Breast liver metastases

Fig. 14.1. TIPS placement in a 54-year-old woman who developed radiation induced liver disease. She developed abnormal liver function tests with elevated alkaline phosphatase levels and portal hypertension 1 month following radioembolization of liver metastasis from breast carcinoma...

The estrogens are used cautiously in patients with gallbladder disease, hypercalcemia (may lead to severe hypercalcemia in patients with breast cancer and bone metastasis), cardiovascular disease, and liver impairment. 

Metastatic breast cancer is not curable, and therapy is intended to palliate symptoms. In most cases, hormonal therapy is the mainstay. While on therapy, patients are monitored monthly for signs of disease progression or metastasis to common sites, such as the bones, brain, or liver. 

In humans, also, preferential sites exist for the formation of metastasis from various primary tumors [reviewed in Zetter (Zl)]. Thus, bone is a preferred site for metastasis from primary malignancies in breast, prostate, and kidney, while liver is a frequent metastatic site for tumors originating in the colon. Different types of leukemias vary widely in their ability to spread to liver, lymph, bone, and spleen. Some organs, however, are rarely colonized by metastatic growth. These resistant sites include skeletal muscle, heart, and skin. 

Liver metastases are frequently multiple. They vary in size and are usually hypodense. In contrast to liver parenchyma, they display relatively sharp contours, with a difference in density of at least 10 -15 HU. In fatty liver, metastases may even appear hyperdense. Liver metastases are mainly supplied by arterial blood. Therefore i.v. (or even intra-arterial) bolus injection of CM produces the best diagnosis the metastasis shows increased CM enrichment during the short hypervascular phase additionally, a peripheral margin forms as a result of the increased concentration of CM. Metastases of 5 -10 mm can be detected. Data in the literature confirm a sensitivity of 65-91% (in breast cancer up to 100%) and a specificity of 81 - 92% with a success rate of 80 - 85%. Proof of metastases clearly depends on the histology of the primary tumour the best diagnostic results are obtained in breast and colon carcinomas. (22,39,50,53,57)... 

Metastatic breast carcinoma is the most likely diagnosis in this case. The liver function tests indicate that there is little hepatocellular damage present and that bilirubin excretion is normal. These findings, however, do not exclude the possibility of hepatic metastasis, giving rise to localized areas of intrahepatic obstruction. 

Pellegrini et al. (P2) reported that combining serum TIMP-1 levels with CEA measurements in patients with colorectal cancer was useful to predict prognosis. TIMP-1 levels have been reported to be more than 3-fold elevated in patients with Dukes D (stage IV) colorectal cancer as compared to healthy donors (H7). Similar increased levels of plasma TIMP-1 were found in patients with advanced breast cancer. Holten-Andersen et al. (H7) proposed that plasma measurements of TIMP-1 may be of value in the management of cancer patients. Yukawa et al. (Y9) further reported that the plasma concentration of TIMP-1 was increased in colorectal cancer patients with serosal invasion by tumor and metastasis to lymph node and liver. 

Fig. 29.6. CT images in the portovenous phase of two different patients suffering from extrahepatic malignancies with liver metastases. On the kft side, typical hypovascular metastases from a breast cancer are depicted (arrows) the larger lesions show central regressive changes with the corresponding bull s-eye appearance. On the right side, a metastasis from a colorectal carcinoma is shown (arrow). This lesion is also a typical hy-...

Liver metastases are the most common tumors in Europe and the United States and are 20 times more common than in Africa, Japan and Eastern countries. The liver is the most common site of metastasis. Colorectal cancer is the third leading cause of death in Western communities, outnumbered only by lung and breast cancer. At the time of death, approximately two-thirds of patients with colorectal cancer have liver metastases. Survival in metastatic liver disease depends on the extent of liver involvement and the presence of metastatic tumors. In several studies, liver metastases of colon carcinoma which were confined to one lobe and involved an area of less than 25% of the liver caused death in 6 months when untreated (Stangl et al. 1994). When 25-75% of the liver was involved, survival was 5.5 months and when more than 75% of the liver was involved, death occurred in 3.4 months. 

Fig. 25.8. The graph shows the applied energy per metastasis for colorectal cancer liver metastases, liver metastases from breast cancer and hepatocellular tumors for lesions 2 cm or less in diameter, lesions between 2 and 3 cm, lesions between 3 and 4 cm and lesions larger than 4 cm in diameter. Values are expressed as mean plus/minus standard error of mean, which is the measurement of how much the value of the mean may vary from sample to sample taken from the same distribution. It is the standard deviation ofthe distribution of all possible means, if samples of the same size are repeatedly taken...

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