April Case: Liver metastases

Posted by on Apr 26, 2014 in Blog, Cancer, Cases | No Comments
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Photo Cases Newsletter

Diagnosis: Liver Metastases

What is shown?
The picture shows two slices of the liver, each with a metastasis (arrows). These were the only metastases in the liver.

Where did the metastases come from?
They came from a lung cancer.

How did this patient die?
The patient died from the lung cancer (which blocked her breathing). The metastases did not cause the patient to die.

What is a metastasis?
When a tumor spreads through the blood to other areas of the body (where it takes hold and grows) this is a metastasis.

What do metastases mean for the patient in life?
Metastases mean the tumor is more advanced and often less likely to be curable. This is because surgery to remove the main tumor will still leave behind the metastasis somewhere else in the body. It also often means the amount of tumor is large. This can affect the success of other treatments (e.g., chemotherapy).

Is this always true?
No. Some tumors can still be curable even with metastases. It depends on the number of metastases, their size, where they are in the body, and if the anatomy allows for a surgical approach. Also the type of tumor matters. For example, some Hodgkin’s lymphomas, and a testicular tumor called seminoma can be curable even with metastases. Each case is different.

Is there any other reason to remove or treat a metastasis?

Yes, this can sometimes relieve symptoms (palliation).

In this case, how did the autopsy help the family?
Anxiety over possible suffering. The amount of tumor is often connected in the family’s mind to the amount of suffering. It is important for this reason to give an exact description of the amount of tumor, where it is located, and how it affected that organ. In this case, the majority of the liver was preserved, and the patient would not have had clinical liver problems. The metastases likely caused this patient no problems.

Guilt/anger over treatment issues: Families often need to know if the autopsy findings indicated that some treatment may have saved the patient “if only” it had been tried. They may feel guilty for not having “tried harder,” or angry with the medical system for the same reason. Here, the patient’s lung tumor overwhelmed her breathing and this was the cause of death. No treatment approach dealing with the liver metastases would have helped – they were not the cause of death. This relieved the family from their worry about the liver metastases.

Summary. The finding of metastases allowed for a discussion of the progress of the disease, but did not at all suggest suffering or a missed opportunity for treatment. This allowed the family to proceed with a sense of calm, peace, and understanding.

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