LIVER CANCER
There are two types of liver cancer and they are:
1. Primary liver cancer
These are cancers that develop from the liver cells itself. The most common type of primary live cancer is hepatocellular carcinoma (HCC). Other rare types are cholangiocarcinoma or angiosarcoma.
2. Secondary liver cancer
These are cancer from other parts of the body that has spread to the liver. Commonest type is from colorectal cancer. But almost every type of cancer can spread to the liver including stomach, breast and pancreas.
Hepatocellular carcinoma (HCC)
This is the commonest primary liver cancer and it more prevalent in males and most patient present in the 5th to 6th decade of life. The risk factors for developing HCC are appended below:
1. Cirrhosis
Cirrhosis is a disease in which liver cells become damaged and are replaced by scar tissue. People with cirrhosis have an increased risk of liver cancer. Most (but not all) people who develop liver cancer already have some evidence of cirrhosis. There are several possible causes of cirrhosis. Most cases in the region occur in people who have chronic HBV or HCV infections and alcohol abuse
Non-alcoholic fatty liver disease, a condition in which people who consume little or no alcohol develop a fatty liver, is common in obese people. People with a type of this disease known as non-
alcoholic steatohepatitis (NASH) might go on to develop cirrhosis.
Some types of autoimmune diseases that affect the liver can also cause cirrhosis. For example, there is also a disease called primary biliary cirrhosis (PBC). PBC seems to be an autoimmune condition, in which the immune system attacks the bile ducts in the liver. This causes the bile ducts to become damaged and even destroyed and can lead to cirrhosis. People with advanced PBC have a high risk of liver cancer.
Certain types of inherited metabolic diseases (see below) can cause problems in the liver that lead to cirrhosis.
Chronic viral hepatitis
Worldwide, the most common risk factor for liver cancer is chronic (long-term) infection with hepatitis B virus (HBV) or hepatitis C virus (HCV). These infections lead to cirrhosis of the liver (see above) and are responsible for making liver cancer the most common cancer in many parts of the world.
In the United States, infection with hepatitis C is the more common cause of HCC, while in Asia and developing countries, hepatitis B is more common. People infected with both viruses have a high risk of developing chronic hepatitis, cirrhosis, and liver cancer. The risk is even higher if they also drink alcohol heavily.
Other viruses, such as the hepatitis A virus and hepatitis E virus, can also cause hepatitis. But people infected with these viruses do not develop chronic hepatitis or cirrhosis, and do not have an increased risk of liver cancer.
Heavy alcohol use
Alcohol abuse is a leading cause of cirrhosis in the west, which in turn is linked with an increased risk of liver cancer.
Obesity
Being obese (very overweight) increases the risk of developing liver cancer. This is probably because it can result in fatty liver disease and cirrhosis.
Type 2 diabetes
Type 2 diabetes has been linked with an increased risk of liver cancer, usually in patients who also have other risk factors such as heavy alcohol use and/or chronic viral hepatitis. This risk may be increased because people with type 2 diabetes tend to be overweight or obese, which in turn can cause liver problems.
Inherited metabolic diseases
Certain inherited metabolic diseases can lead to cirrhosis.
People with hereditary hemochromatosis absorb too much iron from their food. The iron settles in tissues throughout the body, including the liver. If enough iron builds up in the liver, it can lead to cirrhosis and liver cancer.
Other rare diseases that increase the risk of liver cancer include tyrosinemia, alpha1-antitrypsin deficiency, Wilson disease and glycogen storage disease.
Aflatoxins
These cancer-causing substances are made by a fungus that contaminates peanuts, wheat, soybeans, ground nuts, corn, and rice. Storage in a moist, warm environment can lead to the growth of this fungus. Although this can occur almost anywhere in the world, it is more common in warmer and tropical countries.
Long-term exposure to these substances is a major risk factor for liver cancer. The risk is increased even more in people with hepatitis B or C infections.
Vinyl chloride and thorium dioxide (Thorotrast)
Exposure to these chemicals raises the risk of angiosarcoma of the liver.It also increases the risk of developing cholangiocarcinoma and hepatocellular cancer, but to a far lesser degree. Vinyl chloride is a chemical used in making some kinds of plastics. Thorotrast is a chemical that in the past was injected into some patients as part of certain x-ray tests. When the cancer-causing properties of these chemicals were recognized, steps were taken to eliminate them or minimize exposure to them. Thorotrast is no longer used, and exposure of workers to vinyl chloride is strictly regulated.
Anabolic steroids
Anabolic steroids are male hormones used by some athletes to increase their strength and muscle mass. Long-term anabolic steroid use can slightly increase the risk of hepatocellular cancer. Cortisone-like steroids, such as hydrocortisone, prednisone, and dexamethasone, do not carry this same risk.
Arsenic
Drinking water contaminated with naturally occurring arsenic, such as that from some wells, over a long period of time increases the risk of some types of liver cancer. This is more common in parts of East Asia, but it might also be a concern in some areas of the United States.
Infection with parasites
Infection with the parasite that causes schistosomiasis can cause liver damage and is linked to liver cancer. This parasite is not found in the US, but infection can occur in Asia, Africa, and South America.
Tobacco use
Smoking increases the risk of getting liver cancer. Former smokers have a lower risk than current smokers, but both groups have a higher risk than those who never smoked.
SIGNS AND SYMPTOMS OF LIVER CANCER
Signs and symptoms of liver cancer often do not show up until the later stages of the disease, but sometimes they may show up sooner. If you go to your doctor when you first notice symptoms, your cancer might be diagnosed earlier, when treatment is most likely to be helpful. Some of the most common symptoms of liver cancer are:
· Weight loss (without trying)
· Loss of appetite
· Feeling very full after a small meal
· Nausea or vomiting
· An enlarged liver, felt as a mass under the ribs on the right side
· An enlarged spleen, felt as a mass under the ribs on the left side
· Pain in the abdomen or near the right shoulder blade
· Swelling or fluid build-up in the abdomen
· Itching
· Yellowing of the skin and eyes (jaundice)
Some other symptoms that can occur include fever, enlarged veins on the belly that become visible through the skin, and abnormal bruising or bleeding.
People who have chronic hepatitis or cirrhosis may feel worse than usual or just have changes in lab test results, such as AFP levels.
Some liver tumors make hormones that act on organs other than the liver. These hormones may cause:
INVESTIGATIONS
1. Imaging tests
Imaging tests use x-rays, magnetic fields, or sound waves to create pictures of the inside of your body. Imaging tests are done for a number of reasons, including:
· To help find suspicious areas that might be cancerous
· To help diagnose liver cancer
· To help a doctor guide a biopsy needle into a suspicious area to take a sample
· To learn how far cancer might have spread
· To help guide certain treatments in the liver
· To help determine if treatment has been effective
· To look for a possible recurrence of the cancer
People who have (or may have) liver cancer may get one or more of the following tests
a. Ultrasound
This test uses sound waves and can be used to look for tumors in the liver. This is very safe and can be repeated often with no risk of radiation. But it has to be done by an experience radiologist and this is use usually as a screening of patients with suspected liver cancer.
b. Computed tomography (CT)
The CT scan is an x-ray test that produces detailed cross-sectional images of your body. A CT scan of the abdomen is very useful in identifying many types of liver tumors. It can provide precise information about the size, shape, and position of any tumors in the liver or elsewhere in the abdomen, as well as nearby blood vessels. CT scans can also be used to guide a biopsy needle precisely into a suspected tumor (called a CT-guided needle biopsy). If you are found to have liver cancer, a CT of your chest may also be done to look for possible spread to the lungs.
A CT scanner has been described as a large donut, with a narrow table in the middle opening. You will need to lie still on the table while the scan is being done. CT scans take longer than regular x-rays, and you might feel a bit confined by the ring while the pictures are being taken.
For this test, you may be asked to drink 1 to 2 pints of a liquid called oral contrast. This helps outline the intestine so that certain areas are not mistaken for tumors. You may also receive an IV (intravenous) line through which a different kind of contrast (IV contrast) is injected. This helps better outline structures in your body. The injection can cause some flushing (redness and warm feeling). Some people are allergic and get hives or, rarely, more serious reactions like trouble breathing and low blood pressure. Be sure to tell the doctor if you have any allergies or ever had a reaction to any contrast material used for x-rays.
If your doctor suspects you may have liver cancer, you may have one set of CT scans of your abdomen taken before you get IV contrast. Other sets of scans may then be taken over the next several minutes as the contrast passes through the liver and other parts of the body. These sets of scans (together known as a 4-phase or multiphase CT scan) can help spot different types of liver tumors.
c. Magnetic resonance imaging (MRI)
Like CT scans, MRI scans provide detailed images of soft tissues in the body. But MRI scans use radio waves and strong magnets instead of x-rays. The energy from the radio waves is absorbed and then released in a pattern formed by the type of body tissue and by certain diseases. A computer translates the pattern into a very detailed image of parts of the body.
When MRI is used to look at liver tumors, several sets of images may be taken. After the first set is done, a contrast material called gadolinium is injected into a vein to help see details more clearly. Then other sets are taken over the next several minutes as the contrast moves through the liver and other parts of the body. This is known as dynamic contrast-enhanced MRI.
MRI scans can be very helpful in looking at liver tumors. Sometimes they can tell a benign tumor from a malignant one. They can also be used to look at blood vessels in and around the liver, and can help show if liver cancer has spread to other parts of the body.
MRI scans may be a little more uncomfortable than CT scans, and they often take longer. You may be placed inside a narrow tube, which is confining and can upset people with a fear of enclosed spaces. Special more open MRI machines can sometimes be used instead, but the drawback is that the pictures may not be as clear. The MRI machine also makes buzzing and clicking noises that you may find disturbing. Some places will provide earplugs to help block these noises out.
d. Angiography
An angiogram is an x-ray test that looks at blood vessels. Contrast medium, or dye, is injected into an artery to outline blood vessels while x-ray images are taken. Angiography can be used to show the arteries that supply blood to a liver cancer, which can help doctors decide if a cancer can be removed and to help plan the operation. It can also be used to help guide some types of non-surgical treatment, such as trans arterial chemoembolization.Angiography can be uncomfortable because the doctor doing the test has to put a small catheter (a flexible hollow tube) into the artery leading to the liver to inject the dye. Usually the catheter is put into an artery in your inner thigh and threaded up into the liver artery. A local anesthetic is often used to numb the area before inserting the catheter. Then the dye is injected quickly to outline all the vessels while the x-rays are being taken.
TREATMENT OPTIONS FOR HCC
After liver cancer is diagnosed and staged, your cancer care team will discuss your treatment options with you. Depending on your situation, you may have different types of doctors on your treatment team. These doctors may include:
In creating your treatment plan, important factors to consider include the stage (extent) of the cancer and the health of the rest of your liver. But you and your cancer care team will also want to take into account the possible side effects of treatment, your overall health, and the chances of curing the disease, extending life, or relieving symptoms. Based on these factors, your treatment options may include:
In some cases, doctors may recommend combining more than one of these treatments. It is important to discuss all of your treatment options, including their goals and possible side effects, with your doctors to help make the decision that best fits your needs.
We will look into specific options of treatment.
a. SURGICAL RESECTION OF HCC
At this time, surgery, either with resection (removal of the tumor) or a liver transplant, offers the only reasonable chance to cure liver cancer. If all known cancer in the liver is successfully removed, you will have the best outlook.
1. Partial hepatectomy (see “Hepactectomy” info section)
Surgery to remove part of the liver is called partial hepatectomy. This operation is only attempted if the person is healthy enough for surgery and all of the tumor can be removed while leaving enough healthy liver behind. Unfortunately, most liver cancers cannot be completely removed. Often the cancer is in too many different parts of the liver, is too large, or has spread beyond the liver.
Imaging tests, such as CT or MRI with angiography are done first to see if the cancer can be removed completely. Still, sometimes during surgery the cancer is found to be too large or spread too far to be removed, and the surgery has to be cancelled.
More than 4 out of 5 people in the world with liver cancer also have cirrhosis. In someone with severe cirrhosis, removing even a small amount of liver tissue at the edges of a cancer might not leave enough liver behind to perform essential functions. People with cirrhosis are eligible for surgery only if the cancer is small and they still have a reasonable amount of liver function left. Doctors often assess this function by assigning a Child-Pugh , which is a measure of cirrhosis based on certain lab tests and symptoms. Patients in class A are most likely to have enough liver function to have surgery. Patients in class B are less likely to be able to have surgery. Surgery is not typically an option for patients in class C.
Possible risks and side effects: Liver resection is a major, serious operation that should only be done by skilled and experienced surgeons. Because people with liver cancer usually have liver problems besides the cancer, surgeons have to remove enough of the liver to try to get all of the cancer, yet leave enough behind for the liver to function adequately.
A lot of blood passes through the liver, and bleeding after surgery is a major concern. On top of this, the liver normally makes substances that help the blood clot. Damage to the liver (both before the surgery and during the surgery itself) can add to potential bleeding problems.
Other possible problems are similar to those seen with other major surgeries and can include infections, complications from anesthesia, blood clots, and pneumonia.
Another concern is that because the remaining liver still has the underlying disease that led to the cancer, sometimes a new liver cancer can develop afterward.
b. Liver transplant (see “liver transplant” info section)
When it is available, a liver transplant may be the best option for some people with small liver cancers. At this time, liver transplants can be an option for those with tumors that cannot be removed with surgery, either because of the location of the tumors or because the liver is too diseased for the patient to withstand removing part of it. In general, it is used to treat patients with small tumors (either 1 tumor smaller than 5 cm across or 2 to 3 tumors no larger than 3 cm) that have not invaded nearby blood vessels. It can also rarely be an option for patients with resectable cancers (cancers that can be removed completely).
There are two types of liver cancer and they are:
1. Primary liver cancer
These are cancers that develop from the liver cells itself. The most common type of primary live cancer is hepatocellular carcinoma (HCC). Other rare types are cholangiocarcinoma or angiosarcoma.
2. Secondary liver cancer
These are cancer from other parts of the body that has spread to the liver. Commonest type is from colorectal cancer. But almost every type of cancer can spread to the liver including stomach, breast and pancreas.
Hepatocellular carcinoma (HCC)
This is the commonest primary liver cancer and it more prevalent in males and most patient present in the 5th to 6th decade of life. The risk factors for developing HCC are appended below:
1. Cirrhosis
Cirrhosis is a disease in which liver cells become damaged and are replaced by scar tissue. People with cirrhosis have an increased risk of liver cancer. Most (but not all) people who develop liver cancer already have some evidence of cirrhosis. There are several possible causes of cirrhosis. Most cases in the region occur in people who have chronic HBV or HCV infections and alcohol abuse
Non-alcoholic fatty liver disease, a condition in which people who consume little or no alcohol develop a fatty liver, is common in obese people. People with a type of this disease known as non-
alcoholic steatohepatitis (NASH) might go on to develop cirrhosis.
Some types of autoimmune diseases that affect the liver can also cause cirrhosis. For example, there is also a disease called primary biliary cirrhosis (PBC). PBC seems to be an autoimmune condition, in which the immune system attacks the bile ducts in the liver. This causes the bile ducts to become damaged and even destroyed and can lead to cirrhosis. People with advanced PBC have a high risk of liver cancer.
Certain types of inherited metabolic diseases (see below) can cause problems in the liver that lead to cirrhosis.
Chronic viral hepatitis
Worldwide, the most common risk factor for liver cancer is chronic (long-term) infection with hepatitis B virus (HBV) or hepatitis C virus (HCV). These infections lead to cirrhosis of the liver (see above) and are responsible for making liver cancer the most common cancer in many parts of the world.
In the United States, infection with hepatitis C is the more common cause of HCC, while in Asia and developing countries, hepatitis B is more common. People infected with both viruses have a high risk of developing chronic hepatitis, cirrhosis, and liver cancer. The risk is even higher if they also drink alcohol heavily.
Other viruses, such as the hepatitis A virus and hepatitis E virus, can also cause hepatitis. But people infected with these viruses do not develop chronic hepatitis or cirrhosis, and do not have an increased risk of liver cancer.
Heavy alcohol use
Alcohol abuse is a leading cause of cirrhosis in the west, which in turn is linked with an increased risk of liver cancer.
Obesity
Being obese (very overweight) increases the risk of developing liver cancer. This is probably because it can result in fatty liver disease and cirrhosis.
Type 2 diabetes
Type 2 diabetes has been linked with an increased risk of liver cancer, usually in patients who also have other risk factors such as heavy alcohol use and/or chronic viral hepatitis. This risk may be increased because people with type 2 diabetes tend to be overweight or obese, which in turn can cause liver problems.
Inherited metabolic diseases
Certain inherited metabolic diseases can lead to cirrhosis.
People with hereditary hemochromatosis absorb too much iron from their food. The iron settles in tissues throughout the body, including the liver. If enough iron builds up in the liver, it can lead to cirrhosis and liver cancer.
Other rare diseases that increase the risk of liver cancer include tyrosinemia, alpha1-antitrypsin deficiency, Wilson disease and glycogen storage disease.
Aflatoxins
These cancer-causing substances are made by a fungus that contaminates peanuts, wheat, soybeans, ground nuts, corn, and rice. Storage in a moist, warm environment can lead to the growth of this fungus. Although this can occur almost anywhere in the world, it is more common in warmer and tropical countries.
Long-term exposure to these substances is a major risk factor for liver cancer. The risk is increased even more in people with hepatitis B or C infections.
Vinyl chloride and thorium dioxide (Thorotrast)
Exposure to these chemicals raises the risk of angiosarcoma of the liver.It also increases the risk of developing cholangiocarcinoma and hepatocellular cancer, but to a far lesser degree. Vinyl chloride is a chemical used in making some kinds of plastics. Thorotrast is a chemical that in the past was injected into some patients as part of certain x-ray tests. When the cancer-causing properties of these chemicals were recognized, steps were taken to eliminate them or minimize exposure to them. Thorotrast is no longer used, and exposure of workers to vinyl chloride is strictly regulated.
Anabolic steroids
Anabolic steroids are male hormones used by some athletes to increase their strength and muscle mass. Long-term anabolic steroid use can slightly increase the risk of hepatocellular cancer. Cortisone-like steroids, such as hydrocortisone, prednisone, and dexamethasone, do not carry this same risk.
Arsenic
Drinking water contaminated with naturally occurring arsenic, such as that from some wells, over a long period of time increases the risk of some types of liver cancer. This is more common in parts of East Asia, but it might also be a concern in some areas of the United States.
Infection with parasites
Infection with the parasite that causes schistosomiasis can cause liver damage and is linked to liver cancer. This parasite is not found in the US, but infection can occur in Asia, Africa, and South America.
Tobacco use
Smoking increases the risk of getting liver cancer. Former smokers have a lower risk than current smokers, but both groups have a higher risk than those who never smoked.
SIGNS AND SYMPTOMS OF LIVER CANCER
Signs and symptoms of liver cancer often do not show up until the later stages of the disease, but sometimes they may show up sooner. If you go to your doctor when you first notice symptoms, your cancer might be diagnosed earlier, when treatment is most likely to be helpful. Some of the most common symptoms of liver cancer are:
· Weight loss (without trying)
· Loss of appetite
· Feeling very full after a small meal
· Nausea or vomiting
· An enlarged liver, felt as a mass under the ribs on the right side
· An enlarged spleen, felt as a mass under the ribs on the left side
· Pain in the abdomen or near the right shoulder blade
· Swelling or fluid build-up in the abdomen
· Itching
· Yellowing of the skin and eyes (jaundice)
Some other symptoms that can occur include fever, enlarged veins on the belly that become visible through the skin, and abnormal bruising or bleeding.
People who have chronic hepatitis or cirrhosis may feel worse than usual or just have changes in lab test results, such as AFP levels.
Some liver tumors make hormones that act on organs other than the liver. These hormones may cause:
- High blood calcium levels (hypercalcemia), which can cause nausea, confusion, constipation, weakness, or muscle problems
- Low blood sugar levels (hypoglycemia), which can cause fatigue or fainting
- Breast enlargement (gynecomastia) and/or shrinking of the testicles in men
- High counts of red blood cells (erythrocytosis) which can cause someone to look red and flushed
- High cholesterol levels
INVESTIGATIONS
1. Imaging tests
Imaging tests use x-rays, magnetic fields, or sound waves to create pictures of the inside of your body. Imaging tests are done for a number of reasons, including:
· To help find suspicious areas that might be cancerous
· To help diagnose liver cancer
· To help a doctor guide a biopsy needle into a suspicious area to take a sample
· To learn how far cancer might have spread
· To help guide certain treatments in the liver
· To help determine if treatment has been effective
· To look for a possible recurrence of the cancer
People who have (or may have) liver cancer may get one or more of the following tests
a. Ultrasound
This test uses sound waves and can be used to look for tumors in the liver. This is very safe and can be repeated often with no risk of radiation. But it has to be done by an experience radiologist and this is use usually as a screening of patients with suspected liver cancer.
b. Computed tomography (CT)
The CT scan is an x-ray test that produces detailed cross-sectional images of your body. A CT scan of the abdomen is very useful in identifying many types of liver tumors. It can provide precise information about the size, shape, and position of any tumors in the liver or elsewhere in the abdomen, as well as nearby blood vessels. CT scans can also be used to guide a biopsy needle precisely into a suspected tumor (called a CT-guided needle biopsy). If you are found to have liver cancer, a CT of your chest may also be done to look for possible spread to the lungs.
A CT scanner has been described as a large donut, with a narrow table in the middle opening. You will need to lie still on the table while the scan is being done. CT scans take longer than regular x-rays, and you might feel a bit confined by the ring while the pictures are being taken.
For this test, you may be asked to drink 1 to 2 pints of a liquid called oral contrast. This helps outline the intestine so that certain areas are not mistaken for tumors. You may also receive an IV (intravenous) line through which a different kind of contrast (IV contrast) is injected. This helps better outline structures in your body. The injection can cause some flushing (redness and warm feeling). Some people are allergic and get hives or, rarely, more serious reactions like trouble breathing and low blood pressure. Be sure to tell the doctor if you have any allergies or ever had a reaction to any contrast material used for x-rays.
If your doctor suspects you may have liver cancer, you may have one set of CT scans of your abdomen taken before you get IV contrast. Other sets of scans may then be taken over the next several minutes as the contrast passes through the liver and other parts of the body. These sets of scans (together known as a 4-phase or multiphase CT scan) can help spot different types of liver tumors.
c. Magnetic resonance imaging (MRI)
Like CT scans, MRI scans provide detailed images of soft tissues in the body. But MRI scans use radio waves and strong magnets instead of x-rays. The energy from the radio waves is absorbed and then released in a pattern formed by the type of body tissue and by certain diseases. A computer translates the pattern into a very detailed image of parts of the body.
When MRI is used to look at liver tumors, several sets of images may be taken. After the first set is done, a contrast material called gadolinium is injected into a vein to help see details more clearly. Then other sets are taken over the next several minutes as the contrast moves through the liver and other parts of the body. This is known as dynamic contrast-enhanced MRI.
MRI scans can be very helpful in looking at liver tumors. Sometimes they can tell a benign tumor from a malignant one. They can also be used to look at blood vessels in and around the liver, and can help show if liver cancer has spread to other parts of the body.
MRI scans may be a little more uncomfortable than CT scans, and they often take longer. You may be placed inside a narrow tube, which is confining and can upset people with a fear of enclosed spaces. Special more open MRI machines can sometimes be used instead, but the drawback is that the pictures may not be as clear. The MRI machine also makes buzzing and clicking noises that you may find disturbing. Some places will provide earplugs to help block these noises out.
d. Angiography
An angiogram is an x-ray test that looks at blood vessels. Contrast medium, or dye, is injected into an artery to outline blood vessels while x-ray images are taken. Angiography can be used to show the arteries that supply blood to a liver cancer, which can help doctors decide if a cancer can be removed and to help plan the operation. It can also be used to help guide some types of non-surgical treatment, such as trans arterial chemoembolization.Angiography can be uncomfortable because the doctor doing the test has to put a small catheter (a flexible hollow tube) into the artery leading to the liver to inject the dye. Usually the catheter is put into an artery in your inner thigh and threaded up into the liver artery. A local anesthetic is often used to numb the area before inserting the catheter. Then the dye is injected quickly to outline all the vessels while the x-rays are being taken.
TREATMENT OPTIONS FOR HCC
After liver cancer is diagnosed and staged, your cancer care team will discuss your treatment options with you. Depending on your situation, you may have different types of doctors on your treatment team. These doctors may include:
- A surgeon: a doctor who treats diseases with surgery.
- A radiation oncologist: a doctor who treats cancer with radiation therapy.
- A medical oncologist: a doctor who treats cancer with medicines such as chemotherapy.
- A gastroenterologist: a doctor who specializes in treating diseases of the digestive system, including the liver.
In creating your treatment plan, important factors to consider include the stage (extent) of the cancer and the health of the rest of your liver. But you and your cancer care team will also want to take into account the possible side effects of treatment, your overall health, and the chances of curing the disease, extending life, or relieving symptoms. Based on these factors, your treatment options may include:
- Surgery (partial hepatectomy or liver transplant)
- Tumor ablation
- Tumor embolization
- Selective internal radiation therapy
- Chemotherapy
- Immunotherapy
In some cases, doctors may recommend combining more than one of these treatments. It is important to discuss all of your treatment options, including their goals and possible side effects, with your doctors to help make the decision that best fits your needs.
We will look into specific options of treatment.
a. SURGICAL RESECTION OF HCC
At this time, surgery, either with resection (removal of the tumor) or a liver transplant, offers the only reasonable chance to cure liver cancer. If all known cancer in the liver is successfully removed, you will have the best outlook.
1. Partial hepatectomy (see “Hepactectomy” info section)
Surgery to remove part of the liver is called partial hepatectomy. This operation is only attempted if the person is healthy enough for surgery and all of the tumor can be removed while leaving enough healthy liver behind. Unfortunately, most liver cancers cannot be completely removed. Often the cancer is in too many different parts of the liver, is too large, or has spread beyond the liver.
Imaging tests, such as CT or MRI with angiography are done first to see if the cancer can be removed completely. Still, sometimes during surgery the cancer is found to be too large or spread too far to be removed, and the surgery has to be cancelled.
More than 4 out of 5 people in the world with liver cancer also have cirrhosis. In someone with severe cirrhosis, removing even a small amount of liver tissue at the edges of a cancer might not leave enough liver behind to perform essential functions. People with cirrhosis are eligible for surgery only if the cancer is small and they still have a reasonable amount of liver function left. Doctors often assess this function by assigning a Child-Pugh , which is a measure of cirrhosis based on certain lab tests and symptoms. Patients in class A are most likely to have enough liver function to have surgery. Patients in class B are less likely to be able to have surgery. Surgery is not typically an option for patients in class C.
Possible risks and side effects: Liver resection is a major, serious operation that should only be done by skilled and experienced surgeons. Because people with liver cancer usually have liver problems besides the cancer, surgeons have to remove enough of the liver to try to get all of the cancer, yet leave enough behind for the liver to function adequately.
A lot of blood passes through the liver, and bleeding after surgery is a major concern. On top of this, the liver normally makes substances that help the blood clot. Damage to the liver (both before the surgery and during the surgery itself) can add to potential bleeding problems.
Other possible problems are similar to those seen with other major surgeries and can include infections, complications from anesthesia, blood clots, and pneumonia.
Another concern is that because the remaining liver still has the underlying disease that led to the cancer, sometimes a new liver cancer can develop afterward.
b. Liver transplant (see “liver transplant” info section)
When it is available, a liver transplant may be the best option for some people with small liver cancers. At this time, liver transplants can be an option for those with tumors that cannot be removed with surgery, either because of the location of the tumors or because the liver is too diseased for the patient to withstand removing part of it. In general, it is used to treat patients with small tumors (either 1 tumor smaller than 5 cm across or 2 to 3 tumors no larger than 3 cm) that have not invaded nearby blood vessels. It can also rarely be an option for patients with resectable cancers (cancers that can be removed completely).