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 your food into energy. The liver also filters and stores blood.

Primary liver cancer is different from cancer that has spread from another place in the body to the liver (liver metastases).

A separate PDQ statement is available for childhood liver cancer.

Adult primary liver cancer is very rare in the United States. 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.

Like most cancers, liver cancer is best treated when it is found (diagnosed) early. You should see your doctor if you have a hard lump just below the rib cage on the right side where the liver has swollen, you feel discomfort in your upper abdomen on the right side, you have pain around your right shoulder blade, or your skin turns yellow (jaundice).

If you have symptoms, your 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, your doctor may use a needle inserted into your abdomen to remove a small amount of tissue from your liver. This procedure is called a needle biopsy, and your doctor usually will use an x-ray for guidance. Your doctor will have the tissue looked at under a microscope to see if there are any cancer cells. Before the test, you will be given a local anesthetic (a drug that causes loss of feeling for a short period of time) in the area so that you do not feel pain.

Your 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. Your 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. You will be given an anesthetic so you do not feel pain.

Your 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 your 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 your doctor diagnose primary liver cancer.

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

STAGE EXPLANATION

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 (taking out the cancer in an operation)
radiation therapy (using high-dose x-rays to kill cancer cells)
chemotherapy (using drugs to kill cancer cells). 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.

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. Only a very few patients with liver cancer are eligible for this procedure.

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

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 your doctor removes all the cancer that can be seen at the time of the operation, you 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.

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 your body to fight germs and other harmful things; each antibody fights specific cells.

Hyperthermia therapy is the use of a special machine to heat your 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 is the use of methods to get your body to fight cancer. Materials made by your body or made in a laboratory are used to boost, direct, or restore your 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 your disease the condition of your liver, your age, and your general health. You may receive treatment that is considered standard based on its effectiveness in a number of patients in past studies, or you may choose to go 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 going on in most parts of the country for most stages of adult liver cancer. If you want 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

Your treatment may be one of the following:

1.A clinical trial of liver transplantation (in certain patients).
2.A clinical trial of regional chemotherapy, including local infusion of chemotherapy.
3.A clinical trial of systemic chemotherapy.
4.A clinical trial of surgery followed by chemotherapy. Hyperthermia or radiation therapy with or without drugs to make the cancer cells more sensitive to radiation may be given in addition to chemotherapy.
5.A clinical trial of local injection of pure alcohol, or cryosurgery.
6.A clinical trial of radiation therapy.

ADVANCED ADULT PRIMARY LIVER CANCER

Your treatment may be one of the following:

1.A clinical trial of biological therapy.
2.A clinical trial of chemotherapy.
3.A clinical trial of chemotherapy, radiation therapy, and drugs to make the cancer cells more sensitive to radiation (radiosensitizers). 4.A clinical trial of external radiation therapy plus chemotherapy followed by radiolabeled antibodies.

RECURRENT ADULT PRIMARY LIVER CANCER

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


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, you can speak with someone who can answer your questions.

The Cancer Information Service can also send you booklets. The following booklet about liver cancer may also be helpful to you: 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 you can get information about cancer treatment and services to help you. You can check the social service office at your hospital for local and national agencies that help with your finances, getting to and from treatment, care at home, and dealing with your problems.

You can also write to the National Cancer Institute at this address:

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

If you want to know more about cancer and how it is treated, or if you 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.

Source:http://www.noah.cuny.edu:8080/cancer/nci/cancernet/201195.html

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