Metastases to the liver: the most common liver malignancy
- Lesion
Most cancers found in the liver come from elsewhere, especially the colon, pancreas, breast and lung.
What it is
Metastatic tumours are far more common in the liver than primary cancers. The liver receives the whole portal blood flow from the gut plus systemic arterial blood, and its sinusoids are a fertile soil, so carcinomas of the colon, pancreas, stomach, breast and lung, and melanoma and neuroendocrine tumours, spread there often. Metastases are usually multiple and well defined, with central necrosis and umbilication. Resection can cure some colorectal metastases.
Structure
- Gross: multiple well-demarcated grey-white nodules of different sizes; central necrosis and umbilication.
- Micro: tumour resembling the primary, with desmoplastic or pushing borders; colorectal metastases show dirty necrosis.
Step by step
- Tumour cells enter the portal vein or the systemic circulation.
- They lodge in sinusoids, where flow is slow and fenestrated endothelium allows exit.
- Interaction with Kupffer cells, stellate cells and growth factors helps them survive (seed and soil).
- Micrometastases recruit vessels and grow into nodules.
- Nodules outgrow their blood supply: central necrosis and capsular umbilication.
Markers
- CK7 and CK20
- CDX2 (intestinal)
- TTF-1 (lung)
- GATA3 (breast)
- Synaptophysin and chromogranin (neuroendocrine)
Test yourself
Think of the answer, then tap the question to see it.
What is the most common malignant tumour found in the liver?
Metastatic carcinoma, most often from the colon, pancreas, breast or lung.
Why do colorectal cancers metastasize to the liver so often?
Venous blood from the colon drains through the portal vein, delivering tumour cells directly to the hepatic sinusoids.
What gross feature suggests a metastasis under the liver capsule?
Umbilication, a central depression caused by necrosis and fibrosis in the centre of the nodule.
Connections
Educational content on the mechanisms of disease; not a diagnostic or treatment guide and no substitute for a health professional's advice. No doses are given.
Sources: Liver metastases: MedlinePlus Medical Encyclopedia (MedlinePlus, US National Library of Medicine, 2026).
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Representative model, for educational purposes only.