From the Guidelines
Yes, ovarian cancer can metastasize to the liver. Ovarian cancer commonly spreads beyond the ovaries to other organs, with the liver being one of the potential sites for metastasis, as noted in the revised 2014 FIGO staging system for EOC 1. This spread typically occurs through direct extension to nearby organs, through the peritoneal fluid that circulates within the abdominal cavity, or via the bloodstream and lymphatic system. When ovarian cancer metastasizes to the liver, it creates secondary tumors that are still classified as ovarian cancer rather than liver cancer. The liver is particularly vulnerable to metastasis because of its rich blood supply and filtering function.
Key Points to Consider
- Symptoms of liver metastasis may include abdominal pain or swelling, jaundice, unexplained weight loss, and fatigue.
- Treatment for ovarian cancer that has spread to the liver typically involves systemic therapy such as chemotherapy, targeted therapy, or immunotherapy, depending on the specific characteristics of the cancer.
- In some cases, surgical removal of liver metastases might be considered if the disease is limited, as assessed by imaging and surgical exploration 1.
- Preoperative imaging, including CT and positron emission tomography (PET)-CT, can help predict the likelihood of suboptimal cytoreductive surgery and detect liver or spleen parenchymal metastases 1.
- Diffusion-weighted magnetic resonance imaging may have better sensitivity than CT for detecting involvement of surgically critical tumor sites, including mesenteric root infiltration, small bowel, and colon carcinomatosis 1.
From the Research
Ovarian Cancer Metastasis to the Liver
- Ovarian cancer can metastasize to the liver, although it is a rare occurrence 2, 3, 4, 5, 6.
- The liver is not a typical site for ovarian cancer metastasis, but it can occur through the blood or lymphatic stream 2.
- Studies have reported cases of ovarian cancer metastasizing to the liver, including a case of ovarian serous adenocarcinoma metastasizing to the bile duct 2.
- Ovarian cancer liver metastasis (OCLM) has unique oncological characteristics and a variety of metastasis patterns, making it a challenge to treat 5.
- Surgical treatment of OCLM is possible, and R0 liver resection (LR) is a component of R0 cytoreductive surgery (CRS), which is the most favorable determinant for the prognosis of OC patients 5.
Treatment Options for Ovarian Cancer Liver Metastasis
- Treatment options for OCLM include surgery, systemic treatments, and liver-directed therapies such as radiofrequency ablation, microwave ablation, cryoablation, transarterial chemoembolization (TACE), and radioembolization 6.
- The ideal candidate for tumor ablation is a patient with paucifocal disease, a single tumor up to 5 cm or up to 3 tumors smaller than 3 cm, and tumors 1 cm away from major bile ducts and high-flow vessels 6.
- Transarterial chemoembolization could be performed in patients with less than 70% tumor load, while radioembolization is available with less limitation on the sites or number of liver cancers 6.
- Advancing liver-directed therapies through interventional oncology, combined with robust data on the oncological efficacy of these local treatments, will validate their potential as effective locoregional therapies for liver metastases 6.
Prognosis and Outcome
- The prognosis of patients with ovarian cancer metastatic to the liver is uniformly poor, but complete remission is possible with treatment 3.
- A case report described a 45-year-old woman with ovarian endometrioid adenocarcinoma associated with hyperamylasemia and liver metastasis who achieved complete remission after paclitaxel and carboplatin chemotherapy 3.
- Another case report described a 76-year-old woman with ovarian carcinoid tumor that recurred with multiple liver metastases and was successfully treated with chemoembolization 4.