Adult Primary Liver Cancer Treatment (PDQ�)
General Information About Adult Primary Liver Cancer
Adult primary liver cancer is a disease in which malignant (cancer) cells form in the tissues of the liver.
Filtering harmful substances from the
bloodso they can be passed from the body in stoolsand urine.
bileto help digestfats from food.
Storing glycogen (sugar), which the body uses for energy.
This summary refers to the treatment of
Having hepatitis or cirrhosis can affect the risk of developing adult primary liver cancer.
Anything that increases your chance of getting a disease is called a
hepatitis Band/or hepatitis C.
Having a close relative with both hepatitis B and liver cancer.
Eating foods tainted with
aflatoxin(poison from a fungusthat can grow on foods, such as grains and nuts, that have not been stored properly). Obesity.
Possible signs of adult primary liver cancer include a lump or pain on the right side.
A hard lump on the right side just below the rib cage.
Discomfort in the upper abdomen on the right side.
Pain around the right
Unexplained weight loss.
Jaundice(yellowing of the skin and whites of the eyes).
Tests that examine the liver and the blood are used to detect (find) and diagnose adult primary liver cancer.
The following tests and procedures may be used:
Physical examand history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient?s health habits and past illnesses and treatments will also be taken. Serum tumor marker test: A procedure in which a sample of blood is examined to measure the amounts of certain substances released into the blood by organs, tissues, or tumor cellsin the body. Certain substances are linked to specific types of cancer when found in increased levels in the blood. These are called tumor markers. An increased level of alpha-fetoprotein(AFP) in the blood may be a sign of liver cancer. Other cancers and certain noncancerous conditions, including cirrhosis and hepatitis, may also increase AFP levels. Liver function tests: A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by the liver. A higher than normal amount of a substance can be a sign of liver cancer. CT scan(CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-raymachine. A dyemay be injectedinto a veinor swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography. A spiralor helical CTscan makes a series of very detailed pictures of areas inside the body using an x-ray machine that scans the body in a spiral path. MRI(magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI). To create detailed pictures of blood vesselsin and near the liver, dye is injected into a vein. This procedure is called MRA (magnetic resonance angiography). Ultrasoundexam: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram. The picture can be printed to be looked at later. Laparoscopy: A surgicalprocedure to look at the organs inside the abdomen to check for signs of disease. Small incisions(cuts) are made in the wall of the abdomen and a laparoscope(a thin, lighted tube) is inserted into one of the incisions. Other instruments may be inserted through the same or other incisions to perform procedures such as removing organs or taking tissue samples for biopsy.
Biopsy: The removal of cells or tissues so they can be viewed under a
microscopeby a pathologistto check for signs of cancer. The sample may be taken using a thin needle inserted into the liver during an x-ray or ultrasound. This is called a fine-needle aspiration (FNA) biopsy. The biopsy may be done during a laparoscopy.
Certain factors affect prognosis (chance of recovery) and treatment options.
stageof the cancer (the size of the tumor, whether it affects part or all of the liver, or has spread to other places in the body).
How well the liver is working.
The patient?s general health, including whether there is cirrhosis of the liver.
Prognosis is also affected by alpha-fetoprotein (AFP) levels.
Stages of Adult Primary Liver Cancer
After adult primary liver cancer has been diagnosed, tests are done to find out if cancer cells have spread within the liver or to other parts of the body.
The process used to find out if
CT scan(CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, such as the chest, abdomen, and pelvis, taken from different angles. The pictures are made by a computer linked to an x-raymachine. A dyemay be injectedinto a veinor swallowed to help the organsor tissuesshow up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography. MRI(magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI). PET scan(positron emission tomography scan): A procedure to find malignant tumor cellsin the body. A small amount of radioactive glucose(sugar) is injected into a vein. The PET scannerrotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do. Laparoscopy: A surgicalprocedure to look at the organs inside the abdomen to check for signs of disease. Small incisions(cuts) are made in the wall of the abdomen and a laparoscope(a thin, lighted tube) is inserted into one of the incisions. Other instruments may be inserted through the same or other incisions to perform procedures such as removing organs or taking tissue samples for biopsy.
There are three ways that cancer spreads in the body.
The three ways that cancer spreads in the body are:
tissue. Cancer invadesthe surrounding normal tissue.
lymph system. Cancer invades the lymph system and travels through the lymph vesselsto other places in the body.
blood. Cancer invades the veinsand capillariesand travels through the blood to other places in the body.
The following stages are used for adult primary liver cancer:
tumorthat has spread to nearby blood vessels; or
more than one tumor, none of which is larger than 5
Stage III is divided into Stage IIIA, IIIB, and IIIC.
stage IIIA, one of the following is found:
more than one
tumorlarger than 5 centimeters; or
one tumor that has spread to a major branch of
blood vesselsnear the liver.
stage IIIB, there are one or more tumorsof any size that have either:
spread to nearby
organsother than the gallbladder; or
broken through the lining of the
stage IIIC, the cancerhas spread to nearby lymph nodes.
For adult primary liver cancer, stages are also grouped according to how the cancer may be treated. There are 3 treatment groups:
Localized and locally advanced unresectable
Recurrent Adult Primary Liver Cancer
Treatment Option Overview
There are different types of treatment for patients with adult primary liver cancer.
Different types of treatments are available for patients with adult
Five types of standard treatment are used:
The following types of
Cryosurgery: A treatment that uses an instrument to freeze and destroy abnormal tissue, such as carcinoma in situ. This type of treatment is also called cryotherapy. The doctor may use ultrasoundto guide the instrument.
hepatectomy: Removal of the part of the liverwhere cancer is found. The part removed may be a wedgeof tissue, an entire lobe, or a larger portion of the liver, along with some of the healthy tissue around it. The remaining liver tissue takes over the functions of the liver.
Total hepatectomy and liver
transplant: Removal of the entire liver and replacement with a healthy donated liver. A liver transplant may be done when the disease is in the liver only and a donated liver can be found. If the patient has to wait for a donated liver, other treatment is given as needed. Radiofrequency ablation: The use of a special probe with tiny electrodes that kill cancer cells. Sometimes the probe is inserted directly through the skin and only local anesthesiais needed. In other cases, the probe is inserted through an incisionin the abdomen. This is done in the hospital with general anesthesia.
External radiationtherapy uses a machine outside the body to send radiation toward the cancer. Internal radiationtherapy uses a radioactivesubstance sealed in needles, seeds, wires, or cathetersthat are placed directly into or near the cancer. Drugscalled radiosensitizersmay be given with the radiation therapy to make the cancer cells more sensitive to radiation therapy.
Radiation may be delivered to the
tumorusing radiolabeled antibodies. Radioactive substances are attached to antibodies made in the laboratory. These antibodies, which target tumor cells, are injectedinto the body and the tumor cells are killed by the radioactive substance.
The way the radiation therapy is given depends on the type and
Regional chemotherapy is usually used to treat liver cancer. A small pump containing anticancer drugs may be placed in the body. The pump puts the drugs directly into the
Another type of regional chemotherapy is
The way the chemotherapy is given depends on the type and stage of the cancer being treated.
Percutaneous ethanol injection
See Drugs Approved for Liver Cancer for more information.
New types of treatment are being tested in clinical trials.
This summary section describes treatments that are being studied in
Patients may want to think about taking part in a clinical trial.
For some patients, taking part in a
Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.
Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.
Patients can enter clinical trials before, during, or after starting their cancer treatment.
Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from
Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from
Follow-up tests may be needed.
Some of the tests that were done to
Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has
Treatment Options for Adult Primary Liver Cancer
A link to a list of current
Localized Resectable Adult Primary Liver Cancer
Surgery (total hepatectomy) and
clinical trialof regionalor systemic chemotherapyor biologic therapyfollowing surgery.
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with localized resectable adult primary liver cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.
Localized and Locally Advanced Unresectable Adult Primary Liver Cancer
Surgery( cryosurgeryor radiofrequency ablation). Chemotherapy( chemoembolization, regional chemotherapy, or systemic chemotherapy). Percutaneous ethanol injection.
hepatectomy) and liver transplant. Radiation therapywith radiosensitizers. Systemic chemotherapyand/or targeted therapy.
clinical trialof targeted therapy after chemoembolization or combined with chemotherapy.
clinical trialof a combination of surgery, chemotherapy, and radiation therapy. Hyperthermia therapymay also be used. Chemotherapy and radiation therapy may be used to shrink the tumorbefore surgery.
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with localized unresectable adult primary liver cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.
Advanced Adult Primary Liver Cancer
There is no
Biologic therapy, chemotherapy, and/or radiation therapywith or without radiosensitizers. These treatments may be given as palliative therapyto help relieve symptomsand improve the quality of life. Targeted therapy.
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with advanced adult primary liver cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.
Recurrent Adult Primary Liver Cancer
Surgery (total hepatectomy) and
liver transplant. Chemotherapy( chemoembolizationor systemic chemotherapy). Percutaneous ethanol injection.
clinical trialof a new therapy.
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with recurrent adult primary liver cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.
To Learn More About Adult Primary Liver Cancer
For more information from the
Liver Cancer Home Page
What You Need to Know About? Liver Cancer
Liver (Hepatocellular) Cancer Prevention
Liver (Hepatocellular) Cancer Screening
Cryosurgery in Cancer Treatment: Questions and Answers
Drugs Approved for Liver Cancer
Understanding Cancer Series: Targeted Therapies (Advances in Targeted Therapies)
Targeted Cancer Therapies
What You Need to Know About? Cancer
Understanding Cancer Series: Cancer
Chemotherapy and You: Support for People With Cancer
Radiation Therapy and You: Support for People With Cancer
Coping with Cancer: Supportive and Palliative Care
Information For Survivors/Caregivers/Advocates
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Changes to This Summary (10/31/2011)
Changes were made to this summary to match those made to the health professional version.
PDQ is a comprehensive cancer database available on NCI's Web site.
PDQ is the National Cancer Institute's (NCI's) comprehensive cancer information database. Most of the information contained in PDQ is available online at NCI's Web site. PDQ is provided as a service of the NCI. The NCI is part of the National Institutes of Health, the federal government's focal point for biomedical research.
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