Liver Metastasis from Lung Cancer

Liver metastases (sometimes called liver mets) occur when cancer cells spread from the original site in the lung to the liver.

When cancer cells form in the lung, they can build up and at any point a portion of the tumor can break off and travel through the blood vessels and lymphatic system. The chances of this increases with time as the tumor increases in size. As the metastasis moves through the body, it will eventually move further from its original point such as the liver where it will continue to grow, affect liver function, and cause additional symptoms.

There is a high incidence of metastases for people with lung cancer. Close to 70% of people with small cell lung cancer (SCLC) experience metastases at diagnosis and between 17.5% and 20.5% of people with SCLC develop liver metastases. Three percent of people with other types of lung cancer will experience a liver metastasis.

Symptoms of lung cancer liver metastasis include abdominal pain, fatigue, nausea, and jaundice. These symptoms may not appear until the cancer has already progressed to an advanced stage.

In some cases, they can be detected on a routine health check. Sometimes cancer is found in the liver first and traced back to the lung. In other cases, the lung cancer may be diagnosed first, and additional testing may be done to see if the cancer has spread. Radiologists can use special imaging techniques to see spots in the lung and liver. A tissue sample may be taken to confirm malignancy which is called a biopsy.

The location, and size of the tumor(s), testing of the tissue sample, and patient’s overall health can inform the patient’s treatment plan.

CT scans are used to initially detect lung cancer and can also be used for detecting a liver metastasis.

MRIs are not used for the chest to follow lung cancer because it doesn’t show up too well, but it may be used when following a liver metastasis. They are typically longer, about 30-60 minutes and can involve a contrast dye injection.

PET imaging is great for detecting liver metastasis. PET imaging uses a sugar-dye injection that is easily detected in the liver and can last 30-60 minutes. Your doctor may ask you to go on a low carbohydrate diet and avoid strenuous exercise going into a PET scan.

Your care team might recommend multiple tests to find where the cancer may have metastasized to and to follow the cancer as you receive treatment to help determine treatment adjustments. Coverage for these diagnostic tests may vary based on several factors, depending on the insurance. It’s always good to check to see what you are covered for in advance.  

Advances in cancer research and treatment options offer new possibilities. Treatments can include Chemotherapy, and Immunotherapy, as the main treatment options as they are a generalized approach.

Targeted therapies are more specific to the cancer cell’s DNA and requires a biomarker test. Some targeted therapies may even get broken down by liver enzymes before they can work on cancer cells that metastasize from the lung to the liver.

Radiation therapies can also be provided for immediate relief if symptoms progress.  

Surgery and Clinical Trials may also be available in some cases.

The symptoms of liver metastasis and risk of significant liver complications can have an impact on a person’s quality of life. When a person is undergoing chemotherapy and other drug therapies, they may encounter complications when their cancer metastasizes to the liver. Because of this, a person’s healthcare provider will monitor liver function by measuring several enzyme levels made in the liver. Elevated enzyme levels can show a sign of liver damage (hepatotoxicity).

Your care team will adjust treatment with this in mind along with any additional side effects.

It depends. Sometimes tumors invade on surrounding structures like major blood vessels and make it difficult for surgeons to remove. Some patients might not be able to tolerate surgery as well due to preexisting conditions. Complications during surgery may even delay other treatment options.

However, surgery may still be possible if the liver metastases is caught before it spreads too far or if other treatment options do a good job of shrinking the tumor. The liver has the potential to recover and regrow.

Ultimately, your care team will assess your individual case and determine the best course.

Each clinical trial is different from the next, and there are several that are conducted by various institutions year-round. Your doctor can help navigate the right clinical trial for you. Visit the American Lung Association’s clinical trials page for more information.

Lung cancer patients and survivors often recommend joining support groups, seeking one-on-one mentorship support, supportive palliative care, and partaking in complementary therapies.

There is also a growing body of evidence that demonstrates that cigarette smoking is associated with increased progression and severity of liver disease, particularly for fibrosis and liver cancer. A healthcare provider can help an individual effectively quit tobacco use through evidence-based and proven-effective tobacco treatment plans that include a combination of FDA-approved cessation medication plus behavioral counseling, such as the American Lung Association’s Freedom From Smoking program.

Patients and caregivers experience many financial obstacles and often end up paying out of pocket. Experienced patients and caregivers recommend the following tips to those who are newly diagnosed and those underinsured,

1. Writing insurance claims in particular ways to ensure insurance approval.
2. Obtain second opinions on treatments before paying out of pocket.
3. Seek out information on the standard of care from insurance companies to calm nerves and to gain more information about their potential treatment plan.

Visit the American Lung Association’s list of financial assistance programs.

Patients and caregivers confront stigma associated with having a lung cancer diagnosis. Often times patients and caregivers emphasize that a history of smoking did not align with their and their loved one’s disease, they mention that they end up fighting the stigma along with lung cancer.

The Lung Association provides resources when addressing lung cancer stigma.