When doctors find liver metastases in stomach cancer patients, it usually signals the later stages of the disease.
They may be asymptomatic or can cause abdominal pain and jaundice (make you turn yellow).
They occur in stage 4 disease and normally signals’ going from a curative phase of your treatment to one that is palliative or terminal.
More non-specific symptoms can also occur including nausea, tiredness and non-specific discomfort in your upper abdomen.
Your liver is divided in to two lobes, the left and the right, and is located in the right upper quadrant of your abdomen.
It has two blood supplies, the hepatic artery and the portal vein from your gut.
The hepatic artery supplies oxygen from your body’s main circulation and the portal vein supplies nutrients absorbed from your bowel.
The liver is involved with many different processes that keeps you alive and protects you.
These include removing toxins from your blood, production of clotting factors and provide storage for carbohydrates and proteins.
When the liver fails, these processes are interrupted with many different consequences.
Liver metastases in stomach cancer can be asymptomatic and picked up on CT scanning, but if you become jaundiced, it is because these secondary tumors are blocking your bile drainage.
Jaundice can also occur when your cancer affects the lymph glands that surround the tubes that drain bile (known as the common bile duct) in the area known as the porta hepatitis.
Jaundice can make you feel ill, can cause your skin to itch, make your stools go pale in color and your urine can become quite dark in color.
When this occurs, your doctors can treat you in a variety of ways:
Stomach cancer causing obstruction by blocking your bile duct is usually treated by placing a stent.
A stent is a tube, normally made of metal or sometimes plastic, that is passed in to your bile duct to allow it to drain the fluid.
To do this, there are two procedures that can be done. The first is an ERCP or endoscopic retrograde cholangiopancreatography.
This is an endoscopic test normally performed under sedation.
A qualified endoscopist passes an endoscope or flexible camera through your mouth, down your esophagus in to your stomach and then into your small bowel or duodenum.
The bile duct has an opening in to the duodenum called the ampulla through which the endoscopist can pass a guide wire.
This guide wire is pushed past the blocked area and can be seen on x-ray during your test. The stent is then passed over the guide wire and through the blocked area, thus opening it up.
Sometimes this is not possible to do and in this situation the blockage is approached in the opposite direction.
To do this, an interventional radiologist will do a similar procedure, but rather than going internally, they will use CT or ultrasound to guide them and the stent is passed through your skin instead.
If this is not possible, a drain is placed instead which will drain the bile in to a collecting bag. This is known as transcutaneous transhepatic biliary drainage.
Chemoembolization is sometimes used to help destroy tumors.
This is a radiological procedure, using x-ray technology to help destroy a secondary tumor by blocking the blood supply and supplying chemotherapy agents to the cancer.
This is only used in specific circumstances, but not usually used in advanced disease or when a complication such as jaundice occurs.
If a solitary metastasis is present, it is technically possible to remove this although it will only be considered in special cases.
This is because by this point, the stomach cancer has commonly spread to other areas of your body making its removal inappropriate.
Chemotherapy and radiotherapy are sometimes offered when metastases are found to help shrink the tumor/s.
The type of treatment offered for your liver metastases in stomach cancer will need to be discussed with your oncologist.