According to The American Cancer Society, about 42,220 new cases (30,610 in men and 11,610 in women) of primary liver cancer and intrahepatic bile duct cancer will be diagnosed in the United States in 2018. About 30,200 people will die of these cancers. Jay Krishnakurup, MD, Oncology: Gastroenterology Care Team, Parkview Cancer Institute, tells us what we need to know about the condition.
Who is at greatest risk of liver cancer?
The most common risk factor for liver cancer in the western population is having cirrhosis of the liver. The cirrhosis of the liver is caused by many factors, such as alcohol, obesity, viral hepatitis (hepatitis B and C), genetic disorders and disorders in biliary transport and exchange mechanism.
What are the early symptoms?
Liver cancer by itself is asymptomatic, until it deranges the liver function. Symptoms often don't appear in the early stages of the cancer. The most common scenario is an incidental finding of a liver mass on abdominal imaging for other reasons. However, if a patient has cirrhosis of the liver and develops a sudden onset of jaundice, ascites, marked weight loss, severe fatigue or change in sleep pattern with intermittent confusion, they should be evaluated for liver cancer.
What is the recommended screening process?
Any patient with cirrhosis of the liver should get an ultrasound of the liver along with alpha-fetoprotein levels (which is a tumor marker in the blood) every 6 months. In patients with obesity and increased abdominal girth, the ultrasound of the liver can be alternated with contrast (iv) CT of the abdomen.
What can people do for prevention?
The basic steps of prevention are to avoid or treat the cause of cirrhosis of the liver. Any one diagnosed with cirrhosis of the liver should follow up with a gastroenterologist/hepatologist to get timely treatment for the underlying cirrhosis and screening for complications of cirrhosis, such as liver cancer.
What are some lifestyle factors that can be altered to reduce risk?
Avoiding or restricting alcohol, screening for viral hepatitis in susceptible populations, facilitating early detection and treatment, and practicing safe sex and avoiding IV drug use, both of which can result in viral hepatitis, which in turn can lead to cirrhosis and liver cancer.
Obesity is considered to be the new epidemic. Obesity can lead to Fatty Liver and Nonalcoholic Steatohepatitis. Some of these patients can develop liver cancer without going through the stage of cirrhosis. Regular exercise and good dietary habits can go a long way in preventing liver cancer in this population.
What should someone do if they are showing signs/symptoms?
They should promptly seek medical care. Based on the severity of the symptoms, they should consult a gastroenterologist/hepatologist or go to the nearest hospital. If you have any of the risk factors or risk behaviors described above, you should contact your primary care doctor and get screened for liver disease and cirrhosis of the liver.
What does treatment involve?
We review every new case of liver cancer at Parkview with a multidisciplinary team consisting of: radiology, radiation oncology, pathology, interventional radiology, surgical specialty (surgical oncology and interventional endoscopy), Hepatology and medical oncology.
Tumors can sometimes be removed through surgery or transplant. Often we use other methods due to tumor size or because of the patient’s liver disease or stage of the tumor, which might make surgery riskier. In those cases, we may use liver directed therapy through blood vessels given by interventional radiologists (called y-90 or TACE), where radiation is directed by radiation oncologists and specially targeted to the tumor (called “cyber knife”). Additionally, we have new medications which target the immune system (immunotherapy). Your Hepatology and multi-disciplinary team of experts will choose the precise therapy you need.
It is also important to remember that many patients with liver cancer have underlying advanced liver disease, and this can be equally or more important to care for than the cancer itself. Therefore, your cancer care team must have an experienced hepatologist to help optimize your liver as patients many times may be more effected by the liver disease than the cancer.
