The liver is a common site for secondary cancer arising from primary tumours in other organs (other than the bowel or colo-rectum).
Primary breast cancer may spread to the liver in a significant proportion of patients. In those few patients with a less aggressive primary cancer, in whom there has been a long disease free interval between the development of primary and secondary cancers, and in whom there is disease confined to the liver in resectable sites, surgery may be an option. In others radiofrequency ablation may have a role to play.
In addition primary skin tumours such as melanoma have a predilection to spread to the liver. In those with isolated resectable disease surgical removal is an option that provides the only chance of long term survival.
Patients with secondary adenocarcinoma (cancer) to the liver from abdominal viscera, such as the stomach, oesophagus, pancreas, are not usually resected as these primary tumours are aggressive and there is no evidence that resection would be of benefit. However in patients with carcinoid and neuroendocrine primary tumours arising from these sites, resection may be offered with benefit.
Patients with secondaries from the kidney and occasionally the uterus when isolated to resectable sites in the liver may be offered resection.
Patients with isolated secondary sarcomas of the liver are rare but may be helped by resection.
It is unlikely that resection of isolated liver secondaries in patients with primary lung tumours would be of benefit. However in those with a favourable primary tumour (well differentiated and pathologically thought to be less aggressive) and where there has been a long disease free interval surgery may be considered.
In summary surgical resection may be considered for most patients with isolated liver secondaries with non-colorectal primary tumours. In those with unresectable disease radiofrequency ablation is an option. The other option is neo-adjuvant chemotherapy and if this downstages the disease sufficiently surgery may be considered.