The most commonly asked questions
about the liver, liver cancer, its diagnosis, and its treatments.
Questions & Answers
Liver Cancer
To the Patient and Family
The Liver
What is cancer?
What causes liver cancer?
What are the symptoms of liver cancer?
What are the frequent tests used to evaluate liver cancer?
How is cancer of the liver treated?
When is surgery a treatment option?
What about your nutrition?
What happens after surgery?
What if the tumor can’t be removed by surgery?
How can I learn to live with cancer of the liver?
Multidisciplinary Liver Cancer
Team
To the Patient and Family
This booklet has been written for people who have received a
diagnosis of liver cancer (primary or metastatic) or who are being tested for this
illness.
If you have questions that are not answered by this booklet, please
ask your doctor, nurse, or another member of your health care team.
Always ask your doctor for copies of your pathology
reports and operative notes. This way you can keep your own set of these
important records.
For additional information, see our liver web site on the Internet.
You can find it by opening the M.D. Anderson home page at http://www.mdanderson.org. Select Care Centers from
the navigation bar, then select the Gastrointestinal Center.
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The Liver
is located in the right upper section of the abdomen
is surrounded by the stomach, the diaphragm, the gallbladder and
the intestine
is one of the largest organs of the body, representing
approximately 2% of the total body weight
has two main anatomic lobes (right and left), as show in Figure
1. The right and left lobes are further divided into sectors and segments as depicted in
Figure 2
Figure 1:
Figure 2:
carries out essential functions including the processing of
by-products of digested food, the secretion of bile that helps in the digestion of food,
the maintenance of the metabolism of fats, carbohydrates, and proteins including the
production of important proteins (albumin, clotting factors, etc.).
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What is cancer?
Cancer develops when healthy cells become abnormal and grow too
quickly. The abnormal cells form a mass called a tumor. When a tumor has the
ability to spread to other parts of the body, it is called malignant. Another word
for a malignant tumor is cancer.
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What causes liver cancer?
The exact cause of liver cancer is not known. Risk factors
for primary liver cancer (hepatocellular carcinoma) include
In many patients, liver tumors result from the spread (metastasis)
of another cancer to the liver through the bloodstream. Most commonly, cancer occurring in
the colon, rectum, breast, or kidney may spread to the liver. In this instance, these
tumors are the primary source of the liver cancer.
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What are the symptoms of liver cancer?
Many patients do not experience symptoms; the
cancer is discovered during routine follow-up tests for a previous cancer outside of the
liver, or during diagnostic testing for the presence of cirrhosis or viral hepatitis B or
C. Symptoms of liver cancer include
Pain: Pain associated with liver cancer may be
located on the right side of the upper abdomen, in the right shoulder, or in the back.
Indigestion, lack of appetite, nausea, and weight loss:
These symptoms can occur when a liver tumor presses against the stomach and small
intestine. Problems with digestion may also occur for complex reasons not specifically
related to the location of the tumor.
Jaundice: Jaundice shows up as yellow skin and
eyes, dark urine, and light colored stool. Jaundice occurs when a substance called
bilirubin builds up in the blood. Bilirubin is made in the liver and then travels down the
bile duct just before emptying into the duodenum, a section of the small intestine. If a
large amount of the liver is replaced by tumor, or if bile duct obstruction occurs,
bilirubin builds up in the blood. This buildup causes a person to become noticeably
yellow, or jaundiced. Also itching can occur when bilirubin builds up in the blood.
Obstructed (blocked) bile ducts can increase the risk of infection, including sepsis
(infection in the blood).
Fever: Fever is always a possible sign of
infection. Fever, without infection, is occasionally associated with liver cancer.
Infection should first be ruled out with appropriate testing, especially when fevers are
101.5 °F (38.5°C) or higher.
Abdominal or Leg Swelling: Abdominal fluid
(ascites) can build up in the setting of chronic (long-standing) liver disease. It may be
accompanied by swelling of the legs. Abdominal and leg swelling can also be caused by
other illnesses such as heart or kidney disease. Liver cancers are often associated with
ascites (abdominal fluid). This fluid can be removed temporarily with a needle
(paracentesis) or sometimes can be controlled with diuretics (fluid pills). Successful
treatment of liver cancer may result in the reduction of abdominal and leg swelling;
however, this swelling can persist if it is due to the underlying liver disease (for
example, underlying cirrhosis).
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What tests are used most frequently to evaluate
liver cancer?
Blood tests: Some tumors produce measurable
amounts of chemicals known as tumor markers in the blood. Blood tests for the presence of
these markers can be used to help diagnose or monitor the disease process. Other tests
measure the functions of the liver and other organs.
Ultrasound (US): This test uses sound waves to
form a picture that can be seen on a small television screen. The picture can show organs
in the abdomen and possibly the presence of a tumor. Ultrasound is commonly performed by
placing a probe on the surface of the abdomen.
Computed tomography (CT) scan: By means of a
special type of X-ray machine, this test gives detailed pictures of the body and can show
how far the cancer has spread. The CT scan is the primary test used to determine the
number and size of tumors in the liver and whether the tumor can be surgically removed.
Magnetic resonance imaging (MRI): By means of a
magnetic field, precise images of the liver can be obtained. This test is obtained when
further details of the liver and tumor anatomy are required.
Fine needle aspiration (FNA): If a tumor has
been identified, it can be sampled (or biopsied) in one of two ways: under the guidance of
US or with a CT scan. When FNA is performed, a doctor will guide a small needle through
the skin and abdomen and into the liver after injecting some local anesthetic (numbing
medicine). The US or CT scan help the doctor find the exact location of the tumor. The
procedure in which these cells are obtained and then examined under a microscope is called
a biopsy.
Angiography: This
test studies the blood vessels in and around the liver. It is done in the X- ray
department with the aid of local anesthetic. A small catheter is placed into the artery in
the upper thigh. Dye is injected into the blood vessels leading to the liver and X-rays
are taken. These pictures can help the surgeon plan your operation.
Paracentesis: With this procedure, a needle is
placed into the abdominal cavity (but not into the liver) to remove excess abdominal fluid
(ascites). This fluid can be tested for cancer cells or infection. Sometimes the fluid is
removed in large quantities (for example, 3 to 5 quarts) in order to provide symptomatic
relief.
Laparoscopy: This test is done in the operating
room under general anesthesia. The surgeon guides a small camera through a half-inch
incision in the abdomen. The organs in the abdomen can then be examined directly. This
test is done to find out if the liver tumor has spread to other parts of the liver or
other organs or structures inside the abdomen.
Note: The tests described above usually do not
require an overnight hospital stay. Exploratory surgery is rarely done to diagnose liver
tumors or other abnormal conditions.
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How is cancer of the liver treated?
In many instances, individual cases are discussed at a
multi-disciplinary conference. Doctors from all the relevant specialties (surgery, medical
oncology, radiation oncology, gastroenterology, diagnostic radiology, and pathology)
review the main information on the case and make a recommendation on the appropriate
multi-disciplinary management. You can request that your case be presented at this
conference.
The treatment recommended for you will depend on the extent of your
disease, the specific type of liver cancer (primary or metastatic), and your general
health. Your test results will help your doctor plan a treatment program that is best
suited for you. There are four forms of treatment for liver cancer. One or a combination
of these treatments may be used.
removing the area of the liver containing the tumor
killing the tumor using a special needle that destroys the tumor
with heat (called radiofrequency ablation)
placing a device called an infusion pump to give chemotherapy
directly to the liver, or any combination of the above.
Chemotherapy: This therapy uses drugs to kill
cancer cells. The drugs usually are given intravenously (through a vein into the
bloodstream). Some patients receive chemotherapy via a hepatic artery infusion pump.
During surgery a pump is placed under the skin of the abdomen and filled intermittently
with chemotherapy agent(s). The tip of the pump catheter is placed in the hepatic artery
to directly infuse treatment into the liver.
Radiation Therapy: This treatment uses radiation
waves to kill cancer cells. Radiation usually is administered by a machine directed at the
body area to be treated. Following planning with computer simulation, treatments usually
are given on an outpatient basis, Monday through Friday for 2 to 5 weeks. Radiation
therapy is not used as commonly in the treatment of liver cancer as are surgery and
chemotherapy. Sometimes radiation is given together with chemotherapy or given during
surgery.
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When is surgery a treatment option?
If a tumor can be removed, surgery will be done. Figure 3 shows the
extent of the typical surgeries used to remove liver tumors. Up to 75% of the liver can be
removed since the liver does grow back if no cirrhosis or hepatitis is present (regeneration).
The liver and peripheral nerves are the only tissues of the body capable of regeneration.
In some patients, a combination of resection and radiofrequency ablation will be used.
Following surgical removal of the tumor, some patients may have a hepatic artery infusion
pump placed to treat the liver with chemotherapy in an attempt to prevent the return of
the liver cancer.
Figure 3:
After surgery, patients may be required to stay in the Intensive
Care Unit (ICU) for one or two days, and remain in the hospital for 5 - 14 days. Patients
who do not live in the Houston area may need to stay locally for one or more weeks after
discharge from the hospital. Patients usually need one to two months of recovery at home
before they can return to their normal activities.
Chemotherapy may be given before or after surgery and is given
intravenously. The schedule depends on the particular drug given. Patients receiving
chemotherapy and radiation therapy do not need to be admitted to the hospital for these
treatments.
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What about your nutrition?
Before surgery: Many patients with liver
cancer have lost weight by the time they receive the diagnosis. However, to keep your body
strong, it is important to maintain your weight before, during, and after therapy.
Good nutrition helps minimize the side effects of treatment. Side
effects from chemotherapy and surgery may affect your ability to eat and may also cause
your body to need more calories than usual. Eating small, frequent meals (four or five a
day) of a balanced diet will help you maintain your weight and your strength. If needed,
you may talk to a dietician who will help you with any nutritional questions or problems.
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What happens after surgery?
When you are discharged from the hospital,
you will be given a set of instructions regarding "do’s
and don’ts" after major surgery.
a prescription for pain and any other necessary medications will
be given to you. Since constipation is a known side effect of the commonly prescribed pain
medications, an over-the-counter laxative medicine is recommended (Senokot R,
Colace R, etc.).
you will need to return to the clinic or see your doctor every
three to four months for routine checkups.
After surgery, you may have fatigue, diarrhea, weight loss, and a
full feeling that does not disappear after meals. However, after a few weeks, these
feelings will go away, and you will be able to return to a normal diet and routine.
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What if the tumor can’t be removed by
surgery?
If a tumor has spread beyond the liver or cannot be removed
surgically, the next best treatment will be chemotherapy. Many different chemotherapy
drugs and combinations of drugs are available for treatment. The appropriate drug therapy
depends on your specific type of cancer, the extent of your disease, and your physical
condition. Your doctor (medical oncologist) will explain the chemotherapy options, the
expected outcomes and the associated toxicities.
Some patients may be asked to take part in studies, called clinical
trials that test new treatments. These treatments may include new chemotherapy drugs
or new combinations of different drugs. Radiation therapy treatments are sometimes a part
of these clinical trials.
As more effective drugs become available, the treatment options for
liver cancer may change. Your doctor will discuss the risks and benefits of various
treatment options with you and your family. Ask your doctor any questions you have about
the cancer or its treatment so that you will understand and feel comfortable with your
treatment decision.
Many people are aware of the statistics regarding life expectancy,
or prognosis, for liver cancer. Although statistics can be helpful, they can also
be misleading. If you have questions about your prognosis, ask your doctor. Your doctor is
the only person who knows enough about your case to discuss this with you.
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How can I learn to live with cancer of the liver?
Having cancer can change your life and the lives of your family
members in many ways. Patients and their families often feel shock, anger, sadness, fear,
frustration, and confusion when faced with a diagnosis of cancer. These feelings often
come and go, and the experience is sometimes compared to an emotional roller coaster.
You may have many questions about the cancer, its treatment, and
its effect on your life. Your doctors and nurses are the best people to answer these
questions. You may also have questions about how your job, finances, and family
relationships will be affected. Your social worker can suggest services and agencies that
help provide financial aid, transportation, home care, and emotional support.
Living with any serious disease can be difficult and challenging.
Many patients find it helpful to share their thoughts and feelings with a professional
counselor or with other patients who are going through a similar experience. Others may
find it easier to talk with a minister, priest, rabbi, or other religious leader. Your
social worker can help you find support groups, counseling services, or other related
resources.
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Multidisciplinary Liver Cancer Team
Surgical Oncology
J. Nicolas Vauthey, M.D
Arthur
Encarnacion, RN, BSN
(713) 792-2022
Misty
Woodall, RN, ADN
Steven A. Curley, M.D.
(713) 794-4957
Lee M. Ellis, M.D.
(713) 792-6926 |
GI Medical Oncology
Yehuda Z. Patt, M.D.
Richard
Lozano, Ph.D.
Thomas D. Brown, M.D.
Judy Chase, Ph.D.
Paulo M. Hoff, M.D.
Frank Sinicrope, M.D.
Robert A. Wolff, M.D. |
Hepatology
Victor Ankoma-Sey, M.D. |
Pathology
Karen Cleary, M.D.
Michael T. Deavers, M.D.
Asif Rashid, M.D. |
Diagnostic Radiology
Chusilp Charnsangavej, M.D.
Marc J. Fenstermacher, M.D.
Evelyne M. Loyer, M.D.
Delise H. Herron, BS |
Interventional Radiology
Kamran Ahrar, M.D.
Marshall E. Hicks, M.D.
Frank A. Morello, Jr., M.D.
Thomas O. Shelton, M.D. |
Radiation Oncology
Christopher Crane, M.D.
Nora A. Janjan, M.D. |
