Hepatic metastases

Colorectal cancer is the third leading cause of death in Western countries after lung and breast cancer. Nearly 40%-50% of patients with colorectal cancer will develop hepatic metastases. Hepatic resection is the only potentially curative therapeutic option available for patients with isolated liver metastases. Recurrent... 

Fig. 9.9a, h. Breast carcinoma with hepatic metastases. Hepatic artery infusion, a Abdominal computed tomography (CT). Multiple hilohar hepatic metastases prior to intraarterial infusion. The patient had failed previous intravenous therapy, b Abdominal CT, 7 months later, demonstrated an excellent response after treatment with courses of hepatic artery infusion with Taxol (Bristol Myers Squibb, Princeton, NJ)... 

Miller DL, Simmons JT, Chang (1987) Hepatic metastasis detection. Comparison of three CT contrast enhancement methods. Radiology 165 785... 

Lou E, Marshall J, Aklilu M, Cole D, et al. 2006. A phase II study of active immunotherapy with PANVAC or autologous, cultured dendritic cells infected with PANVAC after complete resection of hepatic metastasis of colorectal carcinoma. Clin Colorectal Cancer 5 ... 

Mouse models are critical for the discovery and development of novel therapeutics and to understand the mechanism(s) of metastasis (see Note 1). Commonly, two different models of metastasis are utilized the first is experimental or artificial metastases, in which tumor cells are injected intravenously or via the left ventricle both of which circumvent part of the metastatic process. As a generality, the first capillary bed encountered by the injected cells provides the site for experimental metastasis. Thus, following lateral tail vein injection, pulmonary metastases are observed in rodents. This contrasts with the profile of metastases observed following injection of the left ventricle which results in hepatic metastases, as well as, potentially bone marrow and brain metastases. 

It should be noted that this technique can also be successfully applied to hepatic metastasis. 

Fig. 6.17 Liver metastasis (subcostal section) hypoechoic fringe (arrow) wide, more hyperechoic margin and hypoechoic central colliquation ( bull s-eye ). Structural inhomogeneity of the remaining hepatic segments...

Bissonnette, R.T., Gibney, R.G., Berry, B.R., Buckley, A.R. Fatal carcinoid crisis after percutaneous fine-needle biopsy of hepatic metastasis case report and literature review. Radiology 1990 174 751 —752... 

Tc-DTPA Arterial perfusion accounts for 20%-40% of the circulation in portal hypertension, cirrhosis causes arterial perfusion to increase to over 60%. In portal vein thrombosis, only an arterial curve is visible. Liver metastasis usually displays relatively high arterial perfusion. In (rare) occlusions of the hepatic artery, only a portal venous curve is visible. When a bolus injection of 400 MBq "Tc-diethylenetriamine pentaacetic acid (DTPA) is applied, scintigraphy is able to reveal a bi-phasic time-activity curve. The initial increase of activity is produced by the arterial influence and the second peak by the portal venous inflow. Both curves can be evaluated quantitatively. (36) Perfusion scintigraphy may be useful in the case of liver trauma, TIPS, hyper-vascularized hepatic tumours and partial liver resection as well as after liver transplantation. 

Fig. 37.16 Large metastasis in the right hepatic lobe with distinct cancer umbilicus subsequent to breast cancer (serosa, peritoneum and ligaments without pathological findings)...

Witte, R.S., Cnaan, A., Mansour, E.G., Barylak, E., Harris, XE., Schutt, A.X Comparison of 5-fluorouracil alone, 5-fluorouracil with levamisole, and 5-fluorouracil with hepatic uradiation in the treatment of patients with residual, nonmeasurable, intra-abdominal metastasis after undergoing resection for colorectal carcinoma. Cancer 2001 91 1020-1028... 

Chiannilkulchai, N. Ammoury, N. Caillou, B. Devissaguet, J.P. Couvreur, P. Hepatic tissue distribution of doxorubicin-loaded nanoparticles after I.V. Administration in reticulosarcoma M 5076 metastasis-bearing mice. Cancer Chemother. Pharmacol. 1990, 26, 122-126. 

Radiographic imaging studies evaluate the extent of disease involvement. A chest x-ray should be performed to rule out the presence of metastatic spread to the lungs. A CT scan of the abdomen and pelvis is often performed to evaluate hepatic and retroperitoneal involvement and occult abdominal and pelvic disease, and to determine the depth of tumor penetration into the bowel wall and/or invasion to adjacent organs. Detection of lymph node involvement with either smdy is limited by the difficulty of distinguishing inflammatory or reactive lymph nodes from those infiltrated with tumor. Because CT scans may not adequately detect peritoneal seeding, small distant lymph node metastasis, or liver metastasis in colon cancer, an occasional patient may... 

Fong Y, Salo J. Surgical therapy of hepatic colorectal metastasis. Semin Oncol 1999 26 514-523. 

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. 

A2. Akashi, A., Komuta, K., Haraguchi, M., Ueda, T., Okudaira, S., Furui, J., et al., Carcinoembryonic antigen mRNA in the mesenteric vein is not a predictor of hepatic metastasis in patients with resectable colorectal cancer A long-term study. Dis. Colon Rectum 46, 1653-1658 (2003). 

Hepatic metastasis from a primary tumor in the lung represents advanced and incurable disease and resection is usually contraindicated, because it is without any shown benefit in survival or quality of life. 

Amhiru S, Miyazaki M, Ito H et al (2001) Benefits and limits of hepatic resection for gastric metastasis. Am J Surg 181 279-283... 

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