Cancer of Liver (Hepatoma)
Hepatoma is the one of the most common cancer in the world with 1 Million new cases diagnosed every year. Roughly 20,000 new cases are diagnosed every year in United states. It is more frequent in men and Oriental-Americans. The average age at the time of diagnosis if 60 years. Unfortunately, most patients are diagnosed in advanced stages when cure is not possible. The liver is a gland which is located in the upper part of the abdomen, laying almost on the spine. The liver is a common site for metastasis from other cancers. Hepatoma has to be distinguished from other cancers that spread to liver.
Cause
Many viruses and chemical agents seem to be involved in causation of this cancer.
- Hepatitis B and C viruses are the most important causes worldwide. Hopefully, vaccination with hepatitis vaccine will reduce the frequency of this illness in the next century.
- Alcohol-induced liver damage
- Aflatoxin is a toxin which is produced by fungus that grows in peanuts, corn, etc.
- Throrotrast, which was used decades ago in radiology studies
- PVC-exposure among factory workers. PVC is used in plastic pipes, etc.
- Iron overload and Arsenic poisoning
Signs and symptoms
Cancer of the liver can grow for a long time without causing any problems. Most patients are diagnosed in advanced stages and present with any of the following signs:
- Abdominal pain
- Weight loss
- Nausea, vomiting
- Jaundice, as a result of obstruction of bile ducts
- Anemia
Diagnosis
When suspected, CT scan or Ultrasound examination of the abdomen may establish the diagnosis. A Fine needle aspiration or a trochar biopsy of the liver may confirm the existence of the cancer. This cancer can produce a protein (alpha feto protein) which can be detected in the blood. This test may help in establishing the diagnosis.
Staging
A CT Scan of the abdomen can easily determine the extent of this illness. The disease can be limited to one site in the liver or spread to multiple sites. Hepatoma is a very malignant disease that can be fatal even before spreading to other areas outside the liver.
Treatment
Surgery: Management of this disease relies on surgery in an attempt to remove most or all of the liver and reconstruct the continuity of the bile ducts. This is a rather very difficult procedure which, even in best hands, carries a very high risk. Indications for surgery are limited to younger patients with very small size tumors. Liver transplant is another option which may be considered in certain patients.
Chemotherapy is appropriate for patients in whom the disease is not curable with surgery. Adriamycin, VP-16, Cisplatinum, Mitomycin, 5-FU and Leucovorin are among the most commonly used drugs for liver cancer. These drugs are used in combination and can have moderate to severe toxic effects. This condition is rather difficult to manage with chemotherapy. Attempts at infusion of chemotherapy directly into the liver vessels have not proven to be very effective.
Radiation is rarely used to treat this illness.
Pattern of Spread
If left untreated, or if it fails to respond to treatment, liver cancer can spread to the rest of normal liver, causing liver failure, and also to lymph glands in the abdomen and lungs.
Prognosis
In most Americans, this cancer carries a very poor prognosis. This is due to the advanced stage of the illness at the time of diagnosis. In such cases, survival is very short. The disease can be cured only if it is caught very early.
Survival
Survival of patients with this cancer depends on the extent of the cancer at the time of the initial diagnosis. One-third of patients in very early stages can be cured with surgery alone. In the majority of patients, in whom cure is not possible, survival may vary from weeks to months, depending on the extent of cancer, overall condition of the patient, their response to treatments and the duration of their response.
Follow-up
After completion of treatment, in any combination that might have taken place, patients need to remain under surveillance for the possibility of recurrence of cancer. Follow-up shall be scheduled on a regular basis, initially every one to three months for one to two years. The frequency of follow-up will depend on the condition of the patient and his/her disease. In each follow-up visit, patients are examined and normally a CT scan of abdomen is obtained at intervals.
Treatment of advanced or recurrent disease will depend on the stage and extent of the reoccurred disease. Most patients are then treated with chemotherapy using the same agents as mentioned above. If patients experience pain, various pain medications may be used to alleviate pain. For patients with advanced disease, where most treatments have failed, one could consider assistance from hospice.
