Clinical features and management of liver metastases

Many patients present with symptoms from their liver deposits rather than the primary carcinoma. The ultrasound images of liver metastases on ultrasound
may often prompt further radiological inves tigations for the primary. The symptoms of liver deposits may include non-obstructive jaundice, obstructive jaundice (which may occur if a large mass is present at the porta), hepatomegaly, rightsided pain, increasing abdominal girth from ascites and altered LFTs.
Ultrasound-guided biopsy may be useful in diagnosing the primary and complements further imaging such as X-rays and contrast bowel studies.
Accurate staging of the disease is currently best performed with CT or MRI, which have greater sensitivity for identifying small, sub-centimetre liver metastases, peritoneal deposits and lymphadenopathy and which can demonstrate more accurately any adjacent spread of primary disease.
The prognosis for most patients with liver metastases is poor, particularly if multiple, and depends to a large extent on the origin of the primary
carcinoma. A regime of surgical debulking (removal of the primary carcinoma, adjacent invaded viscera, lymphadenopathy, etc.) together
with chemotherapy can slow down the progress of the disease.
In an increasing number of cases, particularly those with metastases from a colorectal primary, which are less aggressive and grow more slowly,
long-term survival can be achieved by resecting both the primary bowel lesion and then the liver deposits. The smaller and fewer the liver
deposits, the better the prognosis. The success of this treatment has meant that tumours previously considered inoperable are now potentially curable.
In such cases it is particularly useful to localize the lesions using the segmental liver anatomy prior to surgery Intraoperative ultrasound (IOUS) is then used to
confirm the preoperative appearances and examine the tumour margins to plan the line of resection (Fig. below).
Other methods of treatment include chemoembolization, and radiofrequency, microwave or laser ablation often under ultrasound guidance. The success of these options depends upon the number and size of the lesions, and the nature of the primary.
Currently, these methods are considered palliative, rather than curative, and are an option for patients who are unsuitable candidates for hepatic