University of Kentucky’s Liver Transplant program has teamed up with the Markey Cancer Center to develop the UK Multidisciplinary Liver Tumor Program. In addition to the liver transplant surgeons, hepatologist, surgical oncologist, interventional radiologists and endoscopists, medical oncologists and radiation oncologists work together to create expert care for tumors of the liver and bile duct.
These tumors include all primary cancers (including hepatocellular cancer and cholangiocarcinoma), all metastatic cancers (including colorectal, neuroendocrine and others), and any nonmalignant tumors. Multidisciplinary Liver Tumor Program at UK HealthCare provides timely diagnosis and individualized treatment and surveillance for patients – based on expert consensus across multiple medical and surgical disciplines involved with liver disease. In addition to their involvement in the Multidisciplinary Liver Tumor program the transplant surgeons also specialize in benign complex diseases of the hepatopancreaticobiliary tract.
Most cancers found in the liver have spread from other places in the body. However, cancer that occurs only in the liver is known as hepatocellular carcinoma. While hepatocellular carcinoma is common in many parts of the world, it is not as common in the United States and most developed countries. Because it is hard to treat, it causes between 2% and 5% of cancer deaths in the US.
Liver cancer all over the world is related to chronic liver disease. Preventing liver disorders or finding them early will decrease the number of people who develop liver cancer.
Anything that damages the liver can eventually cause liver cancer. Many patients already have extensive damage and cirrhosis. Causes include:
• Chronic hepatitis B and C infection. The hepatitis B vaccine makes this less common in the United States. There is no hepatitis C vaccine at this time.
• Alcohol abuse.
• Inherited diseases which cause damage or prevent the liver from working normally
• Aflatoxin exposure over time. Aflatoxins come from a fungus which can grow stored nuts and grains.
There are other factors making the development of hepatocellular carcinoma more likely, such as being sex, obesity, type 2 diabetes, and anabolic steroid use. Other toxic substances that may contribute to the risk of liver cancer are arsenic and vinyl chloride.
Unfortunately, people with liver disease may already have the symptoms of liver cancer, which include:
• Abdominal pain
• Lack of appetite and weight loss
• Swelling of the abdomen
• Jaundice, a yellowing of the skin and whites
• A large liver or large spleen
• Worsening symptoms of cirrhosis
Anyone who has a chronic liver condition, especially cirrhosis or chronic viral hepatitis may develop cancer. Often these patients are screened every 6 to 12 months with a blood test for alpha-fetoprotein (AFP) and an ultrasound scan of the liver.
People with new symptoms of liver disease and/or cancer need blood tests looking for liver inflammation and function and the presence of hepatitis B or C. Imaging tests are frequently done, such ultrasound, MRI, or CT scan, to look for any suspicious areas. Scanning tests can also help check for spread of cancer to other areas of the body.
If needed, a biopsy can be done with a needle, and or a small lighted tube may be inserted into the abdomen to get a look at the liver and take a biopsy. This is called laparoscopy.
Treatment of liver cancer depends on the size of the tumor, whether it has already spread to other areas of the body, and the individual’s general health.
The best treatment for liver cancer is to remove it surgically. However, it is often difficult to remove the entire cancer.
Very small cancers that have not spread can be treated with a liver transplant, which not only gets rid of the cancer, but gives the person a healthy liver. Most cancers are not found at this stage.
Advanced liver cancer can be treated with chemotherapy or radiation therapy. Tumor cells can be killed by freezing, radio waves, microwaves, or by cutting off their blood supply. Sometimes more than one type of treatment is used.
This is an area of active research, and new treatments may be developed. Again, a liver transplant may be curative, but this option is frequently not possible.