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What is Liver Metastasis?
Advanced breast cancer involves the spread of abnormal growth of breast cancer cells to distant parts of the body. The cells from the primary tumor growing from breast cells break away from this site and are carried through the blood stream and the lymphatic vessels to distant sites like the bones, liver, brain and lungs. These sites where the breast cancer cells are said to metastasize, are usually very vascular or well supplied by blood and lymphatic vessels and become the secondary site of growth. Breast cancer matastasis can also occur as a recurrence after initial treatment of the primary tumor.
Metastasis of cancer cells to different organs may be detected and diagnosed by the kind of cells found in the site. Discovery of abnormal breast cancer cells in the liver will point out that the primary cancer site is the breast, when in some cases the primary tumor has not been first diagnosed. This is because the cells found in the metastatic or secondary site will be similar to those from the primary tumor, and not the former.
The liver is the third most common metastatic site for breast cancer, the first and second being bones and lungs, respectively. However, in ten percent of cases, the liver is the first organ to be invaded. Eventually, 2/3 of women with breast cancer will most likely have liver metastasis.
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Some women do not have any symptoms of liver involvement secondary to breast cancer. They are often found to have metastatic tumors only after doing some laboratory tests like x-rays and blood tests that may reveal abnormalities in the liver.
Often times, vague general symptoms may be felt, such as:
- Loss of appetite
- Weight loss
Symptoms that may point to liver involvement are:
- Right-sided abdominal pain below the ribs
- Yellowing of the skin and membranes (jaundice)
Having one or two of these symptoms does not necessarily mean that a woman has metastatic cancer. Also, these symptoms may not manifest until advanced stages, so tests must be done to detect cancer spread early.
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Metastatic lesions are often difficult to detect, especially if asymptomatic. Once the symptoms manifest, such those mentioned above, diagnostic tests are often done.
Detection methods may include imaging exams like scintigraphy, ultrasound, x-rays and CT scan of the liver. Changes in the liver size and abnormal densities may be found.
Blood tests may include test for tumor markers like CEA (carcinoembryonic antigen) and CA 15-3 which are elevated in women with metastatic cancer of the breast. However, these are not very sensitive and specific. Tests for elevation of liver enzymes may also reveal abnormal results but then again, these may not be specific for cancer, since these changes may also be found in other conditions like infections.
Pathologic examination of biopsy samples from the liver tumor will reveal breast cancer cells when the primary tumor is from the breast. This will provide definitive diagnosis of liver metastasis.
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Liver metastasis in breast cancer should be verified and efforts to identify other sites of metastases must likewise be undertaken. As mentioned earlier, the liver is the third most common site of spread, and the bones and lungs are more likely to be involved.
Choice of therapy depends on the patient’s general health condition, her age, tumor size and location. Combinations may be used to control the tumor, alleviate symptoms and manage side effects.
Treatment usually consists of:
- If the secondary tumor is small and localized, surgical intervention may be done. Radiofrequency energy ablation or cryoablation, that uses heat at the tip of a wire inserted through the skin destroys small lesions in the liver.
- Chemotherapy is one of the most important ways to treat liver metastasis in breast cancer. However side effects such as nausea, vomiting and hair loss may be undesirable and severe.
- Chemotherapy may be combined with hormone therapy and other drugs to control and manage side effects of chemotherapy.
- Radiotherapy may be done if chemotherapy is not effective or contraindicated. Radiotherapy may be also be used to decrease tumor size and pain.
- Alternative therapeutic methods like homeopathy, vitamins and acupuncture may be used to alleviate pain and avoid undesirable side effects of chemotherapy.
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Imaginis, “Advanced (Metastatic) Breast Cancer" (accessed 11/22/10)
Breast Cancer.org, “Prognosis for Liver Metastases?" (accessed 11/22/10)