ENLiver metastases do not always leave drugs as the only option: some lesions can be removed or destroyed. Typically, after bowel cancer or another tumour, a CT scan shows liver lesions, the family hears “stage 4” and assumes nothing can be done. The liver is a common site because blood from the bowel reaches it first through the portal vein.
Treatment of liver metastases in Germany is planned by a tumour board. It differs from primary liver cancer, which arises from the liver’s own cells and follows other rules — see liver cancer treatment. Below: tests, options, care when surgery is impossible, and costs.
Assessing liver metastases
Doctors assess three things: where the metastases come from, how many there are and where, and how much liver would remain. The primary tumour determines almost everything. Most often it is colorectal cancer; less often, neuroendocrine tumours or breast, pancreatic or stomach cancer.
The basic test is CT of the chest and abdomen, showing disease outside the liver, the number and size of lesions and their closeness to large vessels and bile ducts. For unclear findings or surgical planning, liver MRI with liver-specific contrast follows: healthy liver cells take up the agent, so metastases stand out dark against bright tissue, more clearly than on CT. Before surgery for colorectal metastases, PET-CT may help avoid an unnecessary operation.
The surgeon’s key question is how much liver will remain: after surgery the remnant must do the whole organ’s work, and if it is too small, liver failure threatens, so its volume is estimated beforehand. The primary tumour is tested for molecular changes, in colorectal cancer RAS, BRAF and MSI, which guide drug choice. A liver surgeon, an oncologist and an interventional radiologist review all findings.
Treatment options for liver metastases
The options are surgery, heat ablation and drugs, which can be combined. Resection removes the affected part of the liver; for colorectal cancer the German clinical guideline calls it central to curative treatment. If not all lesions can be removed at once, surgery comes in two stages: the future remnant is cleared first and the portal vein branch to the diseased lobe is blocked (portal vein embolisation), so blood flows to the healthy part, which grows over several weeks; then the diseased lobe is removed — see liver resection.
Small lesions can be destroyed by radiofrequency or microwave ablation: a thin probe is guided into the lesion under imaging, such as ultrasound, and heats it with a narrow margin of healthy tissue until the cells die. The German guideline allows ablation for resectable and unresectable metastases, also with surgery, and rates both ablation techniques as equally effective.
Drugs are also given before surgery to shrink lesions and make removal possible and, if tumour biology is unfavourable, to avoid operating on disease that grows despite treatment. A benefit of drugs after removal of colorectal metastases is unproven, and the guideline does not recommend them outside trials. The tumour board sets the order; the US National Cancer Institute’s guide to metastatic cancer explains the principles.
Stage 4 cancer with liver metastases when surgery is not possible
When surgery is not possible, drug therapy matched to the primary tumour becomes the basis, since metastases of different cancers need different drugs. In colorectal cancer the regimen depends on the molecular profile and the side of the bowel where the tumour grew. Honestly, the usual aim is control, stopping or slowing growth and maintaining quality of life, not cure. Some people live for years with well-controlled disease; the tumour board keeps checking whether surgery has become possible.
In chemoembolisation (TACE) a drug is delivered through a catheter into the artery feeding the lesions, which is then blocked — see chemoembolisation. In radioembolisation (SIRT) radioactive microspheres injected into the hepatic artery irradiate the lesions from within; in colorectal cancer it is considered in individual cases of liver-dominant disease. Stereotactic radiotherapy delivers high, precise doses to single lesions, usually when surgery and ablation are unsuitable. The choice depends on the number, size and location of lesions.
What liver metastasis treatment costs in Germany
There is no single price: the cost depends above all on the method. Surgery includes days in intensive care and on the ward, ablation has different costs, chemoembolisation may need several sessions, and drug therapy lasts months.
Only the hospital’s cost estimate (Kostenvoranschlag), made after reviewing images and records, gives an exact amount. International patients pay a deposit into the hospital’s account; any unspent balance is refunded after discharge. See also the cost of cancer treatment in Germany.
Frequently asked questions
Can liver metastases be cured?
No doctor can promise a cure, but in some patients the disease stays away for a long time after all lesions are removed; the most favourable surgical results are reported in colorectal cancer. Many patients later develop new lesions. If removal is impossible, the aim is disease control and quality of life.
Can several liver metastases be removed?
Yes, the number alone does not rule out surgery: what matters is whether all lesions can be removed while leaving enough working liver. Metastases in both lobes can be removed too, sometimes in two stages or with ablation. If not possible at first, drugs sometimes shrink the lesions enough for surgery.
What are the options if chemotherapy stops working?
The tumour board discusses the next line of treatment: for colorectal cancer there are later-line drugs, some chosen by molecular changes in the tumour. If the disease is mainly in the liver, radioembolisation is considered in individual cases. Pain relief, nutrition and psychological support are part of treatment, not an add-on.
How AlenMed arranges treatment of liver metastases in Germany
It starts with documents: MRI and CT discs, the histology of the primary tumour, chemotherapy records with dates and drugs, and blood tests with liver values and tumour markers. AlenMed translates them, sends them to partner hospitals’ tumour boards and requests a cost estimate.
At University Hospital Leipzig, Prof. Daniel Seehofer heads Hepatobiliary Surgery and Visceral Transplantation and, as managing director, the Department of Visceral, Transplant, Thoracic and Vascular Surgery; his team removes liver metastases, including in two stages. The Liver Cancer Centre at Barmherzige Brüder Hospital Munich also treats metastases, above all colorectal; it is jointly led by gastroenterologist Prof. Christian Rust, surgeon PD Dr Johann Spatz and radiologist PD Dr Tobias Jakobs. AlenMed’s office is in Munich, its partner hospitals are across Germany, and it arranges visa invitations and interpreters.
This material is for reference only and is not an offer. The tumour board chooses the method; a doctor sets the plan after an in-person examination.
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