Primary liver cancer: pattern of metastasis.

The causes of death and patterns of metastasis of 43 patients with primary liver cancer were studied and discussed in comparison with reports in the literature. Data from 6 recent reports of 1,673 patients showed that the 3 leading causes of death from hepatoma were liver failure (34%), bleeding (30%), and advanced cancer (24%). Distribution of sites of metastasis in 1,497 patients with hepatoma from 7 reports showed that the 3 leading sites were: lung (median 44%), portal vein (35%), and portal lymph node(s) (27%). The pattern of metastasis of hepatoma arising from cirrhotic liver is somewhat different from that of the noncirrhotic liver; the former are more likely to involve the portal vein, whereas the latter involves more regional lymph node(s). Compared to hepatoma, cholangiocarcinoma is less likely to metastasize to the lung or portal vein, but more likely to involve lymph node(s), peritoneum, and bone and/or marrow.