Yes, you can live with liver metastases, and some patients are cured. When the metastases come from colon or rectal cancer and can be removed completely, between 40% and 60% of patients are alive 5 years later, and about 1 in 5 is cured at 10 years. What changes the outlook most is having a liver surgeon assess whether they can be operated on.
Can liver metastases be cured?
In selected cases, yes. The reference study followed 612 patients operated on for colorectal liver metastases for 10 years: 102 were still alive and 97% of them had no disease, so they were considered cured (Tomlinson, J Clin Oncol 2007).
The condition is almost always the same: all the metastases must be removable, with a liver resection alone or combined with ablation, and there must be no untreatable disease outside the liver. That is why the first question we ask about each patient is not how long they will live, but whether their metastases can be operated on now or could become operable.
How long can you live with liver metastases?
It depends mainly on whether they can be operated on. After complete resection of colorectal metastases, published series report 40% to 60% of patients alive at 5 years. With current chemotherapy and no surgery, trials report median survival of 24 to 30 months (TRIBE trial, N Engl J Med 2014).
A median is the time by which half the patients in a study have died; the other half live longer. None of these figures tells you how long a particular person will live. We explain them in more detail, tumor by tumor, in life expectancy with liver metastases.
Why do some liver metastases have a better outlook than others?
Because of the organ where the cancer started and whether they can be removed. Metastases from colon and rectal cancer and from neuroendocrine tumors respond best to surgery; those from pancreatic, stomach or lung cancer are operated on far less often and have a worse outlook.
The number and size of the lesions also matter, as do where they are in the liver, whether there are metastases in other organs, the time since the original tumor, how they respond to chemotherapy and the patient's general health. Enough healthy liver has to be left for the operation to be safe, and this is calculated before surgery.
What if I have been told they cannot be operated on?
It is worth asking for another opinion at a center with experience in liver surgery. Some patients who are not operable at first become operable: in a reference series, 12.5% of unresectable cases could be operated on after chemotherapy, and 33% of them were alive at 5 years (Adam, Ann Surg 2004).
This is done by combining chemotherapy, interventional radiology (portal vein embolization so the healthy part of the liver grows, ablation of small lesions) and surgical techniques such as two-stage surgery. We explain it in criteria for operating on liver metastases.
Is liver cancer curable?
It depends on which cancer it is. Liver metastases are a cancer that started in another organ, usually the colon or rectum, and has spread to the liver. Primary liver cancer, or hepatocellular carcinoma, starts in the liver cells themselves and is a different disease with a different outlook.
When primary liver cancer is localized, it is treated with surgery to remove the affected part, a liver transplant or ablation, which are the treatments given with curative intent (US National Cancer Institute). When you read any survival figure, check which of the two it refers to.
What is life like after surgery for liver metastases?
Most patients return to normal life within a few weeks. The liver regenerates after a resection and recovers much of its volume, and when the operation is done laparoscopically or with robotic surgery recovery is usually shorter.
Regular check-ups with blood tests and scans follow, because metastases can come back. If they come back in the liver, they can often be operated on again.
Frequently asked questions
Can you live with liver metastases?
Yes. With current chemotherapy, trials report medians of 24 to 30 months in colorectal cancer, and when the metastases can be removed completely 40% to 60% of patients are alive at 5 years.
Can liver metastases be cured?
In selected cases, yes. After surgery for colorectal metastases, about 1 in 5 patients is alive and disease-free at 10 years, which is considered a cure.
Is liver cancer the same as liver metastases?
No. Metastases come from a cancer in another organ, usually the colon or rectum. Primary liver cancer starts in the liver cells and has a different treatment and outlook.
Are liver metastases always operated on?
No. They are operated on when all of them can be removed while leaving enough healthy liver and there is no disease outside the liver that rules it out. Some that are not operable at first become operable after chemotherapy.
Can they come back after surgery?
Yes, which is why there are regular check-ups. If they come back in the liver and can be removed, a second operation is a valid option for many patients.
If you have been told your liver metastases cannot be operated on, you can send us your reports for an online second opinion.
References
- Tomlinson JS, Jarnagin WR, DeMatteo RP, et al. Actual 10-year survival after resection of colorectal liver metastases defines cure. J Clin Oncol. 2007;25(29):4575-4580. PubMed.
- Simmonds PC, Primrose JN, Colquitt JL, et al. Surgical resection of hepatic metastases from colorectal cancer: a systematic review of published studies. Br J Cancer. 2006;94(7):982-999.
- Adam R, Delvart V, Pascal G, et al. Rescue surgery for unresectable colorectal liver metastases downstaged by chemotherapy. Ann Surg. 2004;240(4):644-658. PubMed.
- Loupakis F, Cremolini C, Masi G, et al. Initial therapy with FOLFOXIRI and bevacizumab for metastatic colorectal cancer. N Engl J Med. 2014;371(17):1609-1618.
- US National Cancer Institute. Liver Cancer Treatment (PDQ®), patient version.
This information is for general education and does not replace your doctor's assessment.