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Lung Cancer Metastasis to the Liver

Medically reviewed by Todd Gersten, M.D.
Written by Emily Wagner, M.S.
Posted on June 10, 2021

Metastasis is defined by the National Cancer Institute as “the spread of cancer cells from the place where they first formed to another part of the body.” Metastasis occurs in advanced stage cancers. For lung cancer, the liver is one of the main sites of metastasis, in addition to the bones, brain, and adrenal glands.

A study from 2010 found that 40 percent of non-small cell lung cancer (NSCLC) cases have already metastasized by the time they are diagnosed, classifying the cancer as stage 4 NSCLC. In small cell lung cancer (SCLC), roughly 2 in every 3 people — when first diagnosed — will have extensive stage cancer that may have spread to other organs such as the liver.

Prevalence of Liver Metastases

One study looked at common metastasis sites at diagnosis in different types of lung cancer, along with their prognoses for those cases. The most common site of metastasis at diagnosis for SCLC is the liver. The study found that between 17.5 percent and 20.3 percent of people with SCLC present with liver metastases. By contrast, only 2.9 percent to 4.1 percent of people with other lung cancers — such as adenocarcinomas and squamous cell carcinoma — have liver metastases at diagnosis. For these other types of lung cancers, the bone is the most common site of metastasis at diagnosis.

Symptoms of Liver Metastasis

In addition to the common symptoms of lung cancer, you may experience other symptoms associated with metastasis to the liver. These symptoms can occur if the metastasized tumors block the bile ducts in the liver. They can include:

  • Yellowing of the skin and eyes, known as jaundice
  • Pain under the right ribs
  • Bloating
  • Loss of appetite
  • Itching
  • Weight loss
  • Swelling in the legs

Detecting Liver Metastases

To determine if your lung cancer has metastasized to the liver, your doctor will typically perform a series of tests, including imaging tests and biopsies.

Imaging Tests

Imaging tests help doctors see inside the body to look for metastases in different organs. Imaging tests also provide information on the exact location of the tumor.

Computed Tomography Scans

CT scans use X-rays taken at different angles to create detailed pictures of the liver, bile ducts, gallbladder, lymph nodes, and other organs.

Magnetic Resonance Imaging

MRI uses high-powered magnets and radio waves to take detailed images of other organs. MRI can also be used to detect spinal cord and brain metastases.

Ultrasound

An ultrasound can be performed to look at the main veins of the liver (the hepatic and portal veins) to determine if the metastases are present. An ultrasound can also be used to look for blood clots in those veins, which can cause other serious complications if they enter the bloodstream.

Positron Emission Tomography Scan

A PET scan uses radioactive sugars to identify cancer spread in the body. Cancer cells take up the sugars faster than healthy cells and will light up on the scan. PET scans can be combined with CT scans to give more information on where the cancer has spread and how much it has grown.

Biopsies

A biopsy entails taking a tissue sample from the body that can be analyzed for cancer cells. A few different types of biopsies can be used, depending on the type of sample your doctor needs.

Fine-Needle Aspiration or Core Biopsy

A fine-needle aspiration biopsy uses a thin, hollow needle inserted into the liver to take a tissue sample. A core biopsy can also be done in the same manner using a slightly larger needle to take more tissue.

Laparoscopy

A laparoscopy entails inserting a thin tube fitted with a light and camera through a small cut made in the abdomen. A laparoscopy allows your doctor to look directly at the liver and other organs in the area.

Blood Tests

Blood tests are used to look at the chemical makeup of your blood. If your lung cancer has metastasized to the liver, your liver enzyme levels may be elevated. Your doctor will check your blood for liver-specific enzymes, such as alanine aminotransferase, alkaline phosphatase, and aspartate aminotransferase.

Treatment Options for Metastasis to the Liver

Options for treating advanced stage lung cancer with metastasis will depend on the type you have.

Stage 4 NSCLC can be treated with:

  • Chemotherapy
  • Immunotherapy
  • Radiation therapy
  • Targeted therapy

These treatments may help relieve symptoms and help you live longer, but they probably won’t cure your cancer.

Extensive stage SCLC has spread too much throughout the body to be treated with radiation, so first-line treatments are typically chemotherapy and immunotherapy.

Radiation therapy can be focused on the liver to help destroy metastases there. Since chemotherapy is a systemic (whole-body) treatment, it can be used to treat primary lung tumors in addition to liver metastases.

Targeted therapies treat cancer with mutations in specific genes. If your lung cancer has a mutation that can be treated with one of these drugs, it likely will treat the metastases as well.

Prognosis

Every cancer case is different, and large studies help experts look at trends over time in lung cancer cases. Overall, the five-year survival rate is 25 percent for all stages of NSCLC and 7 percent for all stages of SCLC. For people with distant spread of cancer in the body, such as with lung metastases, the five-year survival rate is 7 percent for NSCLC and 3 percent for SCLC.

One study found that people with adenocarcinoma and SCLC without liver metastases have a better prognosis than those who do have liver metastasis. Overall, lung cancer metastasis to the liver indicates a worse prognosis.

These numbers provide a general outlook and do not take everything into account, such as subtype of cancer, genetic mutations, overall health, age, and how your cancer responds to treatment. If you have questions or concerns about these statistics and want to know more, your doctor will be able to help.

Talk With Others Who Understand

MyLungCancerTeam is the social network for people with lung cancer and their loved ones. Members come together to ask questions, give advice, and share their stories with others who understand life with lung cancer.

Are you living with metastatic lung cancer? Share your experience in the comments below, or start a conversation by posting on MyLungCancerTeam.

Posted on June 10, 2021
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Todd Gersten, M.D. is a hematologist-oncologist at the Florida Cancer Specialists & Research Institute in Wellington, Florida. Review provided by VeriMed Healthcare Network. Learn more about him here.
Emily Wagner, M.S. holds a Master of Science in biomedical sciences with a focus in pharmacology. She is passionate about immunology, cancer biology, and molecular biology. Learn more about her here.

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