Liver Cancer
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Adult primary liver cancer is a disease in which malignant (cancer)
cells form in the tissues of the liver.
The liver is one of the largest organs in the
body, filling the upper right side of the abdomen inside the rib cage. It
has two parts, a right lobe and a smaller left lobe. The liver has many important
functions, including:
- Filtering harmful substances from the blood so they can be passed
from the body in stools and urine.
- Making bile to help digest fats from food.
- Storing glycogen (sugar), which the body uses for energy.
This summary refers to the treatment of primary
liver cancer (cancer that begins in the liver). Treatment of metastatic liver
cancer, which is cancer that begins in other parts of the body and spreads
to the liver, is not discussed in this summary. Primary liver cancer can
occur in both adults and children. Treatment for children, however, is different
than treatment for adults.
Having hepatitis or cirrhosis can affect the risk of developing adult
primary liver cancer.
- Having hepatitis B and/or hepatitis C.
- Having a close relative with both hepatitis and liver cancer.
- Having cirrhosis.
- Eating foods tainted with aflatoxin (poison from a fungus that can grow on foods,
such as grains and nuts, that have not been stored properly).
Possible signs of adult primary liver cancer include a lump or pain
on the right side.
These symptoms may be caused by swelling of
the liver. These and other symptoms may be caused by adult primary liver
cancer or by other conditions. A doctor should be consulted if any of the
following problems occur:
- A hard lump on the right side just below the rib cage.
- Discomfort in the upper abdomen on the right side.
- Pain around the right shoulder blade.
- Unexplained weight loss.
- Jaundice (yellowing of the skin and whites of the eyes).
- Unusual tiredness.
- Nausea.
- Loss of appetite.
Tests that examine the liver and the blood are used to detect (find)
and diagnose adult primary liver cancer.
The following tests and procedures may be used:
- Physical exam and history: An exam of the body to check general
signs of health, including checking for signs of disease, such as lumps
or anything else that seems unusual. A history of the patientfs health
habits and past illnesses and treatments will also be taken.
- Serum tumor marker test: A procedure in which a blood sample is checked to measure
the amounts of certain substances released into the blood by organs, tissues,
or tumor cells in the body. Certain substances are linked to specific types
of cancer when found in increased levels in the blood. These are called
tumor markers. An increased level of alpha-fetoprotein (AFP) in the blood
may be a sign of liver cancer. Other cancers and certain noncancerous conditions,
including cirrhosis and hepatitis, may also increase AFP levels.
- Complete blood count: A procedure in which a sample of blood is drawn and checked
for the following:
- The number of red blood cells, white blood cells, and
platelets.
- The amount of hemoglobin (the protein that carries oxygen) in the red blood cells.
- The portion of the sample made up of red blood cells.
- Laparoscopy: A surgical procedure to look at the organs inside
the abdomen to check for signs of disease. Small incisions (cuts) are made
in the wall of the abdomen and a laparoscope (a thin, lighted tube) is
inserted into one of the incisions. Other instruments may be inserted through
the same or other incisions to perform procedures such as removing organs
or taking tissue samples for biopsy.
- Biopsy: The removal of cells or tissues so they can be viewed under a microscope
to check for signs of cancer. The sample may be taken using a fine needle
inserted into the liver during an x-ray or ultrasound. This is called needle
biopsy or fine-needle aspiration. The biopsy may be done during a laparoscopy.
- CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas
inside the body, taken from different angles. The pictures are made by
a computer linked to an x-ray machine. A dye may be injected into a vein
or swallowed to help the organs or tissues show up more clearly. This procedure
is also called computed tomography, computerized tomography, or computerized
axial tomography.
- MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves,
and a computer to make a series of detailed pictures of areas inside the
body. This procedure is also called nuclear magnetic resonance imaging
(NMRI).
- Ultrasound: A procedure in which high-energy sound waves (ultrasound) are bounced
off internal tissues or organs and make echoes. The echoes form a picture
of body tissues called a sonogram.
Certain factors affect prognosis (chance of recovery) and treatment
options.
The prognosis (chance of recovery) and treatment
options depend on the following:
- The stage of the cancer (the size of the tumor, whether it affects
part or all of the liver, or has spread to other places in the body).
- How well the liver is working.
- The patientfs general health, including whether there is cirrhosis of the liver.
Prognosis is also affected by alpha-fetoprotein
(AFP) levels.
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After adult primary liver cancer has been diagnosed, tests are done
to find out if cancer cells have spread within the liver or to other parts
of the body.
The process used to find out if cancer has spread
within the liver or to other parts of the body is called staging. The information
gathered from the staging process determines the stage of the disease. It
is important to know the stage in order to plan treatment. The following
tests and procedures may be used in the staging process:
- Chest x-ray: An x-ray of the organs and bones inside the chest.
An x-ray is a type of energy beam that can go through the body and onto
film, making a picture of areas inside the body.
- CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas
inside the body, taken from different angles. The pictures are made by
a computer linked to an x-ray machine. A dye may be injected into a vein
or swallowed to help the organs or tissues show up more clearly. This procedure
is also called computed tomography, computerized tomography, or computerized
axial tomography.
- MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves,
and a computer to make a series of detailed pictures of areas inside the
body. This procedure is also called nuclear magnetic resonance imaging
(NMRI).
- Bone scan: A procedure to check if there are rapidly dividing cells, such as
cancer cells, in the bone. A very small amount of radioactive material
is injected into a vein and travels through the bloodstream. The radioactive
material collects in the bones and is detected by a scanner.
- Doppler ultrasound: A type of ultrasound that uses differences in the ultrasound
echoes to measure the speed and direction of blood flow.
In stage I, there is one tumor and it has
not spread to nearby blood vessels.
In stage II, one of the following is found:
- one tumor that has spread to nearby blood vessels; or
- more than one tumor, none of which is larger than 5 centimeters.
Stage III is divided into stage IIIA, IIIB,
and IIIC.
- Stage IIIA: In stage IIIA, one of the following is found:
- more than one tumor larger than 5 centimeters; or
- one tumor that has spread to a major branch of blood vessels near the liver.
- Stage IIIB: In stage IIIB, there are one or more tumors of any
size that have either:
- spread to nearby organs other than the gallbladder;
or
- broken through the lining of the peritoneal cavity.
- Stage IIIC: In stage IIIC, the cancer has spread to nearby lymph
nodes.
In stage IV, cancer has spread beyond the
liver to other places in the body, such as the bones or lungs. The tumors
may be of any size and may also have spread to nearby blood vessels and/or
lymph nodes.
For adult primary liver cancer, stages are also grouped according
to how the cancer may be treated. There are 3 treatment groups:
Localized resectable
The cancer is found in the liver only, has not
spread, and can be completely removed by surgery.
The cancer is found in the liver only and has
not spread, but cannot be completely removed by surgery.
Cancer has spread throughout the liver or has
spread to other parts of the body, such as the lungs and bone.
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There are different types of treatment for patients with adult primary
liver cancer.
Different types of treatments are available
for patients with adult primary liver cancer. Some treatments are standard
(the currently used treatment), and some are being tested in clinical trials.
Before starting treatment, patients may want to think about taking part in
a clinical trial. A treatment clinical trial is a research study meant to
help improve current treatments or obtain information on new treatments for
patients with cancer. When clinical trials show that a new treatment is better
than the standard treatment, the new treatment may become the standard treatment.
Clinical trials are taking place in many parts
of the country. Choosing the most appropriate cancer treatment is a decision
that ideally involves the patient, family, and health care team.
The following types of surgery may be used to
treat liver cancer:
- Cryosurgery: A treatment that uses an instrument to freeze and
destroy abnormal tissue, such as carcinoma in situ (cancer that involves
only the cells in which it began and that has not spread to nearby tissues).
This type of treatment is also called cryotherapy. The doctor may use ultrasound
to guide the instrument.
- Partial hepatectomy: Removal of the part of the liver where cancer is found.
The part removed may be a wedge of tissue, an entire lobe, or a larger
portion of the liver, along with some of the healthy tissue around it.
The remaining liver tissue takes over the functions of the liver.
- Total hepatectomy and liver transplant: Removal of the entire liver and replacement
with a healthy donated liver. A liver transplant may be done when the disease
is in the liver only and a donated liver can be found. If the patient has
to wait for a donated liver, other treatment is given as needed.
- Radiofrequency ablation: The use of a special probe with tiny electrodes that
kill cancer cells. Sometimes the probe is inserted directly through the
skin and only local anesthesia is needed. In other cases, the probe is
inserted through an incision in the abdomen. This is done in the hospital
with general anesthesia.
Radiation therapy is a cancer treatment that
uses high-energy x-rays or other types of radiation to kill cancer cells.
Radiation therapy is given in different ways:
- External radiation therapy uses a machine outside the body to
send radiation toward the cancer.
- Internal radiation therapy uses a radioactive substance sealed in needles, seeds,
wires, or catheters that are placed directly into or near the cancer.
- Drugs called radiosensitizers may be given with the radiation therapy to make
the cancer cells more sensitive to radiation therapy.
- Radiation may be delivered to the tumor using radiolabeled antibodies. Radioactive
substances are attached to antibodies made in the laboratory. These antibodies,
which target tumor cells, are injected into the body and the tumor cells
are killed by the radioactive substance.
The way the radiation therapy is given depends
on the type and stage of the cancer being treated.
Chemotherapy is a cancer treatment that uses
drugs to stop the growth of cancer cells, either by killing the cells or
by stopping the cells from dividing. When chemotherapy is taken by mouth
or injected into a vein or muscle, the drugs enter the bloodstream and can
reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy
is placed directly into the spinal column, an organ, or a body cavity such
as the abdomen, the drugs mainly affect cancer cells in those areas (regional
chemotherapy).
Regional chemotherapy is usually used to treat
liver cancer. A small pump containing anticancer drugs may be placed in the
body. The pump puts the drugs directly into the blood vessels that go to
the tumor.
Another type of regional chemotherapy is chemoembolization
of the hepatic artery. The anticancer drug is injected into the hepatic artery
through a catheter (thin tube). The drug is mixed with a substance that blocks
the artery, cutting off blood flow to the tumor. Most of the anticancer drug
is trapped near the tumor and only a small amount of the drug reaches other
parts of the body. The blockage may be temporary or permanent, depending
on the substance used to block the artery. The tumor is prevented from getting
the oxygen and nutrients it needs to grow. The liver continues to receive
blood from the hepatic portal vein, which carries blood from the stomach
and intestine.
The way the chemotherapy is given depends
on the type and stage of the cancer being treated.
Percutaneous ethanol injection is a cancer treatment
in which a small needle is used to inject ethanol (alcohol) directly into
a tumor to kill cancer cells. The procedure may be done once or twice a week.
Usually local anesthesia is used, but if the patient has many tumors in the
liver, general anesthesia may be needed.
Other types of treatment are being tested in clinical trials. These
include the following:
Hyperthermia therapy is the use of a special
machine to heat the body for a period of time to kill cancer cells. Because
some cancer cells are more sensitive to heat than normal cells are, the cancer
cells die and the tumor shrinks.
Biologic therapy is treatment that uses the
patientfs immune system to fight cancer. Substances made by the body or made
in a laboratory are used to boost, direct, or restore the bodyfs natural
defenses against disease. This type of cancer treatment is also called biotherapy
or immunotherapy.
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Localized Resectable Adult Primary Liver Cancer
- Surgery (partial hepatectomy).
- Surgery (total hepatectomy) and liver transplant.
- A clinical trial of regional or systemic chemotherapy or biologic therapy following
surgery.
Localized and Locally Advanced Unresectable Adult Primary Liver Cancer
- Chemotherapy (regional chemotherapy or chemoembolization).
- Surgery (cryosurgery or radiofrequency ablation).
- Surgery (total hepatectomy) and liver transplant.
- Percutaneous ethanol injection.
- Radiation therapy with radiosensitizers.
- A clinical trial of regional or systemic chemotherapy and/or radiolabeled antibodies.
- A clinical trial of a combination of surgery, chemotherapy, and radiation therapy.
Hyperthermia therapy may also be used. Chemotherapy and radiation therapy
may be used to shrink the tumor before surgery.
There is no standard treatment for advanced
adult primary liver cancer. Patients may consider taking part in a clinical
trial. Treatment may be a clinical trial of biologic therapy, chemotherapy,
and/or radiation therapy with or without radiosensitizers. These treatments
may be given as palliative therapy to help relieve symptoms and improve the
quality of life.
Treatment of recurrent adult primary liver cancer
may include the following:
- Surgery (partial hepatectomy).
- Surgery (total hepatectomy) and liver transplant.
- Chemotherapy (chemoembolization or systemic chemotherapy).
- Percutaneous ethanol injection.
- A clinical trial of a new therapy.
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