Memorial Sloan-Kettering physicians use blood tests, diagnostic imaging, biopsy, or a combination of these methods to identify liver metastases and determine the stage (extent) of the tumor(s). Our physicians usually develop a treatment plan for liver metastases by determining the primary site — that is, the organ in which the cancer began. Occasionally, however, it is not possible to identify the primary tumor, and some patients only learn they have cancer for the first time when a liver tumor is found.
The diagnosis of liver tumors typically begins with a simple blood test to identify the presence of tumor markers (substances that are sometimes found in increased amounts in the blood of people who have certain cancers) such as CEA, or to identify abnormally high levels of liver enzymes. Imaging and other tests may be required to confirm the diagnosis if high levels of these tumor markers are found.
We use state-of-the-art diagnostic imaging tests to create high-quality pictures of liver metastases, pinpointing their exact location and determining the condition of the liver and surrounding organs and blood vessels. Diagnostic imaging techniques reveal precise details about the tumor, such as its exact size and density, helping our doctors to predict its response to treatment. Imaging technology also helps guide surgeons and interventional radiologists during treatment.
Imaging techniques commonly used at Memorial Sloan-Kettering to diagnose metastatic liver tumors include:
- CT Scans
CT uses x-rays to produce an image that reveals the extent of tumor growth, and whether the cancer has spread into the lymph nodes or other areas.
- Triphasic CT
Triphasic CT provides accurate and detailed images of the liver and surrounding areas during three different phases of blood flow through the liver.
This test, which produces a more detailed image of organs and other soft tissue than CT, reveals the extent of tumor growth within the liver, surrounding organs, and blood vessels, and helps determine whether a tumor is malignant or benign.
High-frequency sound waves help map the location and number of tumors found in the body. Ultrasound can also help distinguish a cancerous mass from a benign tumor.
PET imaging is sometimes used in combination with CT scans to find malignant tumor cells and pinpoint the exact location of liver metastases. Before imaging, a small amount of radioactive sugar is injected into a vein. Cancer cells, which absorb sugar more rapidly than normal cells, are highlighted on the PET scan.
Additional Diagnostic Techniques
The following diagnostic tests may be required to gain more information about the extent of the tumor and the types of cells involved.
In a technique called fine-needle aspiration, an interventional radiologist removes a small sample of tissue or fluid from the tumor site, guided by an imaging device. This tissue sample is later examined under a microscope by a pathologist.
A gastroenterologist examines the interior lining of the colon using a long, narrow tube with a light on its tip.
A surgeon passes a laparoscope — a thin, lighted tube with a camera on its tip — through a small incision in the abdominal wall to view the liver and surrounding organs. Tiny instruments are used to remove tissue samples for biopsy. Laparoscopy can be used to avoid exploratory surgery in some patients.
Genetic Testing of Tumors
The Memorial Sloan-Kettering pathology department routinely conducts laboratory tests to identify the genetic makeup of a tumor for most patients with liver or other metastases. Pathologists examine a small sample of the tumor, removed during a biopsy or surgery, to look for specific mutations in the genes KRAS and BRAF. Tumors that contain these mutations do not respond well to a class of drugs called epidermal growth factor receptor (EGFR) inhibitors. Researchers at Memorial Sloan-Kettering are also developing tests to screen for mutations in the genes PIK3CA and NRAS, which will improve our ability to target treatment to the genetic makeup of a tumor. Our researchers are also evaluating a variety of drugs, including novel therapies, to determine their potential effectiveness in treating tumors with these mutations.