How Lung Cancer Spreads to the Liver

Symptoms, Treatments & Prognosis

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Lung cancer spread (metastatic) to the liver is sadly too common. Nearly 40 percent of people with lung cancer have metastases to a distant region of the body at the time of diagnosis. What can you expect if your lung cancer has spread to your liver?

Overview

Lung cancer that has spread to the liver is called “lung cancer metastatic to the liver” (in contrast to metastatic liver cancer, which would refer to cancer that began in the liver and spreads to another region of the body).

For people with non-small cell lung cancer, the spread of cancer to the liver would classify it as a stage 4 cancer. With small cell lung cancer, it would be classified as an extensive stage.

Lung cancer can spread to any region of the body, but most commonly spreads to the liver, the lymph nodes, the brain, the bones, and the adrenal glands. Oftentimes, lung cancer will spread to more than one area of the body. For example, it's common to have both liver metastases and brain metastases. 

Let's take a look at the symptoms of liver metastases and how these are treated. You may also be interested in learning about the management of:

Symptoms 

If your lung cancer has spread to your liver, you may not have any symptoms at all. In fact, the spread (metastasis) is often discovered when a test, such as a CT scan or PET scan is done to determine the stage of your cancer.

If you do have symptoms, these may include pain under your ribs or in your abdomen on the right side of your body, and general symptoms, such as loss of appetite and nausea. If you have many tumors in your liver or if the metastasis is large enough to obstruct your bile ducts, you may develop jaundice, a yellowish discoloration of your skin and the white part of your eyes.

Liver metastases also disrupt the metabolism of bile causing a build up of bile salts in the skin. This can result in severe and frustrating itching.

Diagnosis 

Tests that may be done to look for liver metastases from lung cancer include:

Uncertainty of Liver Findings Is Common

It is important to note that abnormal findings are quite common when scans are done of the liver, and sometimes it can be hard to determine if a spot or spots in the liver are due to the spread of cancer or another (benign) cause. If your doctor is uncertain whether or not an abnormality in your liver is related to your cancer, and the treatment approach would vary depending upon the results, she may recommend a liver biopsy in order to look at the tissue to be certain of your diagnosis. It can be frustrating if your doctor is uncertain about findings in your liver, and this can make you feel anxious and unsure of your care. It may be helpful to know that this is common and that there is a lot of overlap between "normal" abnormalities in the liver and liver metastases.

Treatment

Historically, the treatment of lung cancer that has spread to the liver was mainly palliative, meaning that the goal of treatment is to relieve symptoms rather than to attempt to cure the disease.

Chemotherapy may be used to treat stage 4 in general. 

The approval of both targeted therapy drugs (drugs that target EGFR mutations, ALK rearrangements, and ROS1 rearrangements among others) and immunotherapy is beginning to change that paradigm, and in some cases, these medications may result in long-term control of metastatic lung cancer.

Palliative treatment continues to be the main approach when many liver metastases are present, but for those with fewer metastases—something referred to as "oligometastases"—that is changing.

Metastases Specific Treatment 

In the past, if only a single metastasis was present in the liver, surgery was rarely considered to remove the tumor, but newer radiation therapy techniques are improving upon this.

For those with oligometastases, defined as only a single or a few "spots" of metastatic disease, especially those who have a targetable mutations on gene profiling, two primary radiation techniques have been shown to improve outcome in a select subset of patients. These include:

  • SBRT - Stereotactic body radiotherapy (SBRT) is a procedure in which a high dose of radiation therapy is delivered to a small and precise area with the hope of eliminating the metastases. 
  • SABR - Stereotactic ablative radiation is another radiology technique used to "ablate" or completely destroy a small area such as a metastasis.

Compared to surgery, both of these procedures (termed a metastasectomy) are relatively low risk and have high rates of metastatic control. With SBRT early results have shown an improved median survival (time at which half of people are alive and half have died) and approximately 25 percent long-term survival in carefully selected patients. Clinical trials are in progress further evaluating the benefit of metastasectomy for oligometastases with liver cancer, and a paradigm shift in the treatment of this condition is taking place.

People who have better outcomes with this type of treatment include those with fewer metastases, those in which the person is treated for all known cancerous sites, and in those who have longer disease-free intervals.

Prognosis

Lung cancer that has spread to the liver, sadly, has a poor prognosis.The median survival for people living with stage 4 non-small cell (metastatic) lung cancer is only around eight months, though there is hope that newer statistics based on people with fewer liver metastases treated with the newer radiation techniques will result in higher survival. The average survival time for people with extensive stage small cell (metastatic) lung cancer is two to four months without treatment and six months to a year with treatment.

Support

It can be devastating to learn that your cancer has metastasized. And on top of your grief, there are often a hundred things you feel you need to do. First off, keep in mind that treatments for lung cancer are improving—even for the most advanced stages. If you are feeling good and have only a few metastases, talk to your doctor about the treatments now available. There are many new treatments, but unfortunately these are changing so fast that it is difficult for anyone to stay abreast of the progress.

The National Cancer Institute recommends that people with advanced lung cancer consider taking part in a clinical trial. It can be overwhelming trying to navigate these yourself, but thankfully several of the large lung cancer organizations have worked together to provide a free lung cancer clinical trial matching service, in which a navigator can help to match your specific lung cancer with clinical trials available anywhere in the world.

When cancer can't be cured or life extended, there are still many options for keeping people comfortable enough to enjoy their last days with loved ones. Check out these tips for coping with terminal cancer.

Sources:

Bergsma, D. et al. The evolving role of radiotherapy in treatment of oligometastatic NSCLCExpert Review in Anticancer Therapy. 2015. 15(12) :1459-71.

Guerrero, E., and M.Ahmed. The Role of Sterotactic Ablative Radiotherapy (SBRT) in the Management of Oligometastatic Non-Small Cell Lung CancerLung Cancer. 2016. 92:22-8.

Rusthoven, C., Yeh, N., and L. Gaspar. Radiation Therapy for Oligometastatic Non-Small Cell Lung Cancer: Theory and PracticeCancer Journal. 2015. 21(5):404-12.

Salama, J., and S. Schild. Radiation therapy for oligometastatic non-small cell lung cancerCancer Metastasis Review. 2015. 34(2):183-93.

Ueda, J. et al. Surgical Resection of Solitary Metastatic Liver Tumor Arising From Lung Cancer: A Case SeriesHepatogastroenterology. 2012. doi: 10.5753/hge12000. (Epub ahead of print).

 

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