Case Report

All the following cancers commonly metastasize to the liver except:

A. breast
B. colon
C. lung
D. melanoma
E. prostate
Answer / Explanation:

The answer is E.

The liver is particularly vulnerable to invasion by tumor cells because of its dual blood supply by the portal vein and the hepatic arteries. Most patients with liver metastases present with symptoms from the primary tumor. Sometimes hepatic involvement is suggested by features of active hepatic disease, including abdominal pain, hepatomegaly, and ascites. Liver biochemical tests are often the first clue to metastatic disease, but the elevations are often mild and nonspecific. Typically, alkaline phosphatase is the most sensitive indicator of metastatic disease. Lung, breast, and colon cancer are the most common tumors that metastasize to the liver. Melanoma, particularly ocular melanoma, also commonly seeds the hepatic circulation. Prostate cancer is a much less common cause of hepatic metastases.


For Your Reference:

Related Topic:hepatic cancer metastatic

The liver is a common and important site for metastatic disease. As many as 25% to 50% of cancer patients have liver metastases at autopsy. Most tumors metastasize to the liver, and metastases to the liver strongly affects the stage of the tumor and prognosis of the patient. Most metastases are multiple, diffusely distributed, variable in size, and solid. They may be necrotic and appear more cystic. Liver metastases may be present even when both general and specific serum markers for tumor, e.g., liver function tests and carcinoembryonic antigen are normal. Metastases may be poorly vascularized or highly vascular, a difference that affects their appearance after intravenous contrast administration. Mucin-producing carcinomas, e.g., breast and colon carcinoma, frequently produce calcification, which can be detected with imaging studies. Metastases are almost always evaluated with cross-sectional imaging studies. However, more recently, PET has been used to detect certain malignancies, including liver metastases, with great success.

Although US can evaluate for liver metastases when used by skilled operators, it is limited by ileus and relative insensitivity to subtle lesions, especially against the background of preexisting liver disease. On US, metastases are usually hypoechoic, poorly defined, and hypovascular, and may have a peripheral halo (Fig. 1134). Some types, such as those of breast cancer, may be diffusely distributed in minute form. In most institutions, CT is used to survey and monitor patients for liver metastases, because CT can detect metastases and is probably the most useful technique for evaluating extrahepatic disease. On CT, metastases are usually multifocal, of low attenuation, and often better shown after administration of intravenous contrast material when compared to preinfusion scans (Fig. 1135). Again, some forms present as diffuse inhomogeneity. Because of its sensitivity and potential for characterizing some lesions specifically, MR imaging may become the preferred technique for detecting and characterizing liver metastases. Lesions have low signal intensity on Tl-weighted images and higher signal intensity (but never as high as in cavernous hemangioma) on T2-weighted studies (Fig. 1136). Certain lesions, e.g., melanoma, carcinoid, and endocrine tumors of the pancreas, have very high signal with strongly T2-weighted scans.