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We Can Help Getting the correct diagnosis and the most appropriate treatment from the start is crucial 
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Metastatic liver cancer is most often treated by surgery. However, if a patient's cancer has spread to the liver, it may also have spread to other areas of the body. One notable exception to this is metastatic colorectal cancer. In this disease, the liver is often the first site of spread. Surgery to remove the tumors is most effective for this type of cancer. Memorial Sloan-Kettering is a leader in the treatment of colorectal cancers that have spread to the liver. Patients with this type of metastatic liver cancer may be treated with a combination of surgery and chemotherapy.
The liver has the capacity to regenerate. Up to 80 percent of the organ can be surgically removed and within several weeks, the liver will have entirely regenerated itself. If one lobe -- along with the blood vessels on that side -- is surgically removed, the other lobe will compensate for the loss.
Operating on the liver can be difficult for several reasons. Many of the major blood vessels to and from the heart pass behind or through the liver, so in essence, the liver is "attached" to the heart. Also, the anatomy of the liver is not always obvious from the surface. The organ is large, dense, and delicate, and covered in part by the rib cage. It bleeds profusely when injured and its tissue tears easily. An experienced surgeon can offer a patient the best chance for a good outcome. Our surgeons perform the highest number of liver resections of any cancer center in the country -- 200 to 300 per year.
New technologies are allowing surgeons to remove increasingly smaller portions of the liver. This results in less loss of blood and a quicker and less complicated recovery. Recent improvements in anesthesia have also led to less blood loss during surgery. Our surgeons are also pioneering laparoscopic surgical methods. In this type of surgery, a small incision is made and a tube with a small camera on its end is passed through the abdominal wall. This technique can be used in selected cases to remove part of the liver (partial hepatectomy). Since the procedure is less invasive than traditional surgery, recovery is quicker.
Thanks in part to these surgical techniques and improvements most of our liver surgery patients stay in the hospital less than 10 days, and the majority do not require blood transfusions.
When the liver is burdened with another disease aside from the cancer, surgery is complicated and sometimes impossible. A disease such as cirrhosis dramatically weakens the liver and often leaves it permanently damaged, with limited regenerative capacity. A patient with a liver hampered by both cirrhosis and a tumor is more likely to be treated with a method other than surgery. Some of these treatments are listed below.
Ablative Therapies
Ablation uses a chemical agent or energy to destroy a tumor. Ablative procedures can be performed both percutaneously (through the skin without an incision) or during surgery. Procedures which can be performed percutaneously include cryosurgery, radiofrequency (RF) ablation, alcohol ablation, and embolization. These therapies can be very effective but are usually intended to control cancer rather than cure it.
Ablative therapies can be used alone or in combination with surgical removal of a tumor. For example, a patient who is not a candidate for surgery may first be treated with embolization to shrink the tumor so that it is small enough to make another form of ablative therapy or surgery possible.
Cryosurgery
In cryosurgery, a needle is introduced into the middle of a tumor to freeze it. Residual tumor cells can be left behind, making this method less effective than surgery. It can also be difficult to keep the tumor at temperatures low enough to completely freeze it, since tumors are often near large blood vessels. Nevertheless, cryosurgery can be a very effective way to control liver tumors.
Radiofrequency (RF) Ablation
RF ablation is the opposite of cryosurgery. Rather than freezing the tumor, physicians use radio waves to heat it up to such a high temperature that the tumor is destroyed. RF ablation is effective, but can only be used for smaller tumors. This therapy is not curative; it is intended to control tumor growth.
Alcohol Ablation
Alcohol ablation or PEIT (percutaneous ethanol injection treatment) is a means of administering toxins directly to a tumor. It is quite effective for small tumors of less than 5 cm. This treatment is usually selected for patients who are not candidates for surgery.
Radiation Therapy
Radiation therapy is used in selected cases to help control tumors. Our radiation oncologists use new techniques to focus the radiation beam on the tumor and spare the normal liver from injury.
Embolization
Embolization is a procedure that cuts off the blood supply to the tumor. Physicians pack a branch of the hepatic artery -- the main artery that carries blood to the liver -- with tiny plastic particles, cutting off most of the blood flow and depriving the tumor of life-giving oxygen. The hepatobiliary team at Memorial Sloan-Kettering performs approximately 200 embolizations a year.
Chemotherapy
Chemotherapy can be administered systemically -- injected in the vein -- or via a pump directly into an organ. Our hepatobiliary team inserts a chemo pump -- a small metal disc, slightly larger than a hockey puck -- to deliver chemotherapy directly to the liver. This method delivers the medication slowly, constantly, and at higher doses than can be delivered systemically.
The chemotherapy pump, to date, is used only for metastatic colorectal cancer that has spread to the liver. For those whose disease is only in the liver and cannot be surgically removed, chemotherapy delivered via the pump can increase response rates.
Chemotherapy is often used after surgeons have removed a portion of the liver, but it can also be used before surgery. For instance, if a patient has a tumor in the hepatobiliary area that is too big to be removed surgically, chemotherapy may be used first to shrink the tumor enough so that is can then be removed surgically.
Rehabilitation Therapy
Rehabilitation therapy plays a role in improving the function and quality of life of patients with liver metastasis. At Memorial Sloan-Kettering, physical therapists work closely with the medical team to improve patient's mobility, strength, and endurance after surgery or medical treatments. They offer patients valuable techniques to increase mobility without increasing pain and discomfort and teach energy-conserving techniques to help patients decrease the fatigue they may experience during hospitalization and medical treatments. Occupational therapists here educate patients about the changes they may experience during and after treatment and about adaptive equipment and compensatory techniques that can increase their independence during their daily routines. They also evaluate and treat patients' ability to perform basic daily activities such as bathing, dressing, and moving around their environment.
See Rehabilitation for further information about our services, including appointment information.
