Liver Cancers

Colon and Rectal Cancer Liver Metastases

Signs & Symptoms

About half of patients with colon or rectal cancer will experience spread of cancer to the liver at some point. Half of these patients will have liver disease at the same time as the primary tumor is diagnosed.

• The liver is the first site of blood drainage for most of the colon and rectum, providing an easy method of spread for colorectal cancers.
• Half of patients with liver metastases have the liver as the only site of cancer spread.

Therapies

Surgical therapies for colon and rectal cancer liver metastases:

• At least one-third of patients with colon or rectal cancer liver metastases will be eligible for surgical therapy to remove or burn the tumors.
  • Patients with tumors on both lobes of the liver, multiple liver tumors, and with disease outside the liver may all be candidate for surgical therapy.
  • For patients with synchronous primary colon or rectal cancer and liver metastases, both the primary tumor and liver metastases may be removed with one operation.
• Due to advances in chemotherapy and surgical techniques, patients treated with both surgery and chemotherapy will, on average, experience long-term survival in excess of five years after surgery.  
  • The chance of cure after surgery (e.g. the cancer never comes back after surgical resection) is at least 20%.
• The chance of living for at least five years after surgery is up to 70%.
• Chemotherapy may shrink tumors allowing some patients who are initially not candidates for surgery the opportunity to have liver tumors removed.

Non-surgical therapies for colon and rectal cancer liver metastases:

• Percutaneous ablation (e.g. burning tumors) is possible for those patients who cannot tolerate an operation.
• Radiation can be used to control disease when surgery is not possible. Radiotherapy can be delivered by an external beam from outside the patient or by a catheter inserted into the artery in the liver supply the tumor.

Hepatocellular Cancer

(also known as hepatoma, primary liver cancer, hepatocellular carcinoma, or HCC)

Signs & Symptoms

Hepatocellular cancer; also known as hepatoma, liver cancer, hepatocellular cancer, or HCC; is the fastest rising cause of cancer related death among men and women in the United States. Most cases of hepatocellular cancer arise in the setting of cirrhosis, which is scarring of the liver.   Common causes of cirrhosis include hepatitis viral infection (hepatitis B or C), alcoholic liver disease, and fatty liver disease.

• Hepatitis B viral infection and fatty liver disease can lead to hepatocellular cancer without cirrhosis.
• Older patients can develop hepatocellular cancer without any background liver disease.
• Initial symptoms of hepatocellular cancer include abdominal pain, weight loss, malaise, or symptoms of liver dysfunction.
  • Signs of the liver not working well include jaundice, ascites (fluid build-up in the belly), throwing up blood, bloody or dark, tarry stools, and easy bruising.
  • Importantly, some patients with hepatocellular cancer may have no symptoms.

Hepatocellular cancer can invade the blood vessels supplying the liver and may spontaneously bleed.  This cancer can also spread outside the liver, most often to the lungs.

Therapies

A key factor in the therapy for hepatocellular cancer is that many patients will have some liver dysfunction in addition to having cancer.  The cancer therapy must not only treat the cancer, but also not push the patient into liver failure.

Surgical therapies for hepatocellular cancer:

• When possible, surgical therapy is the only option that offers the potential for cure for patients with hepatocellular cancer.
• When liver function is normal or near normal, surgical resection or ablation (burning the tumor) is the treatment of choice.  This can result in a 5-year survival of over 70% after treatment.
• When liver function is abnormal, liver transplant can be considered to not only treat the cancer but also improve liver function by providing a new liver.

Non-surgical therapies for hepatocellular cancer:

• Trans-arterial therapy:  Because the liver cancer is exclusively supplied by the hepatic artery, direct therapy into the artery with beads laced with chemotherapy or radiation can provide excellent disease control.  Usually an outpatient procedure, this therapy allows for very high doses of treatment into the liver with minimal toxicity elsewhere in the body.
• External beam radiotherapy:  Radiation is administered from outside the body.  Conformal techniques allow for very precise radiation beams with minimal damage to surrounding structures.
• Systemic chemotherapy:  Recently, several different chemotherapy agents have been approved for hepatocellular cancer in the first line and salvage settings.   These therapies can control disease both within and outside the liver.
• Immunotherapies:  Immunotherapy consists of drugs that enhance the ability of the body’s own immune system to fight hepatocellular cancer.  Currently available in the second-line settings, about 20% of patients will respond to immunotherapy.  When they occur, these responses can be substantial and durable.

Cholangiocarcinoma

Signs & Symptoms

Cholangiocarcinoma, also known as bile duct cancer, can occur within the liver (intrahepatic), outside the liver in the common bile duct (perihilar), or at the end of the bile duct near the pancreas (distal).

Most cases of cholangiocarcinoma arise without any prior liver disease.  However, a minority of cholangiocarcinoma cases will arise in the setting of background liver disease (such as primary sclerosing cholangitis), bile duct infections, or cirrhosis.

• Patients with cholangiocarcinoma may present with abdominal pain, jaundice (due to bile duct obstruction), weight loss, malaise, or symptoms of liver dysfunction.
  • Signs of the liver not working well include jaundice, ascites (fluid build-up in the belly), throwing up blood, bloody or dark, tarry stools, and easy bruising.
  • Importantly, some patients with cholangiocarcinoma may have no symptoms.
• Cholangiocarcinoma can invade the blood vessels supplying the liver and may spontaneously bleed. This cancer can also spread outside the liver, most often to the lungs.

Therapies

A key factor in the therapy for hepatocellular cancer is that many patients will have some liver dysfunction in addition to having cancer. The cancer therapy must not only treat the cancer, but also not push the patient into liver failure.

Surgical therapies for cholangiocarcinoma:

• When possible, surgical resection is the only option that offers the potential for cure for patients with cholangiocarcinoma.  Surgery involves liver resection, removing adjacent lymph nodes, and/or removing the bile duct.  The prognosis after surgery depends upon whether lymph nodes and blood vessels are invaded by cancer.
• Chemotherapy or radiation can be used after surgery to decrease the likelihood of the cancer returning.
• Rarely, liver transplantation is an option for patients with perihilar cholangiocarcinoma with primary sclerosing cholangitis.

Non-surgical therapies for cholangiocarcinoma:

• Systemic chemotherapy:  Standard chemotherapy for cholangiocarcinoma includes gemcitabine and cisplatin.  Several other drug combinations can be used in second-line settings.  These therapies can control disease both within and outside the liver.
• Trans-arterial therapy:  Because the liver cancer is exclusively supplied by the hepatic artery, direct therapy into the artery with beads laced with chemotherapy or radiation can provide excellent disease control.  Usually an outpatient procedure, this therapy allows for very high doses of treatment into the liver with minimal toxicity elsewhere in the body.
• External beam radiotherapy:  Radiation is administered from outside the body.  Conformal techniques allow for very precise radiation beams with minimal damage to surrounding structures.

Gallbladder Cancer

Signs & Symptoms

The gallbladder is an organ attached to the undersurface of the right liver. It stores bile made by the liver and can release that bile into the intestine through the bile duct. In the United States, gallbladder cancer most commonly occurs after repeated inflammatory damage due to gallstones. For that reason, gallbladder cancer is most often diagnosed “incidentally” after a cholecystectomy is done for presumed gallstone disease. It is estimated that 1% of gallbladders removed in the United States have cancer.

• Patients with gallbladder cancer may present with abdominal pain, jaundice (due to bile duct obstruction), weight loss, or malaise.
• Importantly, some patients with cholangiocarcinoma may have no symptoms.

Therapies

Gallbladder cancer can be aggressive with potential of spread to the liver, peritoneum (abdominal wall), surrounding lymph nodes, and outside the abdomen to the lungs.

Surgical therapies for gallbladder cancer:

• When possible, surgical therapy is the only option that offers the potential for cure for patients with gallbladder cancer.
• Surgery for gallbladder cancer includes removing the portion of liver attached to the gallbladder, surrounding lymph nodes, and possibly the bile duct.
• The prognosis after surgery depends upon whether lymph nodes and the adjacent liver is invaded by cancer.
• Chemotherapy or radiation can be used after surgery to decrease the likelihood of the cancer returning.

Non-surgical therapies for gallbladder cancer:

• Systemic chemotherapy:  Standard chemotherapy for gallbladder cancer includes gemcitabine and cisplatin.  Several other drug combinations can be used in second-line settings.  These therapies can control disease both within and outside the liver.
• External beam radiotherapy:  Radiation is administered from outside the body.  Conformal techniques allow for very precise radiation beams with minimal damage to surrounding structures.