Metastatic tumours of liver may be expansive or infiltrative. They vary in size, shape,vascularity, and growth pattern in accordance in blood supply, haemorrhage, cellular differentiation, fibrosis, and necrosis. Metastatic carcinoma of the breast and pancreas incitean intense fibrous or sclerosing reaction around the tumour acini, leading to fibrous scar formation. Tumour thrombi occlude the portal vein, the hepatic vein, or both. In the presenceof mucin secretion, necrosis, and phosphate activity, metastases may develop calcificationwhich is detectable radiographically.
The blood supply patterns of the liver metastases are of considerable clinicalimportance because a number of diagnostic and therapeutic approaches depend on the degreeof neovascularity and the source and type of the blood supply. Some focal lesions may besurgically resectable or treated by means of ablation techniques and several minimallyinvasive techniques. These treatments have been successful, especially in treating colorectalcancers, for which hepatic resection may offer potential cure. Chemotherapy is now a feasibleoption in patients with more extensive disease. However, it has little success in treating of liver metastases from the breast, lung, or pancreas due to their presence at the time of diagnosis.
Imaging plays a vital role in the diagnosis of liver metastases and in theassessment of the response to treatment. The recognition of a liver lesion as a metastaticfocus may significantly influence the patient¶s treatment and prognosis. Many patients die of cancer as a result not only of metastases but also recurrence of their primary tumour andtreatment with cytotoxic drugs.Over 50% of patients diagnosed with colorectal cancel will develop hepaticmetastases during their lifetime. Resection for metastatic colorectal cancer to the liver shouldbe performed only for fewer than four metastases, technically.
Improved chemotherapeuticregimens and surgical techniques produced aggressive strategies for the management of thisdisease. Many groups now consider volume of future liver remnant and the health of theliver, and not actual tumour number, as the primary determinants in selection for an operativeapproach.
Therefore, resectability is indicative for what will remain after resection.
Use of neoadjuvant chemotherapy, portal vein embolization, two-stage hepatectomy,simultaneous ablation, and resection of extrahepatic tumour in selected patients haveincreased the number of patient eligibility for a surgical approach.
Studies has shown anacceptable 5-years survival rates in the 20-40% range for resection of hepatic metastasesfrom breast, renal, and other GI tumours.