NeuroEndocrine Cancer Australia aims to shed light on the nature of these metastases, their diagnosis, associated symptoms, and the unique management difficulties they pose.
NeuroEndocrine Cancer Australia is dedicated to the advocacy of patients affected by all kinds of neuroendocrine cancer, including metastases of liver NETs. If you have specific questions related to your condition, you can give our specialised NET cancer nurse a call.
Neuroendocrine tumours (NETs) are a diverse group of neoplasms originating from neuroendocrine cells, which are distributed throughout the body. While NETs can develop in various organs and systems, liver metastases occur when these tumours spread to the liver, significantly impacting a patient’s prognosis.
NETs have various primary sites, including the lungs, pancreas, gastrointestinal tract, and more. Gastroentropancreatic neuroendocrine tumours (GEP NETS) frequently metastasize to the liver. When there are liver metastases patients can experience carcinoid syndrome and also biliary obstruction and liver insufficiency.
A comprehensive history should be done noting diagnostic imaging and treatments given. Also identifying if the symptoms are consistent with carcinoid syndrome and / or functional NETs
To diagnose liver metastases of NETs, imaging plays a pivotal role. Computed Tomography (CT) and Ultrasound (US) are commonly employed to visualise and assess the extent of liver involvement. These imaging modalities help identify tumours and assess their size, number, and location. However, in many cases, specialised scans become necessary for a more precise diagnosis.
Gallium 68 Dotatate PET / CT also known as somatostatin receptor Ga 68 Dotatate PET, is a nuclear medicine imaging test used to detect NETs. The scan involves injecting a radiolabeled somatostatin analogue, which accumulates in NET cells and becomes visible on the scan. This modality is particularly useful for identifying neuroendocrine tumours and their metastases.
Another valuable tool is 18- FDG Positron Emission Tomography (PET) with radiolabeled glucose. This enables imaging to pick up on NET activity – higher uptake of glucose by the cancer indicates faster growth NET. PET scans provide detailed images, enhancing the accuracy of diagnosis.
It is essential to differentiate between the symptoms of functional and non-functional tumours. Functional tumours produce excessive hormones, leading to characteristic symptoms. Non-functional tumours do not produce significant hormone levels and may not exhibit these specific symptoms, making their early detection more challenging.
However, non-functioning tumours cause symptoms similar to those of exocrine pancreatic neoplasms, i.e. nausea, vomiting, and abdominal and/or back pain and display occasionally obstructive jaundice if located in the pancreatic head.
As NETs progress to the liver, they can disrupt liver function and lead to various signs of liver dysfunction, such as:
Monitoring liver function tests in patients with metastases is crucial, as it helps healthcare providers assess the liver’s health and the impact of NETs on this vital organ.
As with other kinds of NETs, liver metastasis symptoms will vary from patient to patient. If you record one or several of the above symptoms, it’s best to get in touch with your GP as soon as possible.
Managing NETs that metastasise to the liver is challenging due to the complex biology and variability of these tumours. There are three main challenges that healthcare teams must deal with when faced with metastasised liver NETs.
Liver metastases of neuroendocrine tumours (NETs) pose a formidable challenge in the realm of cancer treatment. Here we will delve into the diverse approaches for managing neuroendocrine metastatic liver cancer, highlighting the criteria for surgical intervention, liver-directed therapies, medical treatments, prognosis factors, and the crucial role of a multidisciplinary approach.
Surgical resection is a primary treatment option when addressing neuroendocrine metastatic liver cancer. The feasibility of surgery depends on several key factors, including the number, size, and location of liver metastases. In general, surgical resection is considered when:
Surgical removal of liver metastases offers the potential for prolonged survival and symptom relief. However, like any surgical procedure, it carries certain risks, including infection, bleeding, or damage to the liver or adjacent structures. The selection of surgical candidates is a complex decision involving careful assessment of potential benefits versus risks.
Liver-directed therapies, such as embolisation and chemoembolisation, aim to target liver metastases directly.
Embolisation and chemoembolisation are typically considered for patients with extensive liver metastases when surgical resection is not feasible. They are also valuable when liver tumours cause hormonal symptoms.
Liver-directed therapies carry certain side effects, including post-embolisation syndrome, characterised by fever and abdominal pain. While these treatments can shrink tumours and improve patient outcomes, they are generally considered palliative and may require repeat procedures as tumours regrow.
Somatostatin analogues are a cornerstone of medical therapy for neuroendocrine metastatic liver cancer. These drugs, such as octreotide and lanreotide, work by inhibiting the production of hormones by NETs. They help control hormonal symptoms, slow tumour growth, and improve overall quality of life.
In cases where somatostatin analogues are no longer effective, targeted therapies and chemotherapy can be considered. Targeted therapies, like everolimus and sunitinib, focus on specific molecular pathways that drive tumour growth. While they can be effective, they often come with side effects. Chemotherapy, typically reserved for aggressive tumours, may provide temporary symptom relief and tumour control but is often not curative.
PRRT employs radioactive molecules (radiopeptides) that bind to somatostatin receptors on NET cells. These radiopeptides deliver radiation directly to tumour cells, leading to their destruction. PRRT is increasingly used. It can improve symptoms, slow tumour growth, and enhance the patient’s overall quality of life.
As with symptoms, treatment for metastasized liver NETs will vary from person to person. It’s always best to talk to your healthcare team about information specific to your condition.
Similar to other kinds of NETs, metastasised liver neuroendocrine cancer can present a variety of prognosis factors and potential outcomes for patients. For information that directly relates to your condition, talk to your healthcare team.
The prognosis for patients with neuroendocrine metastatic liver cancer depends on several critical factors:
Survival rates can significantly vary based on the extent of disease at diagnosis and response to treatments. While some patients achieve long-term survival or even cure, others may face progressive disease. Generally, treatment aims to extend survival and improve the quality of life.
Quality of life is a central focus in the management of neuroendocrine metastatic liver cancer. The impact of the disease and its treatments on daily life, including symptoms, side effects, and emotional well-being, is carefully considered when planning patient care.
Long-term follow-up is essential for patients with neuroendocrine metastatic liver cancer. It involves regular assessments, including imaging, blood tests, and consultations with a multidisciplinary healthcare team. Continuous monitoring helps track disease progression and adjust treatment strategies as needed.
Most forms of cancer require a multidisciplinary approach to treatment, and metastasized liver NETs are no different. At NECA, we advocate for all patients to follow a multidisciplinary approach to care, beginning with your regular GP and extending to specialists and patient support teams.
Addressing neuroendocrine metastatic liver cancer necessitates a multidisciplinary approach. The complex nature of the disease requires expertise from various specialists, collaboration among these experts ensures comprehensive and personalised care.
Your healthcare team will likely be comprised of:
Collaboration among healthcare providers allows for a more comprehensive evaluation and treatment planning. Surgeons may perform resections when feasible, while medical oncologists and endocrinologists manage systemic treatments and hormonal symptom control. Nuclear Medicine Physicians and Radiologists play a vital role in diagnostics, treatments and interventional therapies.
A holistic approach to care often involves patient support teams, which include nurses, nutritionists, therapists, and other professionals. These teams provide critical support for symptom management, nutrition, and emotional well-being, enhancing the overall quality of care.
Patient-centred care is crucial when addressing neuroendocrine metastatic liver cancer. Treatment plans should be tailored to individual needs and preferences. The patient’s values, priorities, and lifestyle should inform the treatment decision-making process.
The role of patients and their families in decision-making processes is also paramount. Education and support, provided by organisations like NeuroEndocrine Cancer Australia (NECA), empower patients to actively participate in their care and make informed decisions.
Neuroendocrine tumour liver metastases are usually diagnosed at an advanced stage, requiring a multifaceted approach to management. Specialised diagnostic tools play a crucial role in identifying these metastases.
The diversity in the clinical presentation and complexity of NET biology demand personalised treatment plans. As research continues to uncover the mysteries of these tumours, there is hope for more effective therapies and improved outcomes for patients with neuroendocrine tumour liver metastases.
