Gastric cancer, or stomach cancer, develops when abnormal cells grow uncontrollably in the stomach lining. When the disease progresses, it often spreads to distant organs (metastasis), indicating an advanced stage. The liver is the most frequent site for stomach cancer to metastasize, making it a focus of advanced disease management. This spread shifts treatment goals from curative intent to managing the disease and preserving quality of life.
Understanding How Gastric Cancer Reaches the Liver
The liver’s unique anatomical relationship with the stomach makes it highly susceptible to traveling cancer cells. Blood from the stomach and intestines collects into the portal vein before flowing directly into the liver. This system functions as the body’s primary filter, meaning cancer cells that break away from the stomach tumor and enter the bloodstream are often carried straight to the liver.
Once these cells arrive in the liver’s blood vessels, they can “seed” new tumor growth. These masses are known as metastases or secondary tumors, and they are composed of stomach cancer cells, not primary liver cancer cells. The high volume of blood flow and the liver’s filtering function establish this organ as a common destination for spread from the gastrointestinal tract.
Recognizing Signs and Confirming Liver Metastasis
Liver metastases may initially cause no noticeable symptoms because the liver is a large organ that can function well despite tumor involvement. When symptoms appear, they are often subtle, such as fatigue, unexplained weight loss, and general weakness. As tumors grow, they can cause distinct issues like pain or discomfort in the upper right quadrant of the abdomen, where the liver is located.
Advanced liver involvement can lead to jaundice (yellowing of the skin and eyes), which occurs when bile flow is obstructed by the tumors. Nausea, vomiting, and abdominal swelling due to fluid buildup (ascites) may also occur. Physicians rely on a combination of imaging scans and laboratory tests to confirm the spread.
Imaging studies (CT, MRI, and PET scans) visualize the size and location of tumors in the liver and elsewhere. Blood tests provide further evidence, including liver function tests (LFTs) that show abnormal values due to liver compromise. Tumor markers, such as carcinoembryonic antigen (CEA), may also show elevated levels correlating with the extent of metastasis. In some cases, a biopsy of the liver lesion confirms the tumors are metastatic stomach cancer cells.
Systemic and Localized Treatment Strategies
Treatment for stomach cancer spread to the liver is complex, aiming to control the disease, relieve symptoms, and maximize quality of life. This advanced stage requires a combination of systemic therapies (treating the entire body) and localized treatments focused on the liver tumors. Systemic treatment is the backbone of management, often described as a “marathon” rather than a “sprint” for a cure.
Systemic Therapies
Chemotherapy remains a standard first-line approach, often involving a combination of agents like fluoropyrimidines and platinum-based drugs. Regimens such as FOLFOX or FLOT (which adds docetaxel) are commonly used to shrink tumors and slow disease progression. Drug selection depends on the patient’s overall health and tumor characteristics.
Targeted therapies are integrated into the treatment plan after testing the tumor tissue for specific biomarkers. If the cancer is classified as human epidermal growth factor receptor 2 (HER2)-positive, the targeted drug trastuzumab is often combined with chemotherapy, which has been shown to improve outcomes. Other monoclonal antibodies, such as ramucirumab, which targets the blood vessel growth factor (VEGFR2), may be used in later lines of therapy to inhibit the blood supply to the tumors.
Immunotherapy, which harnesses the body’s own immune system to fight cancer, represents a significant advance in treatment. Drugs known as checkpoint inhibitors, such as nivolumab or pembrolizumab, are now incorporated for specific patients, especially those whose tumors have high levels of the PD-L1 protein or certain genetic characteristics like microsatellite instability (MSI-H). These drugs work by releasing the “brakes” on the immune system, allowing it to recognize and attack the cancer cells.
Localized Treatments
Radiofrequency Ablation (RFA)
Treatments focused specifically on the liver tumors are considered when the disease is limited to the liver or when systemic therapy is insufficient for local control. Radiofrequency ablation (RFA) is a minimally invasive technique that uses heat to destroy small tumors within the liver. RFA is a safe option for patients with solitary liver metastases, especially those measuring three centimeters or less.
Transarterial Chemoembolization (TACE)
Another localized approach is transarterial chemoembolization (TACE), which involves injecting chemotherapy drugs directly into the artery feeding the liver tumor, followed by blocking the blood flow to that area. This procedure concentrates the drug at the tumor site while minimizing exposure to the rest of the body.
Hepatectomy
Surgical removal of the liver metastases, known as hepatectomy, is the most aggressive localized option and is reserved for highly selected patients with only a few, easily removable tumors (oligometastatic disease) and no other spread. Hepatectomy is generally considered the most effective local treatment when a complete removal is possible.
Managing Prognosis and Quality of Life
The diagnosis of stomach cancer with liver metastasis is considered advanced, and the prognosis is often guarded. Historically, overall survival for metastatic gastric cancer treated with systemic chemotherapy has been around 12 months. However, outcomes are highly variable and individualized, particularly with the integration of modern targeted and immunotherapies.
The focus of care at this stage shifts significantly to supportive measures alongside active anti-cancer treatment. Palliative care is an organized approach to improve the quality of life for patients and their families facing serious illness, not just end-of-life care. This type of care is provided from the time of diagnosis and works concurrently with treatments like chemotherapy or immunotherapy.
Palliative care focuses on the identification and management of physical symptoms, such as pain, nausea, and appetite loss, common in advanced disease. For specific tumor-related issues in the stomach, like bleeding or obstruction, palliative procedures such as surgery or endoscopic stenting may be used for symptom relief, even if they do not cure the cancer. Integrating proactive supportive care is an important aspect of modern oncology, helping patients maintain comfort and function throughout treatment.