Dr. Keith E. Stuart is a medical oncologist specializing in the study and treatment of cancers involving the gastrointestinal tract, with a special interest in tumors involving the liver. He was educated at Harvard University (graduating magna cum laude) and Albert Einstein College of Medicine and did his medical training at the New England Deaconess Hospital.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
The goal of liver resection is to completely remove the tumor and the
appropriate surrounding liver tissue without leaving any tumor behind. This
option is limited to patients with one or two small (3 cm or less) tumors and
excellent liver function, ideally without associated cirrhosis. As a result of
these strict guidelines, in practice, very few patients with liver cancer can undergo
liver resection. The biggest concern about resection is that following the
operation, the patient can develop liver failure. The liver failure can occur if
the remaining portion of the liver is inadequate to provide the necessary
support for life. Even in carefully selected patients, about 10% of them are
expected to die shortly after surgery, usually as a result of liver failure.
When a portion of a normal liver is removed, the remaining liver can grow
back (regenerate) to the original size within one to two weeks. A cirrhotic
liver, however, cannot grow back. Therefore, before resection is performed for
liver cancer, the non-tumor portion of the liver should be biopsied to determine whether
there is associated cirrhosis.
For patients whose tumors are successfully resected, the five-year survival rate is up to 60%. This means that 60% of patients who actually undergo liver resection for liver cancer are expected to live five years. Many of these patients, however, will have a recurrence of liver cancer elsewhere in the liver. Still, this is the procedure of choice for patients without cirrhosis and a solitary tumor who are felt to be medically able to undergo surgery.
Liver transplantation
Liver transplantation has become an accepted treatment for patients with
end-stage (advanced) liver disease of various types (for example, chronic hepatitis B
and C, alcoholic cirrhosis, primary biliary cirrhosis, and sclerosing
cholangitis). Survival rates for these patients without liver cancer are 90% at one year,
80% at three years, and 75% at five years. Moreover, liver transplantation is
the best option for patients with tumors that are less than 5 cm in size who also
have signs of liver failure. In fact, as one would expect, patients with small
cancers (less than 3 cm) and no involvement of the blood vessels do very well.
These patients have a less than 10% risk of recurrent liver cancer after transplant. On
the other hand, there is a very high risk of recurrence in patients with tumors
greater than 5 cm or with involvement of blood vessels. For these reasons, when
patients are being evaluated for treatment of liver cancer, every effort should
be made to characterize the tumor and look for signs of spread beyond the liver.
There is a severe shortage of organ donors in the U.S. Currently, there are
about 18,000 patients on the waiting list for liver transplantation. About 4,000
donated cadaver livers (taken at the time of death) are available per year for
patients with the highest priority. This priority goes to patients on the
transplant waiting list who have the most severe liver failure. A recent change in distribution rules made liver cancer of under 5 cm a priority, so these people can spend less time on the waiting list. A newer, growing option is live donor transplantation.
The use of a partial liver from a healthy, live donor may provide patients with liver cancer an opportunity to undergo liver transplantation before the
tumor becomes too large. This innovation is a very exciting development in the
field of liver transplantation.
As a precaution, doing a biopsy or aspiration of liver cancer should probably be
avoided in patients considering liver transplantation. The reason to avoid
needling the liver is that there is about a 1%-4% risk of seeding (planting)
cancer cells from the tumor by the needle into the liver along the needle track.
You see, after liver transplantation, patients take powerful anti-rejection
medications to prevent the patient's immune system from rejecting the new
liver. However, the suppressed immune system can allow new foci (small areas) of
cancer cells to multiply rapidly. These new foci of cancer cells would normally
be kept at bay by the immune cells of an intact immune system. It now appears that people who do undergo transplantation for liver cancer have a lower chance of having the cancer return if they are first treated with a local method such as chemoembolization. This also helps them to be treated while they are spending time on the transplant waiting list, so that the cancer does not grow while they are waiting.
In summary, liver resection should be reserved for patients with small tumors and normal liver function (no evidence of cirrhosis). Patients with multiple or large tumors should receive palliative therapy with systemic chemotherapy or TACE, provided they do not have signs of severe liver failure. Patients with an early stage of cancer and signs of chronic liver disease should receive palliative treatment with RFA, cryoablation, or TACE and undergo evaluation for liver transplantation.
Abdominal pain is pain in the belly and can be acute or chronic. Causes include inflammation, distention of an organ, and loss of the blood supply to an organ. Abdominal pain can reflect a major problem with one of the organs in the abdomen such as the appendix, gallbladder, large and small intestine, pancreas, liver, colon, duodenum, and spleen.
Cirrhosis of the liver refers to a disease in which normal liver cells are replaced by scar tissue caused by alcohol and viral hepatitis B and C. This disease leads to abnormalities in the liver's ability to handle toxins and blood flow, causing internal bleeding, kidney failure, mental confusion, coma, body fluid accumulation, and frequent infections. Symptoms include yellowing of the skin, itching, and fatigue.
Hepatitis C is an inflammation of the liver due to the hepatitis C virus (HCV), which is usually spread by
blood transfusion, hemodialysis, and needle sticks, especially with intravenous
drug abuse. Chronic hepatitis C may be treated with interferon, usually in combination with anti-virals.
Cholesterol is naturally produced by the body, and is a building block for cell membranes and hormones. Low-density lipoprotein (LDL) cholesterol is the "bad" cholesterol, conversely, high-density lipoprotein (HDL) cholesterol is the "good" cholesterol. High cholesterol treatment includes lifestyle changes (diet and exercise), and medications such as statins, bile acid resins, and fibric acid derivatives.
Jaundice is a yellowish staining of the skin and whites of the eyes (sclerae) with bilirubin, the pigment found in bile. Jaundice can be an indicator of liver or gallbladder disease, or it may result from the rupture of red blood cells (hemolysis).
Alcoholism is a disease that includes alcohol craving and continued drinking despite repeated alcohol-related problems, such as losing a job or getting into trouble with the law.
The hepatitis B virus is a unique, coated DNA virus belonging to the Hepadnaviridae family of viruses. The course of the virus is determined primarily by the age at which the infection is acquired and the interaction between the virus and the body's immune system. Successful treatment is associated with a reduction in liver injury and fibrosis (scarring), a decreased likelihood of developing cirrhosis and its complications, including liver cancer, and a prolonged survival.
Ascites, the accumulation of fluid in the abdominal cavity is most commonly caused by cirrhosis of the liver. Some of the other causes of ascites include portal hypertension, congestive heart failure, blood clots, and pancreatitis. The most common symptoms include increased abdominal girth and size, abdominal bloating, and abdominal pain. Treatment depends on the cause of ascites.
Polycythemia (elevated red blood cell count) causes are either primary (aquired or genetic mutations) or secondary (diseases, conditions, high altitude). Treatment of polycythemia depends on the cause.
Cancer is a disease caused by an abnormal growth of cells, also called malignancy. It is a group of 100 different diseases, and is not contagious. Cancer can be treated through chemotherapy, a treatment of drugs that destroy cancer cells.
Nonalcoholic fatty liver disease (NAFLD) refers to a wide spectrum of liver disease ranging from simple fatty liver (steatosis), to nonalcoholic steatohepatitis (NASH), to cirrhosis (irreversible, advanced scarring of the liver). All of the stages of NAFLD have in common the accumulation of fat (fatty infiltration) in the liver cells (hepatocytes).
Insulin resistance is the diminished ability of cells to respond to the action of insulin in transporting glucose (sugar) from the bloodstream into muscle and other tissues. Causes of insulin can include conditions such as stress, obesity, metabolic syndrome, and steroid use. Some of the risk factors for insulin resistance include fatty liver, heart disease, strokes, peripheral vascular disease, high cholesterol, and smoking. Treatment for insulin resistance are lifestyle changes and if necessary, medication.
Hepatitis is most often viral, due to infection with one of the hepatitis viruses (A, B, C, D, E, F (not confirmed), and G) or another virus (such as those that cause infectious mononucleosis, cytomegalovirus disease). The main nonviral causes of hepatitis are alcohol and drugs. Many patients infected with hepatitis A, B, and C have few or no symptoms of illness. For those who do develop symptoms of viral hepatitis, the most common are flu- like symptoms including: loss of appetite, nausea, vomiting, fever, weakness, tiredness, and aching in the abdomen. Treatment of viral hepatitis is dependant on the type of hepatitis.
Hereditary hemochromatosis (iron overload) is an inherited disorder in which there is excessive accumulation of iron in the body. Individuals may have no symptoms or signs, or they can have severe symptoms and signs of iron overload. The most effective treatment for hemochromatosis is therapeutic phlebotomy.
Primary Biliary Cirrhosis is a chronic disease characterized by progressive inflammation and destruction of small bile ducts within the liver. The bile ducts transport bile from the liver to the intestine for the absorption of fat and elimination of waste products. The causes of Primary Biliary Cirrhosis may involve autoimmunity, infection, or genetic predisposition, acting alone or in combination. There are many medications and treatment options available for those with this and other associated diseases of Primary Biliary Cirrhosis.
The liver is the largest solid organ in the body, and is actually an gland. The liver has a wide variety of critical functions such as manufacturing proteins and metabolizing fats and carbohydrates. The liver also eliminates harmful biochemical waste products from the body (alcohol, drugs, toxins). The liver secretes bile that aids in digestion. Examples of diseases of the liver include cirrhosis, hepatitis, cancer, and fatty liver. Symptoms of liver disease include bleeding, easy bruising, edema, fatigue, and jaundice.
Mold exposure may cause symptoms in people who are sensitive to molds. Symptoms of mold allergy include sneezing, runny nose, wheezing, coughing, redness of the eyes, and rash. Prevent mold growth by keeping indoor humidity low, between 30%-50%, using bathroom fans when showering, repairing plumbing leaks quickly, and using an air conditioner during humid seasons.
Primary sclerosing cholangitis (PSC) is a chronic, progressive disease of the bile ducts that channel bile from the liver into the intestines. There is an association between primary sclerosing cholangitis and ulcerative colitis and Crohn's disease. Symptoms of primary sclerosing cholangitis include abnormal liver blood tests, itching, fatigue, and jaundice. Primary sclerosing cholangitis is treated with medications and in some cases, liver transplant.
Anabolic steroids are synthetic substances that are related to testosterone and promote skeletal muscle growth and the development of male sexual characteristics in both men and women. In the 1930s, it was discovered that anabolic steroids could promote skeletal muscle growth in lab animals, which lead to anabolic steroid abuse by bodybuilders and weight lifters.
Digestion is the complex process of turning food you eat into the energy you need to survive. The digestive process also involves creating waste to be eliminated, and is made of a series of muscles that coordinate the movement of food.
Alpha-1 antitrypsin deficiency is an inherited disorder that may cause liver and lung disease in adults. Signs and symptoms include shortness of breath, wheezing, weight loss, respiratory infections, fatigue, vision abnormalities. Advanced lung disease from alpha-1 antitrypsin deficiency include emphysema. Liver damage from alpha-1 antitrypsin deficiency causes a swollen abdomen, swollen legs or feet, and jaundice.
Hepatitis A and hepatitis B are the two most commnon viruses that infect the liver. Hepatitis A and Hepatitis B can be prevented and treated with immunizations (vaccinations) such as Havrix, Vaqta, Twinrix, Comvax, Pediarix, and hepatitis b immune globulin (HBIG).
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