Liver metastases mean that cancer cells from another organ, such as the large bowel, pancreas, stomach, breast or lung, have reached the liver; this is the original cancer that has spread, not liver cancer, and it is treated like that cancer [1, 3]. Treatment depends on the type of the original cancer, and most often medicines, meaning chemotherapy, targeted therapy or immunotherapy, are the main treatment [1, 3]. But in bowel cancer, if all the tumours in the liver can be removed with surgery, about half of the patients in a large study were alive 5 years later, and at least 1 in 6 people are cured [5, 6].
Key points
- Liver metastases are not liver cancer: breast cancer that has reached the liver is "metastatic breast cancer" and is treated like breast cancer [1].
- The liver is one of the most common places cancer spreads to; its most common source is bowel cancer [3]. About half of people with bowel cancer develop liver metastases, either at diagnosis or later [2].
- Liver metastases may cause no symptoms and be found on a CT scan or ultrasound; when they do cause symptoms, these are mostly jaundice or a swollen belly [1, 3].
- In bowel cancer, if the cancer is only in the liver and all the tumours can be removed with surgery or destroyed with heat (ablation), there is a chance of long survival and even cure [5, 6, 7].
- In other cancers, such as pancreatic, stomach and breast cancer, the main treatment is medicines, and the aim is long-term control of the disease and a better life [1, 10, 11].
What are liver metastases? Is it the same as liver cancer?
Cancer cells can break away from where they started, travel through the blood to the liver and form new tumours there [1]. These tumours are called "liver metastases" or "secondary liver cancer". Under the microscope their cells look like the original cancer, not like liver cells; that is why the disease keeps the name of the original cancer and is treated like it [1].
This is different from cancer of the liver itself, a cancer that starts in the liver's own cells. Read about it here: What are the symptoms of liver cancer?
Cancers that most often spread to the liver [1, 3]:
- Bowel cancer, the most common source
- Pancreatic cancer and stomach cancer
- Breast cancer and lung cancer
- Melanoma (a type of skin cancer)
- Other cancers, such as ovarian, bladder, kidney, prostate and womb cancer, can also spread to the liver [1]
If cancer has reached the liver, it usually means stage 4 cancer [1]. But as you will read below, stage 4 does not always mean the end of the road. To read about how cancer spreads in general: What is metastasis?, cancer that has spread to the bones and How fast does cancer grow?
Liver metastasis symptoms
Liver metastases do not always cause symptoms [1]. Most often they are found on an ultrasound, CT scan, MRI or PET scan, either when the original cancer is diagnosed or during check-ups after treatment [3]. When they do cause symptoms, these depend on the size and location of the tumours [1]:
- Yellowing of the skin and the whites of the eyes (jaundice)
- A swollen or enlarged belly
These symptoms have other causes too and do not always mean metastases; but if you have or have had cancer, tell your doctor promptly. Read more: What is a PET scan? and What does a high CEA mean?
When should I call my doctor?
If you have a cancer that has reached the liver or might do so, do not wait for your next appointment in these situations; contact your treatment team the same day:
- Yellowing of the skin or the whites of the eyes [1]
- A swollen belly that is quickly getting bigger [1]
- A temperature of 38°C or higher, or shivering, during chemotherapy [12]
- Belly pain that your current medicines do not control (cancer pain can be treated)
In any emergency, such as severe breathlessness, vomiting blood or loss of consciousness, call your local emergency number.
Can liver metastases be treated?
Yes; there is treatment for most cancers that have spread to the liver. The choice of treatment depends on the type of the original cancer, the number and location of the liver tumours, whether the cancer has also spread elsewhere, previous treatments and your general health [1]. Treatments fall into two groups:
Treatment with medicines
Chemotherapy, targeted therapy and immunotherapy work throughout the body; for most cancers that have spread to the liver, these are the main treatment [3]. The choice of medicine depends on the type of cancer and the genetic features of the tumour [1, 3]. Read more: targeted therapy and immunotherapy
Treating the liver tumours themselves
When there are only a few tumours and they are only in the liver, especially in bowel cancer, the tumours themselves can also be treated [2]:
- Surgery: removing the part of the liver that contains the tumour; the surgeon must leave enough healthy liver behind [2].
- Destroying the tumour with heat (ablation), using a needle passed through the skin into the tumour [2, 8].
- Precise radiotherapy (stereotactic), given at a high dose and only to the tumour [9].
Bowel (colon) cancer that has spread to the liver
Bowel cancer is the best example of a cancer in which liver metastases can sometimes be cured. In a joint meeting (a liver surgeon, an oncologist and a radiologist), doctors assess whether all the tumours in the liver can be removed. What matters is the number and location of the tumours, how close they are to the liver's large blood vessels, and how much healthy liver will be left [2].
- If the tumours can be removed: surgery is usually done, and a few months of chemotherapy are often given before and after it; in a large study, this chemotherapy delayed the cancer's return [5].
- If the tumours are small (up to 3 cm): in one study, destroying them with heat was no worse than surgery for survival and caused fewer complications [8].
- If the tumours cannot be removed at first: combination chemotherapy sometimes shrinks them enough that they can be removed later; these patients have about the same chances as those who could have surgery from the start [2].
- If surgery is not possible: in a study of patients whose liver tumours could not be removed, adding heat treatment of the tumours to chemotherapy made the number of people alive 8 years later about 4 times higher [7].
- Liver transplant: in a few specialist centres, a liver transplant has been studied for very carefully selected patients whose tumours are only in the liver and well controlled by chemotherapy; in one study, more than half of the people chosen for a transplant were alive 5 years later [2].
The choice of medicines depends on genetic testing of the tumour; in a particular type called MSI-H, immunotherapy works very well: immunotherapy for MSI-H bowel cancer. Read more on the bowel cancer page.
Life expectancy when bowel (colon) cancer has spread to the liver
The answer is different for every patient and depends above all on whether all the tumours can be removed or destroyed:
- When all the liver tumours are removed with surgery: in a large European study, about half of the patients were alive 5 years later [5]. In a US study of more than 600 patients, about 1 in 6 were alive 10 years later, and almost all of them had no cancer; in other words, they had been cured [6].
- When there are only a few areas of spread: in a study of patients with 1 to 5 areas of spread from various cancers (including bowel cancer), precise radiotherapy to all of them more than doubled the number of people alive 5 years later [9].
- All people with bowel cancer that has spread, taken together: in the United States, about 1 to 2 in 10 are alive 5 years later [4]. This figure also includes people whose cancer had spread to many places and for whom surgery was not possible.
These figures are averages for large groups of patients and cannot predict one person's future. Read more: How long do people with cancer live?
Breast, stomach or pancreatic cancer that has spread to the liver
In these cancers, liver metastases usually show that the cancer has spread through the body; that is why the main treatment is medicines, aiming at long-term control of the disease, fewer symptoms and a better life [1]. In a small number of cases, the treatment team may also suggest treating the liver tumours themselves [9].
- Breast cancer: medicines are chosen according to the type of breast cancer (hormone receptor positive, HER2 positive or triple negative) [13]. Read: hormone receptor positive breast cancer, HER2-positive breast cancer and Can breast cancer be cured?
- Stomach cancer: chemotherapy, sometimes with immunotherapy, or in HER2-positive cancer with the targeted medicine trastuzumab [11]. Read: stomach cancer
- Pancreatic cancer: combination chemotherapy for people who are well enough, and lighter treatment for others [10]. Read: pancreatic cancer
Ask your doctor to refer you to a palliative care team (control of pain and other symptoms) from the start: stage 4 cancer and palliative care
Frequently asked questions
Is liver metastasis the end of the road? Is it fatal?
Can liver metastases go away completely?
Are liver metastases painful?
Liver metastases do not always cause symptoms or pain [1]. If you are in pain, cancer pain can be treated and you should not put up with it: Cancer pain can be treated: do not put up with it
Can you have chemotherapy with liver metastases?
My ultrasound report mentions a liver lesion; does that mean cancer has spread to the liver?
Not necessarily. To find out what a liver lesion is, more detailed imaging such as a CT scan, MRI or PET scan is usually needed [3]; if the result is unclear, your doctor may suggest a biopsy. Go through the result with your doctor. Read more: What is a biopsy?
What questions should I ask my doctor?
- Can the tumours in my liver be treated with surgery, heat treatment or radiotherapy? Has my case been reviewed in a joint meeting with a liver surgeon?
- If not now, could they become operable after chemotherapy?
- What has genetic testing of my tumour shown, and which medicine matches it?
- What is the aim of my treatment: cure or long-term control?
Evidence for local treatment of liver metastases (for doctors)
For physicians
Resectability and outcomes. About 50% of patients with colon cancer have liver metastases at diagnosis or at recurrence. Resectability criteria: limited number of lesions, intrahepatic location of the lesions, no major vascular involvement, absent or limited extrahepatic disease and adequate functional hepatic reserve. After negative-margin resection, 5-year survival is 25% to 40% in mostly nonrandomised studies (level of evidence C3); patients who become resectable after chemotherapy have 5-year survival similar to those resectable at the outset, and no conversion regimen has been shown to be best [2]. In the MSKCC series (612 patients resected in 1985 to 1994), median disease-specific survival was 44 months; 102 patients were actual 10-year survivors, of whom 99 (97%) were disease free, whereas 34% of 5-year survivors later died of cancer. According to the authors, well-selected patients have at least a 1 in 6 chance of cure, and poor prognostic factors do not preclude it [6].
Perioperative chemotherapy (EORTC 40983). 364 patients with up to 4 resectable liver metastases; 6 cycles of FOLFOX4 before and 6 cycles after surgery versus surgery alone. At a median follow-up of 8.5 years, 5-year OS was 51.2% versus 47.8% (HR 0.88; 95% CI 0.68 to 1.14; P=0.34), median OS 61.3 versus 54.3 months; because of the earlier PFS benefit, perioperative FOLFOX4 remained the reference treatment [5].
Ablation. CLOCC (phase 2, 119 patients, fewer than 10 unresectable liver metastases and no extrahepatic disease): systemic treatment plus RFA with or without resection versus systemic treatment alone; at a median follow-up of 9.7 years, HR for death 0.58 (95% CI 0.38 to 0.88; P=0.01), 5-year OS 43.1% versus 30.3% and 8-year OS 35.9% versus 8.9%; median OS 45.6 versus 40.5 months [7]. COLLISION (phase 3, 300 patients, up to 10 resectable metastases ≤3 cm, ECOG 0 to 2): thermal ablation versus resection; stopped early at the interim analysis; overall survival HR 1.05 (95% CI 0.69 to 1.58), adverse events 19% versus 46%, serious adverse events 7% versus 20%, treatment-related deaths 0 versus 3 patients (2%) [8].
SABR in oligometastatic disease (SABR-COMET). 99 patients with a controlled primary tumour and 1 to 5 metastases (breast, lung and colorectal 18 patients each, prostate 16); 5-year OS 42.3% with SABR plus standard of care versus 17.7% with palliative standard of care (stratified log-rank P=0.006), with no difference in quality of life [9].
Liver transplantation. In TRANSMET (94 patients with permanently unresectable liver metastases), 5-year OS in the ITT analysis was 57% with transplantation plus chemotherapy versus 13% with chemotherapy alone, and 73% versus 9% in the per-protocol analysis (level of evidence A1); the aim is good systemic control before transplantation [2].
Other cancers. Metastatic pancreatic cancer with ECOG 0 to 1, bilirubin below 1.5 times the upper limit of normal and no major comorbidity: FOLFIRINOX or NALIRIFOX first line (I, A); gemcitabine plus nab-paclitaxel can also be used (I, B) [10]. Advanced gastric cancer: nivolumab plus chemotherapy for PD-L1 CPS ≥5 and trastuzumab plus chemotherapy for HER2-positive disease (I, A) [11]. The 5-year relative survival for distant-stage colorectal cancer in the United States is 15% [4].
Scientific evidence
Scientific evidence
3 itemsStereotactic Ablative Radiotherapy for the Comprehensive Treatment of Oligometastatic Cancers: Long-Term Results of the SABR-COMET Phase II Randomized Trial
Gastric cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up
ESMO Clinical Practice Guideline Express Update on the management of metastatic pancreatic cancer
Related cancer types
Related questions
References
13 referencesShow all references, 4 with a study cardClose the reference list
Numbers in the text, such as [1], refer to these sources. Sources with a “Study card” button are summarised in the site’s evidence library.
- 1
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- 4Colorectal cancer statistics, 2026
- 5
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- 9
- 10
- 11
- 12Infection and Neutropenia during Cancer Treatment
- 13Breast Cancer Treatment (PDQ®)–Health Professional Version
This page is based on reputable scientific sources and was last updated on 28 October 2026. The content of this website is for educational and informational purposes only and does not replace consultation, diagnosis or treatment by a specialist physician. Consult your treating physician about any treatment decision.
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