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About Breast Cancer > Recurrence & Metastases

Dr. Thomas Leung
Associate Director, Comprehensive Oncology Centre, Hong Kong Sanatorium & Hospital

The liver is one of the common sites of metastasis from breast cancer. Systemic therapy is the mainstay of treatment, and includes hormonal therapy, cytotoxic chemotherapy and targeted therapy. These procedures are very effective (Figure 1) and can achieve complete remission in 15-20% of patients. The type of hormonal therapy used depends on the patient's tumour hormonal receptors and menopausal status. Cytotoxic therapy can induce remission very quickly, but carries with it more side effects than the other therapies. Targeted therapy such as trastuzumab has recently been introduced, and is very useful for a sub-group of patients whose tumour has a specific molecular sub-type. These treatments are either used singly or in combination in order to achieve the best treatment result.

When drug therapy fails, there are also other local procedures that can be performed for palliation of liver metastases. For tumours smaller than 5 cm and less than 3 in number, percutaneous local ablation with radio-frequency can be considered (Figure 2). For liver tumours larger that 5 cm, intra-arterial therapy in the form of chemoembolization or radioembolization can be performed. Intra-arterial therapy has to be done through a hepatic angiogram (Figure 3). Chemoembolization involves the use of cytotoxic chemotherapy while radioembolization (Figure 4) uses radiation to palliate large liver metastases.

Figure 1. Chemotherapy for liver metastases

Before Chemotherapy
After Chemotherapy

Figure 2. Radio-frequency ablation for small liver tumour.

(Before treatment)
(After treatment)

Figure 3. Hepatic Angiogram

Figure 4. Yttrium-90 microspheres that are used in radioembolization

Before Treatment
After Treatment