The most common treatment used for metastatic liver lesions is systemic chemotherapy. In this treatment, anti-cancer medications may be delivered intravenously, or by ingestion of an oral preparation containing the anti-cancer drug.
Cancer cells vary widely in their response to systemic chemotherapy, and some cancers respond well to chemotherapy, while others may be unaffected. This type of treatment is commonly offered for patients who have large malignant tumors that cannot be removed surgically, or patients who have cancer spread to other organs in addition to the liver.
Transarterial Chemoembolization (TACE)
Microspheres injected into the branches of the hepatic artery during transarterial therapy “lock in” chemotherapy and block the blood supply to the tumor.Some patients may be more appropriate for a specialized form of chemotherapy, TACE, which uses special catheters to deliver chemotherapeutic drugs directly into the artery supplying the liver. This procedure focuses the anti-cancer effect on the metastatic lesions in the liver, and tends to have fewer side effects commonly seen with systemic chemotherapy. TACE has the added advantage of being able to partially block the blood supply to the area of the cancer, depriving the blood supply needed by the cancer cells for nutrients and oxygen. For most individuals TACE is well-tolerated, with few side-effects, and can frequently be performed as an outpatient procedure.
During radiofrequency ablation, the surgeon deploys electrodes from a probe that deliver radiofrequency energy. This high heat causes death of tumor cells.Patients with small metastatic tumors may be best treated with radiofrequency ablation (RFA). With this procedure, a specially designed probe is radiographically guided into the liver tumor, and radiofrequency energy is used to destroy tumor cells. During the procedure, tumor cells are heated to more than 50° C.
Most commonly, this procedure is done using laparoscopic surgery (small incisions on the abdomen), or performed in the radiology suite, using CT guidance. In some instances, open surgery may be required to perform this procedure.
RFA may be used for patients who have unresectable metastatic liver lesions, or are too ill to undergo surgical resection, and may be used in combination with other forms of treatment.
Surgical resection involves removing a portion of the liver that contains the metastatic lesion. This treatment is reserved for patients with no underlying liver disease (such as cirrhosis), and who are otherwise healthy enough to withstand a major operation.
Surgeons can remove as much as 70 percent of the liver in attempting to remove cancerous lesions, since the liver possesses the ability to regenerate after surgical resection. The liver will typically replace the removed liver volume within several weeks after surgical resection.
In patients with metastatic liver lesions localized to one anatomic region of the liver, surgical resection offers the best chance for cure. Only a physician or surgeon experienced with the treatment of metastatic liver lesions can determine if surgical resection is right for you.