Tumours / Cancer
- Metastatic (Secondary) Tumours
- Hepatocellular Carcinoma (HCC)
- How is HCC diagnosed?
- Treatment for HCC
How do I get treatment?
For further information and appointments please see the below contact numbers:
For Mr Rob Hutchins:
020 7234 2940
For the following Consultants:
020 7234 2730
Professor Nigel Heaton
Professor Mohamed Rela
Mr Parthi Srinivasan
Mr Andreas A. Prachalias
Dr Phil M. Harrison
Dr Kosh Agarwal and
Dr Michael Heneghan
Liver Metastatic Tumours Treatment London
About Metastatic Tumours
Cancerous cells have the ability to spread throughout the body via the bloodstream or lymphatic tissue drainage systems. These cells are often destroyed by the bodies own immune system but a small percentage may set up in other parts of the body, grow into visible lumps and themselves be a source of secondary spread.
The liver is one of the most common sites of spread with many cancers. Unfortunately many cancers which spread to the liver are not amenable to surgical removal as they are very aggressive and this type of spread generally means cells will appear in other areas. If you think your cancer might be treated by surgery, then ask your clinician if this is feasible.
Some cancers rarely removed from the liver include stomach, oesophageal, pancreatic, gynaecological and prostate cancers. The most common primary cancer that spreads to the liver but can still be removed is bowel cancer (may be called colon cancer, rectal cancer, large bowel cancer or colorectal cancer). Some breast cancers can also be removed from the liver.
Symptoms of liver metastases
A third of liver metastases from colorectal cancer show up at the same time as the primary cancer. Any patient who has been diagnosed with colorectal cancer should have their liver scanned. The surgeon removing the cancer should inspect the liver during the operation. The rest may show up months or years after the primary has been diagnosed and treated.
These tumours often do not cause any symptoms, especially if you are on a surveillance programme actively looking for secondary spread. The liver has a wonderful ability to absorb insult and it is often only when the liver is completely replaced by tumour that any liver dysfunction occurs. Other vague symptoms may include weight loss, abdominal pain or, if the tumour is located in the centre of the liver, jaundice.
How are liver metastases diagnosed?
Most cancers in the liver are initially picked up by screening ultrasound. However, they may be picked up on a staging CT scan when you present with your primary bowel cancer. If your clinician or surgeon thinks these might be removed, then they will probably arrange a special scan more accurately looking at the liver (either CT or MRI) and a scan to look at the whole body – an FDG-PET scan. This relies on uptake of radiolabelled sugar molecules by tumour cells which are delivered so that they accumulate within the cells and can then be seen with a gamma camera.
Colorectal cancers often release a substance in the blood stream, called Carcinoembryonic Antigen (CEA). This is known as a tumour marker. If the CEA level in the blood is raised, it very strongly suggests that the patient has colorectal cancer. But the converse does not always apply – if the CEA levels are normal, that does not rule out cancer. Also, a raised CEA level does not always mean cancer has come back.
Treatment of Liver Metastatic, London
The treatment of colorectal liver metastases depends on:
- Tumour stage (how many nodules are present in the liver, how large are they, where exactly are they located in the liver, has the tumour spread to surrounding lymph nodes or to distant organs like the lungs or bones?)
- Condition of the liver itself (is it healthy or cirrhotic and if it is cirrhotic, how badly damaged is it?)
- Age and overall fitness of the patient
Surgical Management of Liver Metastases
Please note: It is likely that your consultant will recommend a combination of surgery along with chemotherapy when treating liver cancer.
The main risks of liver surgery are bleeding at the time of surgery, or bile leaks and liver failure after the operation. The chances of a complication occurring are approximately 20-40%. Most of these complications relate to infections e.g. in the chest, wound or infected collections of fluid in the abdomen which may need to be drained under imaging guidance.
The hospital may keep a patient in hospital for longer than usual (about 7-10 days usually).
Liver failure occurs because of too little liver left behind after an operation (or a reasonable amount of liver in a very large patient) or because the liver is of an appropriate size but is already damaged by another disease process.
This can be mild and require correction of a bleeding tendency (one of the many jobs of the liver is to produce factors which help us stop bleeding) with plasma and vitamin K, may present as jaundice or yellow discolouration of the tissues (most noticeable in the eyes) which can last a few weeks or may be profound and life-threatening requiring admission to the intensive care unit.
Bile leaks occur in approximately 5-15% of patients after liver surgery. The easiest way to consider this is to think of an orange. When whole, no juice leaks out but when cut in half, juice can leak out of the cut surface. The liver contains many small bile tubes which are cut through at the time of surgery. Although the surgeon makes every effort to seal these tubes, they may leak after the operation.
If a bile leak occurs, the bile that has leaked may cause an infection. It needs to be drained under imaging guidance and then efforts made to prevent any further bile leak to allow healing to occur. This is carried out in either the endoscopy or X-ray Departments, who place a small plastic tube (stent) into the bile duct. This cannot be felt and stays in for approximately six weeks when it can be removed as a day case procedure.
Bleeding is much less of a problem now that liver surgery has advanced.
Liver surgery is only performed by a select group of Consultants with many years and numbers of experience and many tools exist which help reduce blood loss. You may require a blood transfusion however and should mention to your surgeon if you have religious or personal objections to blood product use.
If your liver is too small to allow a liver operation, your surgeon may refer you for a procedure known as portal vein embolisation. In this procedure, the X-ray Department place a needle into one of the liver blood vessels under sedation and local anaesthetic. The blood vessel to the side of liver being removed is then blocked with special inert particles to cease blood flow. The body immediately sends messages to the other side of the liver to grow. It takes about six weeks for the liver to grow to an adequate size to allow safe surgery.
It is an established procedure around the world and is generally painless and very safe. The liver has a dual blood supply and therefore the liver that is “blocked” continues to survive and does not get infected, although this is a risk. It does not always work but is successful in approximately 80-90% of patients.
After your operation your liver will regenerate or grow. You do not grow a new right liver if this has been removed, rather a very large left liver results. It takes about six weeks for the liver to grow but this continues for about a year. The resultant liver volume is usually very slightly smaller than your original volume but this is not significant and your liver should function completely normally after surgery with no dietary restrictions.
Alcohol, unless the cause of your liver problem, is allowed after liver surgery. The London Bridge Hospital advises that if you drink, this is carried out responsibly and in moderation according to government guidelines.
Is there an alternative if I can't have Metastatic Tumour surgery?
Chemotherapy: is the basis of treatment when the tumours in your liver are not amenable to surgical removal. The likely treatments will be based around 5FU or its tablet version caecitabine (xeloda). Added to this will almost certainly be the newer drugs oxaliplatin or irinotecan. Your oncologist may also add some of the newer antibody treatments cetuximab or avastin. Ask your Oncologist for details of each of these treatments. It is important to remember that these may well be given to you even if you have surgery to improve your chances of a cure.
RFA (Radiofrequency Ablation of Tumours): some smaller tumours may be in a location that they can be burned without affecting any of the other delicate structures around the liver or within it. There are no studies comparing surgery to RFA and no-one has ever shown RFA to be equivalent to surgery for bowel cancer. However it does seem to effectively destroy some tumours and is routinely offered at liver surgery centres. The London Bridge team have the options of delivering this treatment in the X-ray department, at open surgery or with keyhole surgery. This involves placing a needle into the tumour and destroying it with energy generated at the tip of the needle.
Portal vein embolisation: sometimes the tumours are located in such a manner within the liver that a large part of the liver needs to be removed (for example the entire right lobe and part of the left lobe). If the amount of liver left behind would not be enough to survive the operation, then the veins to the side being removed can first be blocked in the X-ray department. This encourages the residual liver to grow and allow a safe operation at a later date. This is a well-established option at the London Bridge Hospital and takes about four to six weeks for the liver to grow and allow surgery. The chances of having an operation in this setting are well over 80%.
SIRT or selective intra-arterial radiation therapy involves injection of tiny glass beads or microspheres containing a radioactive substance, directly into the artery that feeds the liver, selectively targeting the tumour deposits in the liver. While it is deemed safe, its efficacy has not been shown to be any better than standard chemotherapy.
Cyberknife Therapy has not been tested adequately in the liver and there is no evidence at present that it is a useful treatment for bowel secondaries within the liver.
Liver Transplantation is not used for metastatic disease to the liver because of disappointing results. There is one case (neuroendocrine tumours) where transplantation has been used with success.
Secondaries from bowel cancer can be removed surgically. Liver surgery is now an extremely safe form of operation. The chances of dying from liver surgery, despite its complexity, is in the region of less than 5%