Diagnostic and Staging Workup

Patients usually present with an isolated liver mass. Diagnostic dilemma with “metastasis of unknown primary”
Rule out potential sites of primary disease. This may include upper/lower GI endoscopy and/or PET scan in conjunction with tumour markers as appropriate
A percutaneous liver biopsy may be necessary
Initial investigations should include:

Liver imaging: Triphasic CT scan or contrast-enhanced MRI
Cholangiography either by MRCP or ERCP. (ERCP and stenting may be preferable for symptomatic patients)
Metastatic work-up/imaging to rule out potential site of primary cancer: CT chest/abdomen/pelvis
CEA and CA 19-9
Laparoscopy may be considered for staging

Obtaining a definitive tissue diagnosis is frequently not possible. If a lesion is potentially resectable, surgery should be considered even in the absence of a tissue diagnosis