Liver cancer is on the rise but early screenings & treatment offer hope

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The Daily Checkup: Liver cancer is on the rise but early screenings & treatment

offer hope

By

THE DAILY CHECKUP

Wednesday, February 2nd 2011

The specialist: Dr. Park, on liver cancer and transplant

A transplant hepatologist and gastroenterologist at Mount Sinai Hospital, Dr.

Park treats patients who have general and advanced liver diseases, which

range from viral hepatitis to cirrhosis and liver cancer (before and after liver

transplantation). A majority of his patients have cirrhosis and liver cancer,

and many of these patients receive liver transplants.

Who's at risk

Last year 24,000 Americans were diagnosed with liver cancer, the fastest-growing

cancer of the past decade.

" Liver cancer is a malignant tumor that arises from the liver as the result of

ongoing damage or cirrhosis, " says Park. " The most common causes of this damage

are hepatitis B, hepatitis C and fatty liver disease. "

Liver cancer is the third-leading cause of cancer deaths world-wide.

Although liver cancer doesn't receive much public attention, doctors consider

the increased number of cases very worrisome. " We speculate that this increase

is due to an epidemic of patients with viral hepatitis B and C and nonalcoholic

fatty liver disease, " says Park.

Studies have shown that up to one in four adults has fatty liver disease in the

U.S. About 10% of these people have liver inflammation and scarring, which are

markers for more severe liver disease.

Of the 5 million Americans with hepatitis B, those born in Asia and sub-Saharan

Africa are at particularly high risk of having hepatitis B. About 10 million

Americans have hepatitis C. One third of those patients eventually develop liver

cirrhosis in two decades.

Liver cancer can strike adults at any age, though it usually takes two decades

to develop following an infection of

hepatitis C.

" Men are more likely than women to develop liver cancer, especially if they have

hepatitis B or cirrhosis, " says Park. " A family history of liver cancer or

cirrhosis also places you at an elevated risk. " These high-risk patients should

receive a liver cancer screening every six months with tests of

alpha-fetoprotein (AFP) and liver imaging, advises Park.

Signs and symptoms

One difficulty in fighting liver cancer is that it's usually asymptomatic in

early stages. " It's often considered the most effective silent cancer, because

the liver is very resilient. Most people don't develop symptoms until the tumor

is very advanced, " says Park.

At that point, the warning signs include vague abdominal pain, weight loss,

lower leg swelling, belly swelling, jaundice, confusion or memory problems, and

gastrointestinal bleeding. " By then, patients do generally seek medical

attention because they feel quite sick, " says Park.

The definitive diagnosis is usually made with the results from a CT scan or an

MRI. A liver biopsy is not needed to confirm the diagnosis if imaging diagnostic

criteria are met.

Traditional treatment

The key to fighting liver cancer is early diagnosis. " Although liver cancer can

be deadly, it's preventable and curable if we catch it in time, " says Park. " The

treatment options depend on tumor size, tumor spread, the patients' overall

health status and liver function. "

For most healthy patients with a small tumor and without significant cirrhosis,

surgery can be effective.

" We call this surgical resection of the tumor, " says Park. " We take out only the

part of the liver with the tumor and leave the healthy liver behind. "

But unfortunately, only 10%-15% of patients are suitable for surgical resection

due to the extent of liver cancer and poor liver function.

Patients whose liver cancer is at early or intermediate stage are candidates for

liver transplant. Moreover, some patients with advanced-stage cancer may be

eligible for liver transplant.

" Currently, the best chance for cure and survival is achieved through liver

transplantation, " says Park. " In those who meet criteria, about 75% of liver

cancer patients are alive four years after the transplantation and 83% of those

remain cancer-free. "

For patients with intermediate and advanced cancer, doctors will often buy time

or delay progression by shrinking the tumor using local therapies like ablation,

which uses an electric current to kill part of the tumor, and chemoembolization,

which delivers a large dose of chemotherapy directly to the liver tumor via the

blood vessels supplying it.

Surgery is not possible for some patients who have advanced cancer that has

spread into their major blood vessels or outside the liver.

" For these patients, we have local treatments and oral anti-cancer pills that

work to prolong life, " says Park.

Research breakthroughs

Doctors are pushing hard to improve the treatment not only for liver cancer but

the liver diseases that lead up to it.

" Mount Sinai is the leading center of research on hepatitis, liver scarring and

liver cancer, " says Park. " We are also running a number of clinical trials that

are studying and using innovative treatment modalities for liver cancer. "

Questions for your doctor

Because liver disease is currently epidemic in the U.S., Park recommends that

all patients ask: " Am I at risk of hepatitis or liver disease? " If the answer is

yes, ask the doctor, " Do I need to be screened for liver cancer? "

What you can do

Watch for risk factors.

Hepatitis B, hepatitis C and fatty liver diseases are the big three risk factors

for liver cancer. Ask your doctor how you can manage and minimize such risks.

Know your numbers.

In the same way you track your cholesterol level, pay attention to your ALT

(liver enzyme) level. Normal ALT levels are 30 IU/L for men and 19 IU/L for

women.

See an expert.

If your primary care physician sees a sign of chronic liver disease, get a

referral to a hepatologist.

Get informed.

Dr. Park directs patients to the reliable information on sites run by the

Liver Foundation (liverfoundation.org), the American Association for the Study

of Liver Disease (aasld.org) and the American Cancer Society (cancer.org).

Read more:

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