Metastatic breast cancer to the liver

In some people, breast cancer cells may spread outside the breast to the liver. This is called liver metastasis, or liver mets. When breast cancer cells spread to distant parts of the body, it’s called metastatic breast cancer, which includes stage IV breast cancer. While breast cancer can spread to any part of the body, the four most common sites are the bones, liver, lungs, and brain.

About half of people diagnosed with metastatic breast cancer develop liver metastases. It can be difficult to diagnose liver metastasis, because most of the time, liver mets do not cause new symptoms.

Researchers are still studying why breast cancer cells spread to the liver and develop new tumors.

About the liver

Your liver is located on the right upper side of your abdomen, protected by the rib cage. It is an important organ because it:

• Cleans toxins from your blood
• Helps digest fat
• Processes nutrients from the food you eat, so your body can use them well
• Processes the medicine you take, including cancer medicines

A healthy liver doesn’t just keep your body functioning well. It also helps your body process cancer treatment. Keeping your liver as healthy as possible is important in treating cancer. Detecting and treating liver metastasis early, if possible, is part of this. Alcohol, some over-the-counter dietary supplements, and some herbal products can cause damage to the liver. If you already take vitamins or supplements, or are planning to start a new supplement, be sure to tell your doctor. Some may interact with your cancer treatment.

Even with liver mets, the liver can continue to function normally. If tumors eventually interfere with the liver’s ability to function, it is possible for liver metastasis to cause liver failure.

What is liver metastasis?

In breast cancer, liver metastasis means that breast cancer cells spread to the liver to form tumors. These tumors can affect how your liver works. It’s possible to have just one tumor in the liver, but most people who get liver metastasis develop more than one tumor.

Video: Liver mets

Anne Blaes, MD, discusses liver mets at the 2021 Virtual Conference on Metastatic Breast Cancer. Learn more about our annual conference here.

Who gets liver metastasis?

After the bones and lungs, the liver is the third most common place for breast cancer to spread. About half of people diagnosed with metastatic breast cancer develop liver metastasis. Women with metastatic breast cancer to the liver usually have metastasis in other parts of the body as well, but not always. Breast cancer that spreads to the liver can include cancers with different cell characteristics, including hormone receptor-positive, HER2 -positive, or triple-negative breast cancers. It’s possible for people of any background or age to develop liver metastasis.

What are the symptoms of liver metastasis?

Liver metastases often do not cause symptoms, but signs of it could be abnormal liver function testing, or abnormal appearance of the liver on a scan.

Other symptoms of liver metastasis include:

• Right upper abdominal pain
• Belly fullness
• Loss of appetite
• Fatigue or feeling weak
• Fever
• Itchy skin, or yellowing of the eyes or skin (a condition called jaundice)
• Swollen legs

Remember to always tell your oncologist about changes you notice in your body. Many of these symptoms are not specific to liver metastasis. Your doctors can help explain what you’re experiencing and how to manage it or order tests for more information.

If you have already been diagnosed with liver metastasis, it’s important to know about some serious symptoms that suggest the liver is not working as well as it used to, which may mean that your treatment plan may need to be changed or adjusted. Call your doctor right away if you experience:

• Sudden weight loss
• New pain, swelling, or discomfort in the legs or belly
• Jaundice, a condition that causes the skin or the whites of the eyes to turn yellow
• Vomiting more than twice a day for more than a day, or vomiting blood

If liver metastasis is causing symptoms like these, your doctor may recommend a different treatment or change the dose of your current treatment.

How is liver metastasis diagnosed?

Doctors use different techniques for diagnosing liver metastasis. Sometimes, blood tests that check liver function can show a higher-than-normal level of liver enzymes, or elevated bilirubin, a yellow pigment that’s produced and passed through the liver as red blood cells break down. Imaging tests, such as a CT or CAT scan, MRI, PET scan, or ultrasound can also be used to look for metastases. These tests create pictures of your liver and can show whether cancer has spread there.

Sometimes an imaging test isn’t enough for a doctor to know you have liver metastasis. A liver biopsy can confirm breast cancer involvement in the liver. Your doctor may recommend a biopsy, during which a radiologist will insert a needle through the skin of your right upper abdomen to obtain a sample of liver tissue. A pathologist then tests the piece of liver for breast cancer cells.

Monitoring liver metastasis

If you are diagnosed with liver metastasis, you and your care team will decide on a treatment plan. That plan will also include regular tests that show your doctors how treatments are working and if the tumors are shrinking, growing, or staying the same. Watching for changes in the cancer allows you and your doctor to continue making treatment decisions, while working to manage or minimize side effects.

Tests to monitor liver metastasis

Your doctor may use some of the same tests to monitor liver metastasis that were used to diagnose them. These can include blood tests and imaging tests:

• Blood tests can show changes in the level of liver enzymes in your blood or find proteins (tumor markers) that have broken away from tumors and entered your blood. Either may suggest the cancer is growing or spreading.
• Imaging tests — for example, a CT or CAT scan, MRI, PET scan, or ultrasound — can create pictures of your liver and show the location of cancer. By comparing the pictures over time, doctors can see whether liver metastases are growing, shrinking, or changing in other ways.

How often you need testing

How often you get which tests for liver metastasis depends on your diagnosis and your doctor’s preferences. But it’s common for doctors to recommend imaging tests every 2-6 months. Your doctor may also recommend additional tests if you experience new or more serious symptoms or side effects. Ask your doctor how often they recommend you have certain tests, and why.

How are liver metastases treated?

We know that learning you have metastatic breast cancer to the liver can be upsetting and scary. But there are several ways to treat liver metastasis and control symptoms and side effects.

Liver metastasis is typically treated with systemic treatments (treatments that impact the whole body), such as chemotherapy and targeted therapies based on the breast cancer’s biomarkers and subtype. Less often, local treatments are used. The local therapies you may be offered include:

• Radiation therapy
• Chemoembolization, in which chemotherapy is delivered directly to tumors
• Ablation therapy, in which tumors are injected with electricity, freezing cold gas, or alcohol to destroy them
• Surgery

If the cancer causes blocks in bile ducts that help the liver get rid of waste, a procedure known as a biliary stent may be recommended to unblock the duct and allow the bile to flow again, which helps with digestion.

Palliative care is another option that can support your physical and emotional well-being. Palliative care team members can work with you to reduce symptoms such as pain, fatigue, loss of appetite, anxiety, and depression. They can also connect you with mental health professionals and spiritual resources.

Ask your doctor about palliative care. It can be used at any stage of breast cancer. Research shows that starting palliative care early can reduce symptoms and side effects and improve survival. Learn more about palliative care.

Factors that affect treatment

How your care team treats liver metastasis is largely based on whether the cancer is hormone receptor-positive, HER2-positive, or triple-negative. Other factors your oncologist will consider include:

• Your age
• The size of the tumor or tumors
• Symptoms you are currently experiencing
• What cancer treatments you’ve had in the past
• Features of the cancer
• Your menopausal status
• How healthy you currently are, aside from cancer
• Whether you also have metastatic breast cancer in other parts of your body, such as the brain, bones, or lungs
• Organ function, such as kidney and liver function

How to cope

We know that coping with cancer is emotionally draining. Many people find some relief by talking about their experience with a licensed professional therapist or with a peer support group. If you’re interested in either of these, ask a social worker or patient navigator from your healthcare team if they can connect you with resources. These professionals are tuned in to the local cancer support landscape and should be able to recommend support groups or counselors who meet at your cancer treatment center or nearby. They may also be able to recommend professionals or groups that are accessible online from any location.

You may also find that it helps to:

• Talk with other women diagnosed with liver mets in online groups.
• Meet up with others living with liver mets in your community or in organized support groups.
• Get insights from others in text or phone conversations through professional helplines. We encourage you to reach out to our Helpline by filling out our online form to be matched with a trained volunteer who has been diagnosed with metastatic breast cancer and is coping with a similar experience.

Clinical trials

In addition to receiving standard treatments for metastatic breast cancer to the liver, you may also be eligible to join a clinical trial looking at new, promising medicines, or at new ways of delivering treatments. Joining a clinical trial may seem like an uncertain way to treat cancer. But in most cases, treatment through a trial allows you to have exposure to new medicines and to be closely monitored by the trial team.

To learn more about clinical trial eligibility and safety, or to search for trials you might be able to join, visit our clinical trials section.

A liver metastasis diagnosis can leave you feeling exhausted and overwhelmed. Below you’ll find articles, personal stories, and downloadable resources to help you make sense of the basics of your diagnosis, from understanding the disease to coping with the lifestyle changes that come with it.