Reviewed By: Pramod Kerkar, MD, FFARCSI

Liver metastases are common in many types of cancer, especially those of the colorectal, breast, lung, and pancreas. It is tumors that have spread (metastasized) to the liver from another part of the body. It can occur a little while after primary cancer which may take months or years later. More than 50% of patients with colorectal cancer will develop liver metastases during their lifespan. Lung, breast, pancreatic, skin, and endocrine cancer may also cause liver metastases. In the USA and Europe countries, secondary liver neoplasms are far more common than primary hepatic neoplasms.

What Are The Symptoms of Liver Metastases?

The first symptoms of liver metastases are usually nonspecific cancer symptoms like fever and loss of appetite. Early stages of liver metastases are always asymptomatic. When the metastasis progress, liver becomes enlarged, hard, or sometimes tender with easily palpable nodules occur. This massive hepatomegaly (enlarged) with nodules indicates the more advanced stage of the disease. Hepatic bruits and pleuritic-type pain with an overlying friction rub are some of the rare characteristic features of liver metastasis. Concomitant peritoneal tumor seeding may produce ascites, but jaundice is usually absent or mild initially unless a tumor causes biliary obstruction. In the terminal stages, progressive jaundice develops causing hepatic encephalopathy leading to death.

Symptoms of liver metastases may vary, which depend on the affected individual health conditions.

  • Loss of appetite or anorexia
  • Nausea
  • Chronic fatigue
  • Weight loss
  • Prolong fever
  • Discoloration of the skin or yellow skin and eye color formation; and dark-colored urine (jaundice)
  • Inflamed skin
  • Severe pain in the abdomen
  • Discomfort and swelling of the abdomen caused by a buildup of fluid (called ascites) and
  • Enlargement of the ankles

Approximately 50% of the affected patients with liver metastases have clinical signs of hepatomegaly. Hepatomegaly is normally associated with ascites in half of the patients. Ascites is described as an abnormal buildup of fluid in the abdominal cavity. 13% of patients with extensive liver metastases have ascites in the peritoneal region resulting in portal hypertension. In advanced stages, infection of this fluid which is known as peritonitis can be deadly.

Hepatomegaly could be pressing on nerves under the diaphragm. Some of these nerves connect to nerves in the right shoulder, which may result in pain in that area. The direct application of a local anesthetic over the source of the pain can provide some relief to the patient. Alternative therapies like acupuncture and acupressure can relieve or reduce severe liver cancer pain, especially in the late stage of the disease. Rarely post-operative pain can cause nausea, discomfort, and GI problems because of medications.

Many individuals with liver metastases have chronic fatigue. It is a multifarious symptom that includes a range of disorders such as lethargy, malaise, lassitude, and exhaustion. Fatigue is the most commonly encountered symptom in metastases patients and it has a significant impact on their quality of life. Central fatigue in liver metastases is often associated with neuropsychiatric complaints such as depression and anxiety.

Jaundice and hepatic encephalopathy are the terminal phases of liver metastasis patients. Jaundice becomes visible when the bilirubin level is about 2 to 3 mg/dL. Hyperbilirubinemia may involve predominantly decreased hepatic uptake (unconjugated hyperbilirubinemia). Dysfunction of hepatocytes, slowing of bile egress from the liver, and obstruction of extrahepatic bile flow is often caused by conjugated hyperbilirubinemia. Hepatic dysfunction can result in coagulopathy, encephalopathy, and portal hypertension (which can lead to GI bleeding).

Conclusion

The liver is the largest organ in the human body with a fair amount of reserve function. The cancer cell diffusion into the liver forms the metastasis which may have direct or indirect effects. However, prescriptions can be supportive of specific symptoms such as pain, nausea, and itchiness. But advanced symptoms like coagulopathy, encephalopathy, and GI bleeding is hard to manage in liver metastasis. Without treatment, life expectancy for liver metastasis patients is poor and ranges from 5 to 9 months. It depends upon the patient’s age, immunity, and extent of spread of primary cancer.

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Pramod Kerkar

Written, Edited or Reviewed By:

, MD,FFARCSI

Pain Assist Inc.

Last Modified On: June 28, 2018

This article does not provide medical advice. See disclaimer

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