When a cancer spreads from a single organ—where it’s known as a primary cancer—to other parts of the body, doctors refer to the disease as a secondary, or metastatic, cancer. Because the liver functions as the body’s cleansing organ, detoxifying blood that comes from other organs, it is a common site of metastatic cancer.
Nearly half of patients with colorectal cancer have a liver metastasis before or during their treatment. For breast cancer, the liver is the third most frequent site of metastasis. At this point, doctors start to think about sending the cancer into remission, rather than completely curing the disease.
Remission starts with treating the secondary cancer, with the intention of slowing the spread. "Luckily, we have multiple treatment options these days,” says Yale Medicine’s Kevin Kim, MD, vice chair of the Department of Radiology & Biomedical Imaging and director of the Interventional Oncology Program at Yale Cancer Center and Smilow Cancer Hospital. At Yale our treatments have very high success rates, especially if patients arrived with a metastasis that was only in their liver.
What are some common types of secondary liver cancer?
Once doctors find liver cancer, it is typically already Stage IV— late-stage cancer. That means they need a different way to classify the disease. Yale Medicine doctors look at what’s called the shape of the cancer, making a distinction between a low-tumor burden (meaning fewer cancerous cells or a smaller tumor size) and a high burden (larger tumor size).
They also determine whether the metastasis is liver-only or liver-predominate (meaning the disease has also migrated elsewhere). Lastly, treatment decisions incorporate whether the tumors are localized in one area or disseminated throughout the liver.
How is secondary liver cancer treated?
Treatment is customized based on factors such as a patient’s tumor burden, location and localization. For small, localized tumors, surgery is the treatment. Systemic chemotherapy may be advised for cancers that are large and disseminated. In the past few decades, says Dr. Kim, doctors have focused on the emerging field of interventional oncology treatments for secondary cancer.
Yale Medicine doctors target the tumor or tumors with high doses of medication, radiation, or the application of heat and cold. For tumors that are contained, doctors start with percutaneous ablation (a small incision). This is an outpatient therapy that’s minimally invasive and takes just an hour.
“Through that puncture, doctors can use heat or cold to burn or freeze the tumor, killing it,” Dr. Kim says. “We can also apply high doses of ultrasound to kill the tumor. The result is that a patient can avoid arduous chemotherapy or surgery.”
When tumors are multiple or diffuse, doctors turn to regional therapy. This includes chemoembolization, which means inserting a catheter that goes directly into the liver’s arteries to deliver very high levels of specialized toxic drugs precisely to the tumor.
This treatment is not painful or invasive. “The patient walks home,” Dr. Kim says. No repeat sessions are needed, unlike with traditional chemotherapy. Doctors can also choose radiation embolization, like other interventional oncology treatments, it is well tolerated and efficient.
As with chemoembolization, doctors insert a catheter through the groin into an artery. Little beads loaded with radiation are then injected into the artery. They reach the tumor in the liver, where they “fry up the tumor cells by radiation,” Dr. Kim says.
What is the prognosis after treatment?
The goal in treating secondary cancer is remission, or what doctors call making the cancer dormant, or quiescent. Yale Medicine’s treatments have very high success rates, especially if patients arrived with a metastasis that was only in their liver. (If the cancer is in the liver and elsewhere, doctors may perform interventional oncology therapies and also refer the patient for systemic therapy, such as chemotherapy.)
Remission does not mean patients are “cured,” but that they will have an improved quality of life and can refocus on monitoring the primary cancer.
What are common side effects?
The experience of being treated for secondary liver cancer at Yale Medicine is centered around the minimal invasiveness of the process. That means that even though we are treating patients’ cancer with very toxic doses, their selective and direct application keeps side effects to a minimum.
After treatment, patients can typically go back to work and a normal life within two or three days. “Compared to surgery, which may require a week’s stay in the hospital, plus four to six weeks of recovery, that is remarkably fast!” Dr. Kim says.
What makes Yale Medicine’s approach to secondary liver cancer unique?
At Yale Medicine, Dr. Kim, a national leader in interventional oncology, has a new position that allows him to focus exclusively on the field. “I am wholeheartedly dedicated to patients with cancer, particularly metastatic liver cancer,” he says.
At other centers, practitioners have to juggle more, but Yale Medicine allows doctors to concentrate on this expertise. In addition, we are running several clinical trials.
Plus, our radiology and biomedical imaging doctors are able to coordinate patient care with top doctors in other departments.