Treatment
Of Liver CancerAs 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.
| 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% |
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. 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 shortterm 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 dosaging 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). |
