As already indicated above, liver cancer is treated quite differently depending on the liver cancer stage the patient is in.
Generally speaking the more localized liver cancer is, it can be removed by surgery. There are 8 liver segments that have been defined by liver surgeons (see Ref.1, p.884) and if the tumor is found early enough, it might be possible to remove just this segment. This is called a segmental resection of liver cancer.
With stage II a liver lobe is removed (called “lobectomy”) and if the lymph glands that are probed during the surgery are negative this should lead to good survival results. From stage III onwards the survival becomes extremely poor as liver cancer has a potential to metastasize very quickly when stage III or IVA is reached. As can be seen from the survival rate table, the only hope for longterm survival comes from surgical resection and experience with liver transplants. Liver transplants are relatively easy to find compared to heart transplants, as pointed out in the introduction. There is no need to match for histocompatibility loci.
Survival of liver cancer patients (various treatments)
| Stage: | No treatment: | Surgical resection: | Liver transplant: |
| (TNM) | 3-year survival | 5-year survival | |
| I | ‹ 10% | 50% | 75% |
| II | 0% | 25% | 60% |
| III | 0% | no cirrhosis:50% | 40% |
| with cirrhosis:‹10% | |||
| IVA | 0% | 0% | 10% |
| IVB | 0% | 0% | 0% |
The only match that is necessary is the ABO blood group and this can be done within one hour. The advantage of a liver transplant is that in a patient with liver cirrhosis, where the liver metabolism is compromised, two problems are solved with one procedure: the cancer is removed and the liver metabolism is normalized. In the 1990’s the surgical techniques have been improved so that mortality rates with liver transplantation surgery have dropped to 10% or less in the large cancer centers. Considering the alternative of less than 10% survival with no therapy or 50% survival with a segmental resection after 3 years, makes the 5-year survival of 75% very attractive (Ref. 1 and 2).
Radiotherapy
As liver cells are very sensitive to radiation and radiation hepatitis occurs with it, there is no big place for radiotherapy in the treatment of liver cancer. However, radiotherapy has a limited place under certain conditions: that not more than 30% of the liver is radiated, that fractionated smaller doses are used or that brachytherapy (local radiation with radioactive device that is left in place for a period of time) is used (Ref. 1, p. 894).
Chemotherapy
On the other hand, chemotherapy is already being used widely as there is an overall improvement of short-term survival by 25% utilizing agents like 5-fluorouracil, cisplatin, doxorubicin and others. The most effective way of administering chemotherapy in liver cancer is to give it by way of an intra-arterial catheter, which allows higher dosing with a lack of systemic side-effects.
Unfortunately, the response is short lived and with chemotherapy alone the overall survival does not change. When chemotherapy is combined with surgery, either before surgery to reduce the bulk of the cancer, or after surgery to remove any remaining cancer cells, the longterm survival appears to be improved by 10 to 15%. Protocols are being more refined, partially modelled according to the successful cytoreductive therapy with ovarian cancer where chemotherapy and surgery are combined as well. With these newer methods combined with liver transplantation stage II and IV liver cancer patients may experience longer survival times. Some encouraging pilot studies have already been done, but properly designed clinical trials are required before this can be generally recommended (Ref. 3).
References:
1. Cancer: Principles &Practice of Oncology.4th edition. Edited by Vincent T. DeVita, Jr. et al. Lippincott, Philadelphia,PA, 1993. Chapter on Hepatobiliary Neoplasms.
2. Cancer: Principles&Practice of Oncology. 5th edition, volume 1. Edited by Vincent T. DeVita, Jr. et al. Lippincott-Raven Publ., Philadelphia,PA, 1997. Chapter on Hepatobiliary Neoplasms.
3. SA Hussain et al. Ann Oncol 2001 Feb;12(2):161-172.
4. M Nakamura et al. J Cell Physiol 2001 Jun;187(3):392-401.
5. Conn’s Current Therapy 2004, 56th ed., Copyright © 2004 Elsevier
6. Ferri: Ferri’s Clinical Advisor: Instant Diagnosis and Treatment, 2004 ed., Copyright © 2004 Mosby, Inc
7. Suzanne Somers: “Breakthrough” Eight Steps to Wellness– Life-altering Secrets from Today’s Cutting-edge Doctors”, Crown Publishers, 2008
