Diagnosis & Staging
At Memorial Sloan Kettering, we use the results of blood tests, sophisticated diagnostic imaging, an analysis of biopsy tissue, or a combination of these methods to identify liver metastases and determine the stage (extent) of your cancer.
Our multidisciplinary team of doctors will develop a treatment plan based in part on the original (primary) site of your cancer — if it can be identified. We order blood tests to check for tumor markers (substances that are produced by cancer cells or in response to cancer) and abnormally high levels of liver enzymes.
We may also use imaging and genetic testing to confirm a diagnosis of liver metastases and get insight into what might be effective for treating it.
Imaging Tests to Help Pinpoint the Tumor
We use state-of-the-art diagnostic imaging techniques to create high-quality pictures of liver metastases. With these images, we can pinpoint the location of your tumor and determine the condition of the organ and surrounding organs and blood vessels.
The images reveal precise details about the tumor, such as its exact size and density, helping us predict the response to treatment. Imaging technology also guides our surgeons and interventional radiologists during treatment.
The imaging techniques our doctors commonly use are a magnetic resonance imaging (MRI) a triphasic computed tomography (CT) scan, which provide detailed cross-sectional images of the liver, gallbladder, bile ducts, nearby lymph nodes, and other internal organs during different phases of blood flow through the liver.
Ultrasound tests are also used to distinguish a benign (noncancerous) tumor from a cancerous mass. We use a special kind of ultrasound, known as Doppler ultrasound, to look at the portal and hepatic veins to determine whether the tumor has invaded these structures and to see if they contain a blood clot.
In several cases we use positron emission tomography (PET) in combination with CT to pinpoint the exact location, extent and activity 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 then highlighted on the PET scan.
Your doctor may also recommend that you undergo a biopsy to learn more about the extent of the tumor, the types of cells it contains, and certain markers that provide the specific signature of each tumor. In a technique called fine-needle aspiration or core needle sampling, an expert interventional radiologist uses image guidance and tiny needles to remove a small sample of tissue or fluid from your tumor site.
While most liver biopsies are guided by ultrasound or CT imaging, at Memorial Sloan Kettering we also have unique interventional MRI and interventional PET/CT to assist us with challenging cases that can only been identified with certain imaging.
For some patients, our doctors recommend laparoscopy to obtain the biopsy sample. In this procedure, 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.
A pathologist examines the tissue sample under a microscope to learn more about its characteristics and behavior. This information can help in shaping a treatment plan customized for you.
Our pathologists will likely conduct laboratory tests on the biopsy tissue to identify the genetic makeup of your tumor. Having this information can help in selecting the most effective treatment approach.
In examining a small sample of the tumor removed during a biopsy or surgery, we look for specific mutations in a number of genes. Tumors containing mutations in the genes KRAS and BRAF, for example, do not respond well to a class of drugs called epidermal growth factor receptor (EGFR) inhibitors, so our doctors know to start treatment with a different approach.
Our researchers are evaluating a variety of drugs, including new and experimental drugs, for their potential effectiveness in treating tumors with these and other mutations.
Staging Metastatic Liver Cancer
Staging is a way of describing how advanced a cancer is, or to what “stage” it has progressed. This can help our doctors decide how to treat the cancer.
Because liver metastases are cancers that have already spread from a primary location (for instance, the colon) to a distant organ (the liver), they are considered to be at the most advanced cancer stage — stage IV.