Treatment of Liver Cancer

        So far we have looked through the multiple steps that lead up to one important factor when looking at liver cancer.  For many cancer patients, and their families, this step can sometimes be one of the toughest steps on the road to recovery.  This step that I am referring to is treatment.  When going through the battle of any type of cancer, this is one of the longest and toughest stages of the fighting process.  Before deciding what treatment option is right for you, the patient, it is important that you understand each of the options you have available.  It is important to keep in mind that the type of treatment you have available to you is also affected by the stage your cancer has been classified.

       Unfortunately, liver cancer is difficult to cure.  Primary liver cancer is difficult to detect in its early stages, as we discussed previously, when it can be treated most effectively.  Secondary liver cancer is difficult to treat because this means the cancer has already spread from another location within the body.  Because of the location of the liver within the body, surgery is quite difficult to complete due to the various blood vessels and bile ducts surrounding it.  With these ideas in mind, treatment for liver cancer tends to be strongly focused on simply making the patient feel better, more comfortable, and hopefully live longer than expected.

      Just like many other cancers, quite a few options are available to treatment, depending upon the stage one’s cancer is diagnosed.  Listed below are treatment options with brief descriptions that may be used for patients with liver cancer.  Also listed with treatment options are the side effects for each treatment type.  Each treatment type is likely to impact patients differently depending how their body is impacted by the treatment.  It is very important for patients to discuss treatment options over with their doctor because they will have the best idea about which treatment option will be the best for you, their patient.

·        

      Radiation Therapy

o  Radiation therapy consists of high-powered energy beams that target areas of the liver in order to shrink the tumor and/or destroy the cancer cells.

o   Side Effects:

§  Skin changes similar to that of sunburn: redness, peeling, blistering at the sight of radiation

§  Nausea and vomiting

§  Fatigue

§  Low blood counts

www.dvucancercare.com

            

       Chemotherapy

o   Chemotherapy is a drug that is used to treat cancer, aimed towards destroying the cancer cells.

o   Unfortunately, liver cancer usually rejects most chemo drugs.  They tend to only shrink the tumor very slightly, and these drugs don’t typically the response to the tumor and cancer cells doesn’t last very long.

o   Chemotherapy also comes with quite a few side effects:

§  Loss of hair

§  Mouth sores

§  Loss of appetite

§  Nausea and vomiting

§  Diarrhea

§  Low white blood cell accounts, leading to increased chance of infections

§  Low platelet counts, leading to easy bruising and bleeding

§  Fatigue, from low red blood cell count

www.ovca.org

        

       Surgery

o   Currently, surgery seems to offer patients the best chance for a true cure of liver cancer; however, this is only if all known cancer is removed.  Two common types of surgery for liver cancer patients includes resection, which is removal of the tumor, or a liver transplant.

o   Side effects from surgery (through removal)

§  Bleeding problems, from the inability to clot

§  Infections

§  Problems from anesthesia

§  Blood clots

§  Pneumonia

o   Side effects from liver transplant

§  Problems tend to arise from the drugs given to the patients to prevent their body from rejecting the liver transplant.

·         Increased risk of infection

·         High blood pressure

·         High cholesterol

·         Diabetes

·         Weakened bones and kidneys

·         Lead to new cancer

www.forerunnershealthcare.com

·         

       Tumor Ablation

o   This treatment focuses on destroying liver cancer cells without actually removing the cancer cells from the body.  Patients who use this form of treatment typically have only a few small tumors, and no more than 3 centimeters across, but aren’t a good candidate for surgery.  Although this form of treatment doesn’t work as well as surgery, it does work well for some patients and is typically used in patients waiting for a liver transplant.

o   Side effects:

§  Abdominal pain

§  Liver infections

§  Bleeding in the chest cavity or abdomen

www.cpmc.org

      

       Tumor Embolization

o   This form of treatment consists of injections of substances used to try and block/reduce the blood flow the cancer cells receive.  This option is used for students with cancerous tumors that cannot be removed through surgery.  Many times this form of treatment is used with ablation.

o   Side effects:

§  Abdominal pain

§  Fever

§  Nausea

§  Infection to the liver

§  Inflammation of the gallbladder

§  Blood clots within the vessels surrounding the liver

www.cigsurg.com

There are many times when a patient’s doctor is looking at treatment options that they will end up suggesting that their patient do a combination of two different treatments in order to get the most effective treatment possible for killing the cancer cells and shrinking the tumor.  No matter the circumstance, it is always important to discuss your options with your doctor to ensure you understand your best possible options.



Resources:
http://www.mayoclinic.org/diseases-conditions/liver-cancer/basics/treatment/con-20025222
http://www.webmd.com/cancer/understanding-liver-cancer-treatment
http://www.cancer.org/cancer/livercancer/detailedguide/liver-cancer-treating-general-info

Diagnosing Liver Cancer

Once a patient or doctor has discovered some of the symptoms known with liver cancer, a doctor will likely begin to ask the patient many questions dealing with the patient’s medical history.  When completing this series of questioning and a physical examine, the doctor will most likely be looking very closely at the patient’s abdomen, as well as the skin and eyes to look for jaundice.    After completing the exam and questioning, the doctor may ask for further testing to be completed for further answers.

www.urmc.rochester.edu

Testing for liver cancer is broken down into 3 main categories: imagining tests, other procedures, and lab tests.  Imagining tests use x-rays, magnetic fields, or sound waves to develop a picture from the inside of the body, and these tests are completed for a number of reasons.  These reasons include finding areas impacted by cancer, diagnosing cancer, determining if the cancer has spread, guiding treatments, and determining the effectiveness of treatment.  Some different kinds of imagining tests include ultrasound, Computed tomography (CT), and Magnetic resonance imaging (MRI) just to name a few.

www.hivandhepatitis.com

Although other procedures are rather broad, these are a couple different procedures that might be used to help diagnose liver cancer.  The two procedures that fall into this category are laparoscopy and biopsy.  During a laparoscopy, the doctor inserts a small tubed camera into the abdomen to look at the liver.  A biopsy means the doctor will remove a sample of tissue from the liver (or whatever area is being looked at) to see if the tissue is cancerous.  There are a few different ways a biopsy can be completed: needle, laparoscopic, and surgical. 

www.stfranciscare.org

Lastly, doctors may choose to do a variety of lab tests.  Some of these tests may include alpha-fetoprotein blood (AFP) tests, liver function tests (LFTs), complete blood count (CBC) are just a few of these tests.    Just like the imagining tests, there are a few reasons these tests may be completed.  Lab tests may be done to help diagnose liver cancer, determine possible causes, determine the function of the liver, and determine the effectiveness of the treatment.

Stages of Liver Cancer

Once a patient has been diagnosed with liver cancer, the next step is to determine the stage of the cancer.  Liver cancer is broke up into 4 different numbered stages. 

·        Stage I of liver cancer is when there is only one tumor found and it has not reached the point of spreading to nearby blood vessels. 

·        Liver cancer reaches stage II when either one tumor has spread to blood vessels nearby, or more than one tumor is present but has not grown bigger than 5 centimeters. 

·        Stage III is slightly different than the other stages; this is because stage III is split into three different categories: Stage IIIA, Stage IIIB, and Stage IIIC. 

o   Patients are diagnosed at stage IIIA if they have more than one tumor that is larger than 5 centimeters or a tumor moves to a major branch of blood vessels around the liver. 

o   Stage IIIB is when one or more tumors, regardless of the size, spreads to a nearby organ, other than the gallbladder, or they have broken through lining of the peritoneal cavity.

o   Stage IIIC is when a patient’s cancer has spread to the nearby lymph nodes.

·        Stage IV of liver cancer is when the patient’s liver cancer has spread to other places within the body, like bones or lungs.  At this stage, tumors can reach any size and spread to blood vessels or lymph nodes nearby.

www.dna2life.com

For adults who have been diagnosed with primary liver cancer, sometimes their stages may also be grouped by how their form of cancer may be treated. 

·        Localized resectable: This means the cancer is only found in the liver, has not spread to any other location, and it can be removed entirely by surgery.

·        Localized and locally advanced unresectable: This means the cancer remains strictly in the liver without having spread, but it cannot be removed fully by surgery.

·        Advanced: At this point, the cancer has spread to different areas of the liver or has moved to other parts of the body, like bones or the lungs.

Resources

http://www.mayoclinic.org/diseases-conditions/liver-cancer/basics/tests-diagnosis/con-20025222

http://www.cancer.org/cancer/livercancer/detailedguide/liver-cancer-diagnosis

http://www.mdanderson.org/patient-and-cancer-information/cancer-information/cancer-types/liver-cancer/diagnosis/index.html

Symptoms, Causes, & Risk Factors

As I discussed in my last post, Liver Cancer has a variety of different types, both primary and secondary.  Additionally, I spent some time defining what exactly cancer itself is before going too in depth about what liver cancer was.  Before you can do too much research about the other areas of liver cancer, it is extremely important that you understand what it is.  I highly suggest that if you need a refresher that you refer back to my last blog post in order to make sure you benefit from this next post as much as possible!  J

Now that we have a strong understanding of what exactly liver cancer is, we can start looking to answer another question about it.  What are the causes of liver cancer?  What are some of the symptoms of liver cancer?  If these are questions you are currently asking yourself about liver cancer, you should be able to answer these questions soon!

Liver that has suffered from Liver Cancer.
livercancersymptoms.org

What are some symptoms?

Unfortunately, most people don’t show signs of liver cancer when it’s in the early stages of development.  More times than not, symptoms of the common forms of primary liver cancer show before the more rare types.  As symptoms begin to appear patients may notice some of the following signs:

·        Weight loss, without trying

·        Loss of appetite

·        Upper abdominal pain

·        Nausea and vomiting

·        General weakness and fatigue

·        Abdominal swelling

·        Skin turning yellow, as well as whites of the eyes (jaundice)

·        White, chalky stools

Comparison of skin color for someone w/ and w/o jaundice.
www.puristat.com

As with any other type of sickness, or cancer, it is extremely important for patients to make an appointment with their doctor once these symptoms begin to appear.

What about causes?

At this point in time, researchers don’t have a clear answer for what exactly causes liver cancer.  However, they do have an idea of the cause in some cases.  One cause appears to be found when a patient has a hepatitis virus present within their body.  When this disease is present, infections tend to be long lasting, which in turn result in the development of liver cancer.  Just as I pointed out in my last post, liver cancer becomes present when the DNA within liver cells begins to form mutations.  Once this happens, the cells hold a strong possibility for growing out of control and developing a tumor.

Comparison between Liver Tissue.
13leesub.wordpress.com

Although researchers haven’t decided upon a clear cause for liver cancer, they have been able to uncover what appear to be some possible causes in patients who have been affected by liver cancer in the past.  Typically primary liver cancer develops when the liver has suffered some kind of damage.  This damage can happen through birth defects, alcohol abuse, and infections from diseases, such as Hepatitis as I discussed above.

Normal Liver vs. a Liver with Cirrhosis
depts.washington.edu

Risk Factors...?

Now that we have a better idea of the symptoms and causes of liver cancer, it’s important to also consider the risk factors that could put any one at risk for developing liver cancer.  A risk factor, according to the American Cancer Society, is anything that affects a person’s chance of getting a disease, such as cancer.  It is extremely important to keep in mind that just because a person meets some of these risk factors does not automatically mean they are at risk of developing liver cancer.  What these risk factors represent is what researchers have found to develop into liver cancer at some point in time with other patients.  Additionally, some patients who discover they have liver cancer sometimes do not meet any of the risk factors listed.  This shows just exactly how difficult and confusing liver cancer really is.

Some risk factors believed to lead to cancer include:

o   Gender: typically the most common form of liver cancer develops in men

o   Race: in the U.S. Asian Americans and Pacific Islanders have the highest rate of liver cancer development

o   Cirrhosis: disease where liver cells become damaged and are replaced by scar tissue

o   Chronic Viral Hepatitis, as I discussed above

o   Heavy alcohol use

o   Obesity

o   Type 2 Diabetes: patients with this risk factor typically fall under another risk factor as well

o   Inherited Metabolic Diseases: can lead to cirrhosis

o   Anabolic Steroids

Process of damaged liver due to alcohol consumption.
healthylivingguy.com

Although these are not the only risk factors for liver cancer, these tend to be some of the most popular risk factors among patients.

As we continue to look further into Liver Cancer, we will continue to take this information and use it towards new information in the near future!



Resources:
http://www.mayoclinic.org/diseases-conditions/liver-cancer/basics/risk-factors/con-20025222
http://www.cancer.org/cancer/livercancer/detailedguide/liver-cancer-risk-factors
http://www.webmd.com/cancer/liver-cancer-hepatocellular-carcinoma-hcc-directory

What is Liver Cancer?

Before we can take a deeper look into what Liver Cancer is specifically, it is important that we have a good idea of what exactly cancer itself is. 

As we learn through most of our science courses, normal and healthy cells within our body grow, divide, and die on their own, in this order.  When we are young, our cells go through this process much more quickly in order to help us grow.  As we get older, cells divide as needed to replace cells that are dying.  However, when this process becomes out of control, cancer begins.  Unlike normal cells that eventually die, cancer cells don’t die on their own; this means they continue to divide and create new cancer cells.  Because these begin to get out of control, these cells start invading in other areas of the body, or tissues.  Once they invade other tissues within the body, they begin to grow and divide within that area as well.  This is the biggest difference between cancer cells and normal cells.

www.cancer.gov

One important thing to remember with cancer is that there are many different kinds of cancer.  Although the effects of each are different, they all start due to an abnormal growth of cancer cells.  When looking at what type of cancer a person has, we look at where the cancer itself originated within the body.  This means that the diagnostic type of cancer a patient has is where the cancer cells were found first in the body.  Even after the cells move to another part of the body and begin to divide in a new location, the cancer maintains the original location it started.  For example, if cancer cells first appear in a patient’s liver, and then spread to the prostate, the cancer is still considered to be liver cancer.

So… What is liver cancer?

In order to help us better understand liver cancer, it is important that we look into what exactly is the function of a normal liver.  Our liver is an extremely important organ within our body.  In fact, there’s really no way for us to live without our liver.  In fact, our liver has four extremely important jobs: breaking down and storing nutrients that our come from our intestines, it helps clot our blood when we cut or injury ourselves, makes bile to absorb the nutrients from our intestines, and it filters the waste and toxins within our blood that is later removed.

www.bath.ac.uk

Liver cancer is actually broken down into two different categories: primary and secondary.  The difference between these two is where the cancer originates.  Primary liver cancer is cancer that starts in the liver.  Something many people don’t really know is that liver cancer actually has more than one type of cancer.  The most common form of liver cancer is Hepatocellular carcinoma (HCC).  This form happens to be the most common form of liver cancer found in adults; 4 out of 5 cases of liver cancer are diagnosed as HCC.  Bile duct cancer (cholangiocarcinoma) is another type of primary liver cancer; however, this form only shows up in about 1 or 2 out of 10 patients diagnosed with liver cancer.

Just like many other forms of cancer, liver cancer also has two rare forms that are considered primary: Angiosarcomas and hemangiosarcomas.  Unlike the other two that begin in cells or bile duct, these forms begin in the cells that line the blood vessels of the liver.  Unfortunately with patients who become diagnosed with this form, it is nearly impossible to remove the tumor, that grows quickly, because it has already become widespread.  Although treatment for the other two primary types of liver cancer provides a chance for patients to rid of the cancer, Angiosarcomas and hemangiosarcomas are different.  Due to the widespread, treatment only provides patients with an opportunity to slow down the disease, but these two types of cancer almost always “win the fight” against the patient.

One last primary type of liver cancer is Hepatoblastoma, which is a rare form of cancer that typically is found in children under that age of 4.  Two-Thirds of the children who develop this type of cancer have good outcomes from surgery and chemotherapy because the cancer has not spread yet.

Secondary liver cancers are cancers that originated in another part of the body and have spread to the liver.  According to the American Cancer Society, secondary types of liver cancer are much more common than primary liver cancers.  In fact, most of the common types of cancer, like breast cancer and colon cancer, spread to the liver.  What makes secondary liver cancer different from primary liver cancer is that the secondary liver cancer cells act and look like the cancer cells of the originating place within the body; in other words, the secondary cells don’t look like primary liver cancer cells and are treated with the treatment from the primary location.

We will use this information as we continue to take a deeper looks into the bits and pieces of liver cancer soon to come!

Resources used:

American Cancer Society. (2013). Liver Cancer. Retrieved from American Cancer Society: http://www.cancer.org/acs/groups/cid/documents/webcontent/003058-pdf.pdf

Mayo Clinic Staff. (2014). Liver Cancer. Retrieved from Mayo Clinic: http://www.mayoclinic.org/diseases-conditions/liver-cancer/basics/definition/con-20025222

National Liver Foundation. (2013, December 12). Liver Cancer. Retrieved from American Liver Foundation: http://www.liverfoundation.org/abouttheliver/info/livercancer/