Treatment of Liver Metastases
Each case is different and must be evaluated specifically by different specialists to take into account the general condition of the patient; the disease the metastasis has produced (if there are other metastases as well as those in the liver); previous treatment and response to it; and the location of the disease in the liver. Each case must be individualised to assess if it can be subjected to surgery.
Planning the appropriate treatment for each patient is essential. Liver metastases imply advanced diagnoses of a malignant disease. For this reason, a multidisciplinary approach is essential. Treatment will vary according to the origin of the metastases, the amount, the location and the condition of the patient.
This treatment can include:
- Chemotherapy (treatment with different drugs).
- Surgery.
- Other treatments aimed at destroying the metastasis with radiofrequency, radioembolisation.
- Supportive and palliative treatment.
Making the right treatment decisions is important. Expert opinion and a review of tests performed can take several weeks before a final treatment plan is devised.
A multidisciplinary team made up of liver surgeons, oncologists, radiation therapists, radiologists, interventional radiologists and palliative care specialists collaborate to decide the most appropriate therapeutic strategy with the patient. For surgical treatment, the specialists with the most experience in the treatment of liver metastases are the hepatobiliopancreatic surgery teams.
Surgical treatment
The extent of the surgery performed depends on the needs of the patient.
- Metastasectomy: This is the limited resection of one or more lesions.
- Major hepatectomy: This requires the removal of the lesion and a significant part of the liver where there is no metastasis, due to the number of lesions or their location (extension to essential parts of the liver).
- Radiofrequency ablation: This is the destruction of the metastasis through the use of electrical heat achieved after insertion into the lesions. This is done in special situations and must be assessed beforehand.
Drug treatment
Chemotherapy. Chemotherapy uses anti-cancer drugs to kill cancer cells and is a common treatment in patients with liver metastases from colorectal carcinoma. Chemotherapy can destroy cancer cells circulating in the blood and those that have already settled in the liver.
- Adjuvant chemotherapy. This is performed after liver surgery to reduce the chance of the cancer returning.
- Neodjuvant chemotherapy. This is performed before surgery to treat potential cells at a distance from the tumour and reduce tumour size as the only treatment for cases of liver metastases that are not candidates for surgery.
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