Lung Cancer Spread to the Liver - Symptoms, Treatments, and Prognosis

Understanding Lung Cancer with Liver Metastases

Woman holding her stomach in pain
What happens when lung cancer spreads to your liver?. B2M Productions/Photodisc/Getty Images

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?

Definition of Lung Cancer Spread to the Liver

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.

Symptoms

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

If you do have symptoms, these may include pain under your ribs 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.

Diagnosis

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

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.

How is Lung Cancer That Has Spread to the Liver Treated?

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 and/or targeted therapies may be used to treat stage  4 in general. The approval of immunotherapy drugs 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.

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, especially those who have an EGFR mutation or other treatable mutations, 2 primary radiation techniques have been shown to improve outcome in a subset of patients. These include:

  • SBRT - Stereotactic body radiotherapy, in which high-dose radiation therapy is delivered in 1 to 5 treatments, or
  • SABR - Stereotactic ablative radiation.

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 patients are alive and half have died) and approximately 25 percent long-term survival in 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.

Patients who have better outcomes with this type of treatment include patients with fewer metastases, those in which the patient 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 8 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 2 to 4 months without treatment and 6 to 12 months 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. 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 NSCLC. Expert Review in Anticancer Therapy. 2015. 15(12):1459-71.

Nagashima, A. et al. Long-term survival after surgical resection of liver metastasis from lung cancer. The Japanese Journal of Thoracic and Cardiovascular Surgery. 2004. 52(6):311-3.

Ravenel, J. et al. ACR Appropriateness Criteria® noninvasive clinical staging of bronchogenic carcinoma. Journal of Thoracic Imaging. 2010. 25(4):W107-11.

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

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

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

Westover, K., Iyengar, P., Sharma, A., and R. Timmerman. SABR for aggressive local therapy of metastatic cancer: A new paradigm for metastatic non-small cell lung cancer. Lung Cancer. 89(2):87-93.

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