[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [General pathology](https://durgical.com/en/general-pathology/) › [Liver and gallbladder](https://durgical.com/en/general-pathology/areas/liver/) › Metastases to the liver: the most common liver malignancy

# 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.

Updated Nov 12, 2026

## Key points

- Metastases are the most common malignant tumours in the liver.
- Commonest primaries: colon, pancreas, breast, lung, stomach; also melanoma and neuroendocrine tumours.
- Gut cancers spread through the portal vein; others reach the liver through the hepatic artery.
- Gross: multiple pale nodules, often with central necrosis and umbilication under the capsule.
- Liver function is often preserved until most of the liver is replaced; alkaline phosphatase rises early.
- Immunohistochemistry (e.g. CK7/CK20, CDX2, TTF-1, GATA3) points to the primary.

## 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)

## Memory aid

In the liver, think 'imported before local': metastases outnumber primary cancers.

## 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.

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## Connections

## Related 5

- [Hepatocellular carcinoma](https://durgical.com/en/general-pathology/hepatocellular-carcinoma/)
- [Benign liver masses](https://durgical.com/en/general-pathology/benign-liver-masses/)
- [Pathways of spread and the usual metastatic sites](https://durgical.com/en/general-pathology/pathways-of-spread-and-the-usual-metastatic-sites/)
- [Invasion and metastasis: the metastatic cascade, step by step](https://durgical.com/en/general-pathology/invasion-and-metastasis-the-metastatic-cascade-step-by-step/)
- [Immunohistochemistry: the principle and the markers to know](https://durgical.com/en/general-pathology/immunohistochemistry-the-principle-and-the-markers-to-know/)

## Related conditions 7

- [Colorectal cancer](https://durgical.com/en/conditions/colorectal-cancer/)
- [Pancreatic cancer](https://durgical.com/en/conditions/pancreatic-cancer/)
- [Breast cancer](https://durgical.com/en/conditions/breast-cancer/)
- [Lung cancer](https://durgical.com/en/conditions/lung-cancer/)
- [Gastric cancer](https://durgical.com/en/conditions/gastric-cancer/)
- [Melanoma](https://durgical.com/en/conditions/melanoma/)
- [Carcinoma of unknown primary](https://durgical.com/en/conditions/carcinoma-of-unknown-primary/)

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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](https://medlineplus.gov/ency/article/000277.htm) (MedlinePlus, US National Library of Medicine, 2026).

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Representative model, for educational purposes only.

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License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/general-pathology/metastases-to-the-liver-the-most-common-liver-malignancy/