Liver Cancer

Liver is the second largest human organ, coming after skin. It is the chemical factory of human body and has some important functions, as storing some nutrients, converting fat to energy when necessary, producing bile, making certain amino acids, filtering harmful substances from blood, producing cholesterol, and so on. No one can live without liver. Liver cancer is the sixth most common diagnosed cancer and the third cause of cancer death worldwide. The incidence rates of liver cancer in Europe, and America is low, while the incidence rate of East Asia and Middle Africa can be three-fold higher than the average level, perhaps due to the high infection rate of hepatitis B and C and consumption of foods contaminated with aflatoxin in those areas. And the incidence rate in males is about three times that in females. But even in western country the new cases of primary liver cancer increase while many other cancers are declining. What is liver cancer?Liver cancer refers to the growth of malignant tumors in liver tissue. Cancer is named after where it originally starts. Only cancer that starts in the liver is called liver cancer, or primary liver cancer. In all cases of liver tumors, primary liver cancer is relatively rare. In most cases, it is secondary cancer or metastatic liver cancer, which means that tumor originally grows in other part of the body, has spread to liver. Usually the data of liver cancer only refers to the cases of primary liver cancer. There are two different types of primary liver cancer, heptoma and cholangiocarcinoma. Heptoma or hepatocullular carcinoma (HCC) is the cancer that arises from hepatocytes, the main function liver cells. HCC is a ball-like tumor, usually confined to the liver, thought sometimes it spreads to other organs. It is more common in men and mostly occurs in people with cirrhosis. Cholangiocarcinoma or bile duct cancer starts in the bile duct cells. This cancer grows along the bile ducts in sheets or lines, and is hard to find with X-ray. Cholangiocarcinoma is more common in women. Some primary tumors in the liver are benign (non-cancerous). They are usually small and may cause no symptoms. And they do not usually need to be removed unless they are causing symptoms. Most cases of liver cancer are actually metastases. Liver is one of the most common places for metastases to grow due to its high blood flow and biological functions. Secondary liver cancers can be metastases originally from colon, pancreas, stomach, lung or breast. What are the symptoms for liver cancer?A very early liver cancer usually has little or no symptoms since it is too small to cause any. As the cancer enlarges, it will have symptoms. Following are some of the symptoms for liver cancers.
Weight loss: Significant weight loss is defined as weight loss of more than 10% of the normal weight. Obvious loss of body weight doesn¡¯t necessarily mean that you are ill if you are on diet. But when there is no obvious explanation for the weight loss, please go to check it out with doctor. Swollen tummy (abdomen): Liver itself can get bigger with the cancer growing large, which may cause swelling over the right side of the abdomen. Meanwhile, sometimes swollen tummy is caused by ascites because the high pressure in the cancerous liver veins forces the fluid to leak from the veins into the abdomen. If ascites does develop, a tube can be put through the wall of the abdomen to drain the fluid away.Jaundice: Jaundice is yellowish discoloration of the skin and sclerae (white of the eyes). As the tumor grows large, the bile ducts of liver can become blocked, and the bile produced by the liver will flow back into the bloodstream, and the bilirubin in the blood accumulates, which causes juandice. Other signs of jaundice are dark-coloured urine and pale stools. The jaundice can be relieved sometimes by itself, or by inserting a narrow tube called stent in to the bile duct to keep it open and to allow the bile to flow normally into the small intestine. Pains: Sometimes people carrying liver cancer may feel a pain in the upper abdomen due to enlargement of the liver. Pains can also be felt in the right shoulder blade as nerves beneath the diaphragm connecting the right shoulder are stimulated by the enlarged liver. Other symptoms of liver cancer include loss of appetite, breast swelling in males, feeling sick and feeling full after a small meal. Some even have a high fever and feel shivery. If you have any one or some of the risk factors for liver cancer, and any of the above symptoms, please go to check it out with your doctor immediately. What are the risk factors for liver cancer?The exact cause of liver cancer is still unknown. But there are several risk factors that are known to increase one¡¯s likelihood to get liver cancer.
Cirrhosis: Over 80 percent of liver cancer cases in western countries are linked to cirrhosis. Liver cirrhosis is a fine scar tissue throughout the liver due to previous damages, including infection, inherited diseases and alcohol abuse. In the United States, hepatitis C and heavy alcohol drinking over a long period of time are the main causes of liver cirrhosis. However, only a small proportion of people who have liver cirrhosis develop primary liver cancer. Infection: Chronic infection with hepatitis B virus (HBV) or hepatitis C virus (HCV) increases greatly the risk of developing liver cancer. Infection with HBV and HCV can also be the cause of cirrhosis, which increases the risk of liver cancer. HBV and HCV can spread from person to person through sharing contaminated needles (such as in drug use), unprotected sex, childbirth and blood transfusion. In the Unites States, infection of HCV is the most common cause of liver cancer while in Asia and developing countries, infection of HBV is more common. People infected by the two virus have higher risk to develop chronic hepatitis, cirrhosis and liver cancer. Of the two viruses, infection with HBV is more likely to cause symptoms, such as a flu-like illness and jaundice. And only a very small percentage of adults become chronic carriers. But the risk is higher in infants and small children who become infected. HCV, on the other hand, is less likely to cause symptoms. But most people with HCV develop chronic infections, more likely leading to liver cancer. Smoking: There is a link between smoking and liver cancer. Studies conducted in China and Japan show that among those who infected with HBV or HCV, the risk of smoker to develop liver cancer is as high as 12 times of non-smoker¡¯s. Inherited metabolic diseases: Certain inherited metabolic diseases can also lead to liver cancer. People with conditions of haemochromatosis, alpha1-antitrypsin deficiency, or porphyria cutanea tarda, have a higher risk of developing hepatoma. Obesity: Obesity can result in fatty liver disease and cirrhosis, which increase the risk of liver cancer. Aflatoxins: Alatoxin is a cancer-causing substances, found in mouldy peanuts, wheat, soybeans, ground nuts, corn and rice. Long-term exposure to aflatoxins is a major cause of hepatoma in Africa and Asia. The risk increases in people with HBV, or HCV infection.Anabolic Steroids: Anabolic steroids are male hormones that some athletes are known to use to increase their strength. Long-term use of anabolic steroid can slightly increase the risk of hepatocellular cancer. Arsenic: Long-term exposure to arsenic in drinking water, which might occur in some wells, increases the risk of liver cancer. This is more common in parts of East Asia.Diabetes: Diabetes can increase the risk of liver cancer if the patients have other risk factors such as heavy alcohol consumption or chronic hepatitis.Please remember that risk factors are not at all absolute. Having a risk factor, or even several risk factors, does not mean that you will get liver cancer. And many people who carry liver cancer may not have had any known risk factors listed above. How is primary liver cancer staged?Stage tells how widespread a cancer is. It tells whether the cancer is still contained within the liver or has spread to elsewhere. The stage of liver cancer is the most important factor for the doctor to decide the appropriate treatment options. The most accepted stage system of liver cancer is the American Joint Committee on Cancer (AJCC) TNM system. It tells the information including, tumor (T), extent of spread to regional lymph nodes (N), and whether the cancer has metastasized to other organ of the body (M).
Information for staging: TX, primary tumor cannot be assessed; T0, no evidence of tumor; T1, single tumor (any size) without invasion into blood vessels; T2, single tumor (any size) with invastion into blood vessels, or multiple tumors none of which are greater than 5 cm across; T3, multiple tumors that are greater than 5 cm across, or a tumor involving a major branch of the portal or hepatic veins; T4, tumor invading a nearby organ (other than the gallbladder), or tumor invading the visceral peritoneum (covering surrounding the liver).NX, regional lymph nodes cannot be assessed; N0, cancer has not spread to regional lymph nodes; N1, the cancer has spread to the regional lymph nodes.MX, distant spread cannot be assessed; M0, the cancer has not spread to distant lymph nodes or other organs; M1, the cancer has spread to distant lymph nodes or other organs. Summary of stages The T, N, M groups are combine to give an overall stage: Stage I - T1, N0, M0: there is a single tumor (any size) that does not invade blood vessels.Stage II - T2, N0, M0: there is a single tumor (any size) that does invade blood vessels; or there are several tumors, and all are less than 5 cm in diameter.Stage IIIA - T3, N0, M0: there are several tumors, and at least one is larger than 5 cm in diameter; or a tumor invades a branch of the major liver blood vessels (portal vein or hepatic vein).Stage IIIB - T4, N0, M0: a tumor invades a nearby organ (other than the gallbladder); or tumor has penetrated the outer covering of the liver.Stage IIIC - Any T, N1, M0: the cancer has invaded nearby lymph nodes, no matter the size and number of tumors.Stage IV - Any T, Any N, M1: the cancer has spread to other parts of the body, no matter the size and number of tumors, and whether nearby lymph nodes involved or not.Traditional TreatmentsThe treatments vary greatly according to the individuals. To create a treatment plan, the most important factor is the stage of liver cancer, and the doctors would also take into account the age, general stage of health, personal preference. Some possible treatments are surgery, chemotherapy, radiotherapy.
SurgerySurgery is the most effective treatment for primary liver cancer that has not spread. There are two main options: liver transplant and partial hepatectomy. Both are potentially curable treatments. But only a very small portion of patients could benefit from surgeries. Hepatectomy is the surgical removal of the liver. The extent of hepactectomy depends on the number, size and site of cancer. The surgery may remove part of liver containing cancer, an entire lobe, or an even larger portion of liver. Liver has an amazing ability for self-repair. Even more than half of the liver is removed, it would grow back to its normal size in a couple of weeks. But hepatectomy is only available for those who are diagnosed early and no cirrhosis or metastasis occurs and whose rest of liver is still healthy. However even hepatectomy is taken, recurrence may occur sometimes if the liver still contains cancer the underlying disease that led to the first one. Liver transplant is to remove the whole liver and to replace it with a liver from another person. It may be a good option for the patients who have cirrhosis. But only those, whose liver tumor is less than 5 cm or up to 3 tumors all smaller than 3 cm across, can have liver transplant. Unfortunately the suitable donor for liver cancer is limited. And for most cases of primary liver cancer, liver transplant couldn¡¯t help. It is a too big surgery to survive if the patient is too ill. Or if the cancer has spread to other part of body, transplant won¡¯t cure it.ChemotherapyIn cancer treatments, doctors use chemotherapy to slow down the progress of cancer and palliate symptoms. But generally, primary liver cancers in adults are not sensitive to the usual chemotherapy. But chemotherapy is a standard tool to hepatoblastoma, the type of liver cancer that affects only children. Chemotherapy is often used to shrink the cancer before the surgery, or try to stop the cancer from coming back after surgery. RadiotherapyRadiotherapy uses high¨Cenergy ray to kill cancer cells. It helps to shrink the cancer to relieve the pain but no improvement of survival since normal liver cancer is sensitive to radiation together with liver cancer cells.
Pilot treatmentsCombination of surgery and immunotherapy for early stage liver cancer.Surgery, or hepatectomy, is the most promising option for early stage liver cancer patients with no cirrhosis to remove the lesion and control the development of the disease. Then CIK biotherapy, as the most efficient immunotherapy at present, will be adopted to kill the tiny scattered cancerous cells in blood and lymph and to restore the immune system.
Features:1. Radical cure for early stage liver cancer.2. Efficient prevention of recurrence and metastasis. 3. No toxicity or side effects to human body. No destroy to normal tissues. CIK cells could recognize and kill cancerous cells with no harm to healthy cells. 4. Quick recovery after treatments. 5. Quality of life improved with an enhanced immune system.Combination of Cryoablation, Gene therapy, Antiangionesis therapy, interventional therapy and immunotherapy for advanced stage liver cancerAdvanced stage refers to stage IIIb or IV. At advanced stage, the liver tumors usually are relative large with multiple metastases. Surgery is no longer available and chemotherapy cannot control the growth of tumor for advanced liver cancer. Our pilot treatment could cease the development of liver cancer and relieve the pains suffered by patients with good quality of life. Cryoablation kills cancer cells by freeze-thaw cycle and it is available to advanced stage liver cancer patients as well as early stage ones. Transcatheter hepatic arterial chemoembolization (TACE) is the interventional therapy usually applied to treat liver cancer. Small catheters are punctured to the branches of the hepatic artery supplying the tumors and aliquots of chemotherapy dose and of embolic particles are injected through the catheters. TACE kills tumor in a better efficiency since it cuts off the blood supply for tumor and it allows a higher dose to the cancerous tissue while reducing toxicity to the whole body. CIK-DC cell immunotherapy, the most efficient immunotherapy at present, can kill the tiny scattered cancerous cells in blood and lymph and to restore the immune system.
Features:1. Minimally invasive surgery-cryoablation, with little harm to normal function and little pains to patients, small wound and quick recovery.2. Available for advanced liver cancer patients. Most of primary liver cancers diagnosed are advanced liver cancer patients who have no chance for hepatectomy. Then cryoablation is a good option to remove the lesions safely and quickly.3. Ar-He cryoablation can block out blood vessel, which helps to enhance the therapeutic effects of TACE on large liver tumors.4. CIK-DC cell immunotherapy, as well as enhances the efficacy of Ar-He cryoablation and TACE, can improve the immune function against tumor, which significantly extends survival time with a good quality of life. 5. No toxicity or side effects.The pilot treatment for advanced stage liver cancer offered by CTC removes the lesions as well as improves immune system. It is a promising treatment to improve life quality and extend survival time. Combination of Cryoablation, Gene therapy, Antiangionesis therapy, interventional therapy and immunotherapy for recurrence and metastatic liver cancer. Metastatic liver cancer is secondary liver cancer. Together with recurrence, metastatic liver cancer usually happens in advanced stage, when the patient is too weak for another surgery or for chemotherapy. Combination of Cryoablation, interventional therapy and CIK-DC cell immunotherapy is a good systematic treatment for recurrence and metastatic liver cancer.