The liver is the body's laboratory, filtering blood and performing hundreds of vital functions. Unfortunately, this makes it vulnerable to cancer cells that travel through the bloodstream and settle there, forming secondary liver cancer called metastases. According to large-scale studies, colorectal cancer accounts for 21.4% of liver metastases, while breast cancer represents 4.4%, and lung cancer and skin cancer also contribute to these cases [3]. Modern German medical centers offer numerous treatment options that can control the disease, reduce symptoms, and significantly extend quality of life. Clinical studies have shown encouraging outcomes, with 1-year survival rates exceeding 80% and 5-year rates exceeding 30% using advanced treatments. With comprehensive, personalized treatment using the latest technologies, patients can focus on spending meaningful time with loved ones and pursuing what matters most to them.
Diagnosis of metastases in the liver
The detection of metastases in the liver requires a thorough examination before starting treatment. The examination aims to:
- Detect secondary liver cancer
- Estimate the number of metastases
- Evaluate the location of metastases relative to the blood vessels
Beyond all doubt, the primary tumor must also be detected. Cancer metastases in the liver should be diagnosed only in well-equipped clinics with the participation of experienced and highly qualified specialists. The most advanced imaging techniques are used here, including:
- Magnetic resonance imaging
- Multispiral computed tomography
- Positron emission tomography
- Angiography (contrast-enhanced X-ray)
- Fine-needle aspiration biopsy
Thermal Ablation Techniques
When surgical removal of liver metastases isn't possible, thermal and ablation techniques offer patients effective alternatives that can destroy cancer cells while preserving healthy liver tissue. These minimally invasive procedures use controlled temperature changes to target metastatic liver cancer with precision and can often be repeated as needed. [4]
Hyperthermia
Hyperthermia represents a sophisticated auxiliary treatment that enhances traditional cancer therapies. This method, continuously refined by the German Society for Hyperthermia and the European Society for Hyperthermic Oncology (ESHO), exploits cancer cells' greater heat sensitivity compared to healthy tissue.
The treatment involves precisely heating affected liver areas to temperatures between 40-45°C using electromagnetic waves or infrared radiation. At these elevated temperatures, several critical mechanisms occur that specifically benefit patients with primary cancer that has spread to the liver:
- Enhanced drug penetration: hyperthermia improves blood flow to metastatic sites, allowing chemotherapy agents to reach tumor cells more effectively
- Radiation sensitization: heat damages cancer cells' DNA repair mechanisms, making previously radiation-resistant secondary liver cancer responsive to treatment
- Immune system activation: temperatures above 40°C trigger heat shock protein production, which helps the immune system better recognize and attack metastatic foci
- Direct cell death: at temperatures exceeding 42°C, programmed cell death (apoptosis) begins in cancer cells
For liver metastases treatment, hyperthermia is typically combined with chemotherapy or radiation therapy, allowing physicians to reduce drug dosages while maintaining effectiveness.
Cryosurgery
Cryosurgery offers a viable treatment option for patients with liver metastases from colorectal cancer up to 5 cm in size, using extreme cold to destroy cancer cells. This minimally invasive technique can be performed through open surgery, laparoscopic approach, or percutaneous (through-the-skin) procedures under imaging guidance.
During treatment, specialized probes deliver liquid nitrogen or argon gas to freeze secondary liver cancer to temperatures below -40°C, causing cancer cells to die while preserving surrounding healthy liver tissue. The procedure is particularly valuable for patients who cannot undergo traditional surgery due to:
- Multiple metastases in both liver lobes
- High-risk medical conditions that make major surgery dangerous
- Strategic tumor locations near critical blood vessels or bile ducts
- Patient preference for less invasive treatment options
Smaller metastases (≤3 cm) and lower CEA levels typically yield better results. The procedure shows low recurrence rates at treated sites (6-15%) and can be safely repeated if new secondary liver cancer sites develop.
Radiofrequency and Microwave Ablation
Radiofrequency ablation (RFA) and microwave ablation (MWA) represent advanced thermal destruction techniques for liver metastases, offering minimally invasive alternatives when surgery isn't feasible. Under ultrasound or CT guidance, physicians insert thin electrodes or probes directly into metastatic cancer tissue. [5]
RFA uses high-frequency electrical current to generate controlled heat that destroys cancer cells while preserving healthy liver tissue. The procedure typically takes 10-30 minutes per lesion and can often be performed as an outpatient treatment. Patients experience minimal discomfort and can usually return to normal activities within days rather than weeks required for major surgery.
MWA uses electromagnetic waves to create larger, more uniform heating zones with several key advantages:
- Faster treatment times with more predictable ablation zones
- Superior performance near blood vessels, where RFA may be limited
- Multiple lesion treatment capability during a single procedure
- Particularly effective for liver tumours ≥3 cm in diameter
Both techniques are most effective for secondary liver cancer sites measuring 4-5 cm or less and can be safely repeated if new lesions develop.
Chemical and Vascular Interventions
Chemical and vascular interventions offer targeted approaches that work through the liver's unique blood supply system. These techniques either deliver concentrated treatments directly to tumors or use chemical agents to destroy cancer cells while preserving healthy liver tissue.
Transarterial chemoembolization (TACE)
Transarterial chemoembolization (TACE) is a minimally invasive procedure that combines targeted chemotherapy delivery with vascular occlusion to maximize treatment effectiveness while minimizing systemic side effects [6].
During TACE, interventional radiologists use advanced imaging guidance to navigate a microcatheter through blood vessels directly to the hepatic artery feeding the metastases. High-concentration chemotherapy drugs are then injected precisely into the tumor's blood supply, delivering doses up to 15 times higher than possible with systemic chemotherapy. Following drug delivery, tiny embolic particles block the tumor's blood vessels, trapping the chemotherapy within the cancer cells while starving them of nutrients.
Key advantages for liver metastases patients include:
- Targeted drug delivery with minimal systemic toxicity compared to traditional chemotherapy
- Outpatient procedure performed under local anesthesia with same-day discharge
- Repeatable treatment that can be safely performed multiple times as needed
- Preserved liver function by protecting healthy liver tissue during treatment
- Extended survival for cancer metastasis
TACE has proven particularly effective for colorectal, breast, gastric, and lung cancer metastases, with response rates up to 80% depending on tumor characteristics. The procedure's effectiveness can be enhanced through a combination with systemic therapies.
To provide deeper insights into this treatment approach, we present an exclusive interview with Prof. Dr. Thomas Vogl, a leading expert in interventional radiology at University Hospital Frankfurt, who has performed over 9,000 chemoembolization procedures.
"Targeting Cancer with Precision": Prof. Thomas Vogl on Revolutionary Chemoembolization Therapy/h2>
Alcoholization of metastases
Percutaneous alcohol injection (PAI) offers a simple, cost-effective treatment for small liver metastases under 4 cm. Under ultrasound guidance, physicians inject sterile ethyl alcohol directly into metastatic tissue, causing immediate cell death through dehydration and protein coagulation.
The alcohol destroys tumour cells and triggers blood vessel thrombosis, leading to complete tissue necrosis followed by fibrotic scar formation. Clinical studies show complete tumor destruction in over 50% of treated lesions, with particularly good results for colorectal, breast, and endocrine primary cancers that have spread to the liver.
Key benefits include:
- Outpatient procedure with minimal invasiveness
- Low complication rates – mainly mild pain and occasional fever
- Cost-effective alternative when liver resection is contraindicated
- Repeatable treatment for multiple lesions
PAI is especially valuable for patients unable to undergo surgery due to medical conditions or tumor location. While newer thermal ablation techniques are increasingly preferred, alcohol injection remains a reasonable option for carefully selected patients with small, accessible liver metastases when other treatments aren't suitable.
Radiation-Based Therapies
Radiation-based therapies offer precise treatment options that deliver high-dose radiation directly to liver metastases. These advanced techniques use either implanted radioactive sources or targeted microspheres to destroy cancer cells while minimizing exposure to healthy liver tissue.
Brachytherapy
Interstitial brachytherapy combines interventional radiology with radiation therapy to deliver high-dose radiation directly into the primary cancer and its spread to the liver. Under CT guidance, physicians place thin catheters into tumors and insert radioactive sources through an afterloading technique.
This minimally invasive procedure offers several advantages for liver metastases:
- Precise radiation delivery unaffected by breathing motion or blood vessel cooling effects
- Single-session treatment with high local control rates exceeding 80-90%
- Minimal healthy tissue damage due to targeted radiation placement
- Effective for various tumor types, including colorectal, breast, and pancreatic metastases
Studies show excellent local control rates with low complication rates under 4%. The technique is particularly valuable for metastases near critical structures where other treatments may be limited.
Selective internal radiation therapy (SIRT)
SIRT delivers targeted radiation through tiny radioactive microspheres injected directly into the hepatic artery feeding cancer that has spread to the liver. These yttrium-90 spheres become trapped in tumor blood vessels, delivering concentrated radiation while sparing healthy liver tissue.
Key benefits include:
- Preferential tumor targeting with microspheres clustering around secondary cancer sites
- Minimal toxicity – mainly fatigue, mild nausea, and temporary liver enzyme elevation
- Excellent local control with impressive survival rates for colorectal metastases
- Outpatient procedure with quick recovery times
SIRT has shown particular effectiveness for colorectal liver metastases, offering months to years of progression-free survival with good quality of life. The treatment can be safely repeated and combined with other therapies.
Targeted Drug Therapy
Targeted therapies offer precise medical approaches that focus on specific molecular pathways driving cancer growth. These treatments work alongside the body's natural systems to control secondary cancer sites while minimizing damage to healthy tissues.
Targeted therapy
Targeted therapy uses medications that interfere with specific molecular processes essential for cancer survival and growth. For primary cancer that has spread to the liver, angiogenesis inhibitors represent a key treatment category that blocks the formation of new blood vessels feeding tumors.
These drugs work by:
- Blocking the tumor blood supply by preventing new vessel formation
- Starving secondary cancer sites of nutrients and oxygen needed for growth
- Enhancing other treatments when combined with surgery or chemoembolization
Targeted therapy is typically administered intravenously and can be safely combined with other liver-directed treatments. The approach offers patients extended disease control with manageable side effects compared to traditional chemotherapy.
Dendritic cell vaccines
Dendritic cell immunotherapy represents one of the most promising advances in cancer treatment, building on the Nobel Prize-winning discovery by Ralph Steinman in 2011 [7]. This revolutionary approach harnesses the body's own immune system to create a personalized vaccine specifically designed to target liver metastases.
Dendritic cells function as the "generals" of the immune system, identifying cancer cells and training specialized immune "soldiers" (T-lymphocytes) to recognize and destroy malignant tissue. The treatment process involves extracting immune cells from the patient's blood, transforming them into trained dendritic cells in specialized laboratories, and reintroducing them as a personalized vaccine.
The treatment offers remarkable benefits for cancer that has spread to the liver:
- Personalized medicine tailored to each patient's specific cancer characteristics
- Minimal side effects with only mild injection site reactions or temporary fever
- Long-lasting immunity that provides lifelong protection against cancer recurrence
- Quality of life preservation without the debilitating effects of traditional cancer treatments
Clinical evidence demonstrates significant improvements in liver function, reduced tumor markers, and extended survival in patients with advanced cancer. The immune response is transformative – once activated, it develops lifelong memory against specific cancer cells, with blood tests showing dramatic increases in cancer-targeting lymphocytes.
To provide expert insights into this groundbreaking treatment, we present an exclusive interview with Prof. Dr. Frank Gansauge, a pioneer in dendritic cell therapy with over 22 years of experience treating cancer patients at specialized facilities in Germany.
Leading Immunotherapy Expert Prof. Frank Gansauge: "Revolutionizing Cancer Treatment with Dendritic Cell Therapy"
Specialized hospitals
Treating liver metastases is most successful in multidisciplinary University Hospitals. Medical institutions of this level have the necessary equipment to carry out technically complex interventional procedures, innovative types of radiation therapy, and novel approaches. Doctors from different departments cooperate closely, so the attending physician can quickly get advice from colleagues on any changes in the patient's condition.
Among the leading hospitals, we should mention the following ones:
- University Hospital of Ludwig Maximilian University of Munich. The Department of Gastroenterology and Hepatology offers physical removal of secondary cancer sites with a part of the liver (if necessary, a liver transplant from a healthy donor is performed afterward), as well as local destruction of the metastatic liver disease. The head physician of the department, Professor Julia Mayerle, is a board member of the European Association of Gastroenterologists, Endoscopists, and Nutritionists (EAGEN).
- University Hospital Düsseldorf. The Department of Gastroenterology, Hepatology, and Infectology is the supra-regional center for the detection and treatment of chronic liver diseases and their complications. High-tech procedures allow patients to get rid of cancer that has spread to the liver and maintain the normal function of the organ. Patients can also take part in clinical investigations of new treatment options.
- University Hospital Ulm. The Department of Gastroenterology and Hepatology is a part of the Comprehensive Cancer Center Ulm (CCCU), which specializes in the treatment of gastrointestinal tract malignancies. For outstanding success in treatment, the department received a certificate from the German Cancer Society (treatment of liver cancer). Here, procedures are carried out for treating liver metastases and the subsequent normalization of the gastrointestinal tract function.
- University Hospital Jena. The Department of Gastroenterology, Hepatology and Infectology specializes in the treatment of gastrointestinal tumors and liver diseases using advanced endoscopic techniques. The department offers minimally invasive procedures for tumor treatment, including argon plasma and laser coagulation therapy for bleeding or obstructive tumors, and mucosectomy for cancers. Under Prof. Dr. med. Andreas Stallmach's leadership, the facility conducts extensive clinical trials that provide patients with access to the latest cancer treatment options specifically adapted to individual cases.
- University Hospital Rechts der Isar Munich. The Department of Gastroenterology, Hepatology, Endocrinology and Infectology provides comprehensive cancer care with particular expertise in malignant diseases of the digestive system. Led by Prof. Dr. med. Roland Schmid, the department ensures multidisciplinary cancer care through close collaboration with oncologists, radiation therapists, and surgeons, guaranteeing patients access to all necessary treatment modalities. With their focus on liver diseases, the department is well-equipped to manage complex cases involving cancer that has spread to the liver and associated hepatic complications.
You can find a full list of hospitals and detailed information about treatment plans on the Booking Health website.
Arrangement of the treatment of liver metastases in Germany
Patients with primary liver cancer and secondary cancer sites in the liver, who receive quality treatment in the best German clinics, have a longer life expectancy. Booking Health can arrange your trip for treatment. We are experts in the field of medical tourism and clinical oncology.
The use of our services will ensure:
- Selection of the best clinic for the treatment of metastatic cancer and booking of the diagnostic and treatment program at the best price.
- Service package: assistance in obtaining a visa, booking a hotel located as close to the clinic as possible, booking airline tickets, translation of documents, and interpreter services during your communication with the medical staff of the healthcare facility.
- Saving up to 70% of the total costs of cancer treatment and its arrangement.
- Insurance to cover unforeseen medical expenses for up to 200,000 euros.
- Doctor’s follow-up consultation within three months after treatment program completion at no extra charge.
To use the Booking Health services, please leave a request on the website. We will call you as soon as possible.
Advanced Cancer Treatment: Patient Success Stories with Booking Health
Frequently Asked Questions About Liver Metastases Treatment
Send request for treatmentLiver metastases are secondary cancerous tumors that spread to the liver from other organs, like in metastatic colon cancer. Treatment options include surgical removal, ablation techniques, targeted radiation therapy, and advanced procedures like chemoembolization.
Surgical removal is possible when metastases are limited in number and favorably located, with healthy liver tissue remaining for normal function. Most cases require alternative treatments due to multiple lesions, locations, or concomitant medical conditions.
Non-surgical options include thermal ablation (radiofrequency, microwave, cryosurgery), TACE, radioembolization, brachytherapy, and immunotherapy. Embolization techniques block the blood supply to tumors while delivering concentrated treatments directly to metastatic tissue.
Leading German university hospitals, including Ludwig Maximilian University Munich, University Hospital Düsseldorf, University Hospital Ulm, and University Hospital Jena, offer comprehensive liver metastases treatment.
Treatment effectiveness varies by approach and patient factors. For instance, ablation techniques show 1-year survival exceeding 80% and 5-year rates up to 65%. Combined treatments and newer immunotherapies demonstrate promising results with improved quality of life and extended survival.
Yes, many treatments don't require systemic chemotherapy. Options include surgical resection, ablation, targeted radiation, and immunotherapy like dendritic cell vaccines. Some procedures use localized chemotherapy delivery that minimizes systemic side effects.
Choose treatment abroad and you will for sure get the best results!
Authors:
This article was edited by medical experts, board-certified doctors Dr. Nadezhda Ivanisova, and Dr. Bohdan Mykhalniuk. For the treatment of the conditions referred to in the article, you must consult a doctor; the information in the article is not intended for self-medication!
Our editorial policy, which details our commitment to accuracy and transparency, is available here. Click this link to review our policies.
Sources:
[1] P. Tinguely et al. / European Journal of Cancer 187 (2023) 65–76
[2] Fiorentini G et al Anticancer Res 2012;32:1387. Aliberti C et al Ancancer Res 2011;31:4581. Richardson A et al J Vasc Interv Radiol 2013;24:1209
[3] PubMed Central. Colorectal cancer liver metastases – a population-based study on incidence, management and survival. https://pmc.ncbi.nlm.nih.gov/articles/PMC5769309/
[4] PubMed. Role of thermal ablation in the management of colorectal liver metastasis. https://pubmed.ncbi.nlm.nih.gov/32140478/
[5] PubMed. Radiofrequency Ablation and Microwave Ablation in Liver Tumors: An Update. https://pubmed.ncbi.nlm.nih.gov/31217342/
[6] Cochrane. Transarterial embolisation, with or without chemotherapy, for liver metastases. https://www.cochrane.org/evidence/CD009498_transarterial-embolisation-or-without-chemotherapy-liver-metastases
[7] PubMed. The 2011 Nobel Prize in physiology or medicine. https://pubmed.ncbi.nlm.nih.gov/22053831/
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