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Liver Metastases : Treatment & Prognosis

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Treatment & Prognosis::The prognosis depends upon the extent of replacement of liver parenchyma by metastases. The greater the tumor burden, the worse the prognosis. Only about 50% of patients are alive 3 months after presentation and less than 10% survive for a year or more. The treatment is mainly aimed at palliation. The prognosis has improved lately with advancements in surgical techniques for resection, availability of new chemotherapeutic agents, and the use of regional therapies.

Colorectal Cancer: Patients with isolated liver metastases from colo-rectal cancers should undergo resection. Long-term disease-free survival or even cure has been achieved in many such cases. Liver has remarkable capacity to undergo hypertrophy and up to 80% of the liver can be resected as long as vascular perfusion and biliary and venous drainage is intact in the remnant liver. Rapid hypertrophy can restore normal liver function within weeks. Patient who are unable to tolerate or refuse surgery may be offered radiofrequency ablation of tumor.

Neuroendocrine Tumors: Hepatic metastases of neuroendocrine tumors may sometimes cause Carcinoid syndrome. The patients often experience dramatic relief of symptoms after resection of metastatic foci. Hepatectomy followed by liver transplantion with or without chemotherapy has been attempted in a small number of advanced cases. The failure rate is unacceptably high.

This autopsy photograph shows liver metastases from squamous cell carcinoma (SCC) of lung. Metastatic SCC is uncommonly seen in the liver. The primary sites include lung, esophagus, head and neck, genital tract, and anorectal region. The determination of primary site rests on accurate clinical history as immunohistochemical studies are unhelpful.

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