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Adult primary liver cancer


Table of Contents

OVERVIEW OF PDQ
What is PDQ?
How to use PDQ
DESCRIPTION
What is adult primary liver cancer?
STAGE EXPLANATION
Stages of adult primary liver cancer
Localized resectable
Localized unresectable
Advanced
Recurrent
TREATMENT OPTION OVERVIEW
How adult primary liver cancer is treated
Treatment by stage
LOCALIZED RESECTABLE ADULT PRIMARY LIVER CANCER
LOCALIZED UNRESECTABLE ADULT PRIMARY LIVER CANCER
ADVANCED ADULT PRIMARY LIVER CANCER
RECURRENT ADULT PRIMARY LIVER CANCER
TO LEARN MORE

OVERVIEW OF PDQ


What is PDQ?

PDQ is a computer system that gives up-to-date information on cancer and its prevention, detection, treatment, and supportive care. It is a service of the National Cancer Institute (NCI) for people with cancer and their families and for doctors, nurses, and other health care professionals.

To ensure that it remains current, the information in PDQ is reviewed and updated each month by experts in the fields of cancer treatment, prevention, screening, and supportive care. PDQ also provides information about research on new treatments (clinical trials), doctors who treat cancer, and hospitals with cancer programs. The treatment information in this summary is based on information in the PDQ summary for health professionals on this cancer.


How to use PDQ

PDQ can be used to learn more about current treatment of different kinds of cancer. You may find it helpful to discuss this information with your doctor, who knows you and has the facts about your disease. PDQ can also provide the names of additional health care professionals who specialize in treating patients with cancer.

Before you start treatment, you also may want to think about taking part in a clinical trial. PDQ can be used to learn more about these trials. A clinical trial is a research study that attempts to improve current treatments or finds information on new treatments for patients with cancer. Clinical trials are based on past studies and information discovered in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help patients with cancer. Information is collected about new treatments, their risks, and how well they do or do not work. When clinical trials show that a new treatment is better than the treatment currently used as "standard" treatment, the new treatment may become the standard treatment. Listings of current clinical trials are available on PDQ. Many cancer doctors who take part in clinical trials are listed in PDQ.

To learn more about cancer and how it is treated, or to learn more about clinical trials for your kind of cancer, call the National Cancer Institute's Cancer Information Service. The number is 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615. The call is free and a trained information specialist will be available to answer cancer-related questions.

PDQ is updated whenever there is new information. Check with the Cancer Information Service to be sure that you have the most up-to-date information.


DESCRIPTION


What is adult primary liver cancer?

Adult primary liver cancer is a disease in which cancer (malignant) cells start to grow 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 and protected by the rib cage. The liver has many functions. It has an important role in making food into energy and also filters and stores blood.

People who have hepatitis B or C (viral infections of the liver) or a disease of the liver called cirrhosis are more likely than other people to get adult primary liver cancer. Primary liver cancer is different from cancer that has spread from another place in the body to the liver. (A separate PDQ summary is available for childhood liver cancer).

A doctor should be seen if the following symptoms appear: a hard lump just below the rib cage on the right side where the liver has swollen, discomfort in the upper abdomen on the right side, pain around the right shoulder blade, or yellowing of the skin (jaundice). If there are symptoms, a doctor may order special x-rays, such as a computed tomographic scan or a liver scan. If a lump is seen on an x-ray, a doctor may use a needle inserted into the abdomen to remove a small amount of tissue from the liver. This procedure is called a needle biopsy, and a doctor usually will use an x-ray for guidance. The doctor will have the tissue looked at under a microscope to see if there are any cancer cells. Before the test, a patient will be given a local anesthetic (a drug that causes loss of feeling for a short period of time) in the area so that no pain is felt.

A doctor may also want to look at the liver with an instrument called a laparoscope, which is a small tube-shaped instrument with a light on the end. For this test, a small cut is made in the abdomen so that the laparoscope can be inserted. The doctor may also take a small piece of tissue (biopsy specimen) during the laparoscopy and look at it under the microscope to see if there are any cancer cells. An anesthetic will be given so no pain is felt.

A doctor may also order an examination called an angiography. During this examination, a tube (catheter) is inserted into the main blood vessel that takes blood to the liver. Dye is then injected through the tube so that the blood vessels in the liver can be seen on an x-ray. Angiography can help a doctor tell whether the cancer is primary liver cancer or cancer that has spread from another part of the body. This test is usually done in the hospital.

Certain blood tests (such as alpha-fetoprotein, or AFP) may also help a doctor diagnose primary liver cancer.

The chance of recovery (prognosis) and choice of treatment depend on the stage of the cancer (whether it is just in the liver or has spread to other places) and the patient's general state of health.


STAGE EXPLANATION


Stages of adult primary liver cancer

Once adult primary liver cancer is found, more tests will be done to find out if the cancer cells have spread to other parts of the body (staging). The following stages are used for adult primary liver cancer:


Localized resectable

Cancer is found in one place in the liver and can be totally removed in an operation.


Localized unresectable

Cancer is found only in one part of the liver, but the cancer cannot be totally removed.


Advanced

Cancer has spread through much of the liver or to other parts of the body.


Recurrent

Recurrent disease means that the cancer has come back (recurred) after it has been treated. It may come back in the liver or in another part of the body.


TREATMENT OPTION OVERVIEW


How adult primary liver cancer is treated

There are treatments for all patients with adult primary liver cancer. Three kinds of treatment are used:

Surgery may be used to take out the cancer or to replace the liver.

Resection of the liver takes out the part of the liver where the cancer is
found.

A liver transplant is the removal of the entire liver and replacement with a
healthy liver donated from someone else. Very few patients with liver cancer
are eligible for this procedure.

Cryosurgery is a type of surgery that kills cancer by freezing it.

Radiation therapy is the use of x-rays or other high-energy rays to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy) or from putting materials that contain radiation through thin plastic tubes (internal radiation therapy) in the area where the cancer cells are found. Drugs may be given with the radiation therapy to make the cancer cells more sensitive to radiation (radiosensitization).

Radiation may also be given by attaching radioactive substances to antibodies (radiolabeled antibodies) that search out certain cells in the liver. Antibodies are made by the body to fight germs and other harmful things; each antibody fights specific cells.

Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy for liver cancer is usually put into the body by inserting a needle into a vein or artery. This type of chemotherapy is called a systemic treatment because the drug enters the bloodstream, travels through the body, and can kill cancer cells outside the liver. In another type of chemotherapy called regional chemotherapy, a small pump containing drugs is placed in the body. The pump puts drugs directly into the blood vessels that go to the tumor.

If a doctor removes all the cancer that can be seen at the time of the operation, the patient may be given chemotherapy after surgery to kill any remaining cells. Chemotherapy that is given after surgery to remove the cancer is called adjuvant chemotherapy.

Hyperthermia (warming the body to kill cancer cells) and biological therapy (using the body's immune system to fight cancer) are being tested in clinical trials.

Hyperthermia therapy is the use of a special machine to heat the body for a certain period of time to kill cancer cells. Because cancer cells are often more sensitive to heat than normal cells, the cancer cells die and the tumor shrinks.

Biological therapy uses the body's immune system to fight cancer. Materials made by the body or made in a laboratory are used to boost, direct, or restore the body's natural defenses against disease. Biological therapy is sometimes called biological response modifier therapy or immunotherapy.


Treatment by stage

Treatments for adult primary liver cancer depend on the stage of the disease the condition of the liver, and the patient's age and general health. Standard treatment may be considered, based on its effectiveness in patients in past studies, or participation into a clinical trial. Many patients are not cured with standard therapy, and some standard treatments may have more side effects than are desired. For these reasons, clinical trials are designed to find better ways to treat cancer patients and are based on the most up-to-date information. Clinical trials are ongoing in most parts of the country for most stages of adult liver cancer. For more information, call the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.


LOCALIZED RESECTABLE ADULT PRIMARY LIVER CANCER

Treatment is usually surgery (resection). Liver transplantation may be done in certain patients. Clinical trials are testing adjuvant systemic or regional chemotherapy following surgery.


LOCALIZED UNRESECTABLE ADULT PRIMARY LIVER CANCER

Treatment may be one of the following:

1. Surgery to freeze and kill the tumor (cryosurgery), injection of ethanol into the tumor, or use of highly focused radio waves designed to destroy the tumor.

2. Liver transplantation.

3. Regional chemotherapy, including injecting the chemotherapy directly into the tumor.

4. Systemic chemotherapy.

5. Surgery with or without chemotherapy possibly followed by radiation therapy.

6. Injection of alcohol directly into the tumor.

7. Radiation therapy plus special drugs that make the tumor more susceptible to the radiation.

8. Highly focused radio waves designed to destroy the tumor


ADVANCED ADULT PRIMARY LIVER CANCER

Treatment of advanced adult primary liver cancer depends on what treatment a patient has already received, the part of the body where the cancer has come back, whether the liver has cirrhosis, and other factors. Patients may wish to consider taking part in a clinical trial.


RECURRENT ADULT PRIMARY LIVER CANCER

Treatment of recurrent adult primary liver cancer depends on what treatment a patient has already received, the part of the body where the cancer has come back, whether the liver has cirrhosis, and other factors. Patients may wish to consider taking part in a clinical trial.


TO LEARN MORE

TO LEARN MORE..... CALL 1-800-4-CANCER

To learn more about adult primary liver cancer, call the National Cancer Institute's Cancer Information Service at 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615. By dialing this toll-free number, trained information specialists can help answer your questions.

The Cancer Information Service also has booklets about cancer that are available to the public and can be sent on request. The following booklet about liver cancer may also be helpful:

In Answer to Your Questions About Liver Cancer

The following general booklets on questions related to cancer may also be helpful:

What You Need To Know About Cancer
Taking Time: Support for People with Cancer and the People Who Care About
Them
What Are Clinical Trials All About?
Chemotherapy and You: A Guide to Self-Help During Treatment
Radiation Therapy and You: A Guide to Self-Help During Treatment
Eating Hints for Cancer Patients
Advanced Cancer: Living Each Day
When Cancer Recurs: Meeting the Challenge Again

There are many other places where people can get material and information about cancer treatment and services. The social service office at a hospital can be checked for local and national agencies that help with getting information about finances, getting to and from treatment, getting care at home, and dealing with problems.

For more information from the National Cancer Institute, please write to this address:

National Cancer Institute
Office of Cancer Communications
31 Center Drive, MSC 2580
Bethesda, MD 20892-2580

Date Last Modified: 07/1999


If you want to know more about cancer and how it is treated, or if you wish to know about clinical trials for your type of cancer, you can call the NCI's Cancer Information Service at 1-800-422-6237, toll free. A trained information specialist can talk with you and answer your questions.


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