Symptoms of colorectal liver metastases: correlation with CT findings

To correlate CT appearances of colorectal liver metastases (LM) with pattern and severity of symptoms.

One hundred and twenty patients with treated primary colorectal carcinoma were prospectively assessed by questionnaire for recent symptoms when attending for CT examination. Thorax, abdomen and pelvic CT scans were prospectively assessed for LM and extrahepatic disease (EHD). The number of LM, percentage liver replaced by LM and distribution of LM were recorded.

Patients' ages ranged from 35 to 89 years (median 60) and 74/120 (62%) were male. Four subgroups were compared: group 1 - LM only (n = 30); 2 - EHD only (n = 22); 3 - both LM and EHD (n = 28); 4 - neither LM/EHD (n = 40). Anorexia was significantly worse in gp2 vs gp4 (P = 0.016) and lower abdominal pain (LAP) was significantly worse in gp2 vs gpl (P = 0.019). General pain was the worse symptom in all groups but notstatistically greater in any group. Patients with more than 10 LM had significantly worse anorexia (P = 0.002). general pain (P < 0.001) and LAP (P = 0.001). There was a trend (P > 0.05) towards worse symptoms with either volume of diseased liver or subcapsular LM.

With increasing liver tumour burden there was an increase in symptomatology but extrahepatic abdominal metastatic tumour produced more symptoms than LM alone. Symptoms, particularly pain, therefore are not good predictors of hepatic metastatic disease.