Liver Cancer
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Liver cancer may be either secondary, originating from a cancer somewhere else in the body such as the breast or colon, or it may be primary, originating in the liver. Hepatocellular carcinoma (HCC) is the most common primary liver cancer and usually occurs as consequence of damage inflicted by chronic hepatitis and cirrhosis. If the patient's liver function is not already excessively compromised by liver disease and if the cancer has not spread and tumors are limited in scope and size, primary liver cancer can be successfully treated through surgical removal of tumors or liver transplant.
Fibrolamellar hepatocellular carcinoma (FHC) is a distinct form of primary liver cancer and is not typically associated with cirrhosis. It often occurs in young adults. Prognosis of FHC is much better than that of HCC, with 50-75 percent of cases being operable. Long term survival is common.
Secondary liver cancers include:
- Cholangiocarcinoma (CCA), primary cancer of the bile ducts
- Neuroendocrine tumors, which originate in the neuroendocrine system. The liver is a common site for this type of cancer to spread, and is often the cause of death from neuroendocrine cancer.
- Colon cancer that has spread to the liver
- Melanoma
- Breast cancer
Diagnosis and Treatment of Liver Cancer
For tumors in the liver, blood tests may lead a physician to suspect liver cancer, which can then be diagnosed via CT, MRI or ultrasound with contrast. Cholangiocarcinoma must be diagnosed with special endoscopic and contrast imaging techniques to explore the bile ducts.
Treatment of Liver Cancer
Liver Cancer Surgery
The Center for Liver Disease and Transplantation's oncologists and radiation specialists, who specialize in treating liver cancer, provide all available nonsurgical options for liver disease patients with HCC. In addition, the Center offers several novel HCC treatment options, including radiofrequency ablation, chemoembolization, laparoscopic resection, nexavaar (a recently FDA approved treatment for HCC).
- When the tumor is localized and small, physicians may recommend liver transplant. Non-transplant options are often used as a bridge to transplant, while the patient is awaiting a donor organ.
- Surgery to remove the entire tumor is effective if the cancer has not spread and if the patient's liver function has not been overly compromised by cirrhosis.
- Minimally invasive techniques including laparoscopic surgery and hand-assisted laparoscopic surgery allow for resection of up to 60% of the liver without need for large incisions.
- Radiofrequency ablation (RFA), the directing of thermal energy directly to the tumor, is an option for tumors 5cm or more. The procedure can often be conducted on an outpatient basis with a minimal access approach utilizing ultrasound to guide the ablation probe.
- Transcatheter arterial chemoembolization (TACE), involves shutting off blood flow from the hepatic artery to the tumor in combination with delivery of a chemotherapeutic agent to the tumor. The technique spares normal liver tissue, which is not as dependent as the tumor upon the hepatic artery for its blood supply. Effectiveness of TACE, as with other therapies, is dependant upon size and extent of the HCC.
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