Liver Cancer (cont.)
What is fibrolamellar carcinoma?
Fibrolamellar carcinoma is an liver cancer variant that is found in non-cirrhotic
livers, usually in younger patients between the ages of 20 and 40 years. In
fact, these patients have no associated liver disease and no risk factors have
been identified. The alpha-fetoprotein in these patients is usually normal. The
appearance of fibrolamellar carcinoma under the microscope is quite
characteristic. That is, broad bands of scar tissue are seen running through the
cancerous liver cells. The important thing about fibrolamellar carcinoma is that
it has a much better prognosis than the common type of liver cancer. Thus, even with a
fairly extensive fibrolamellar carcinoma, a patient can have a successful
surgical removal.
What's in the future for the prevention and treatment of
liver cancer?
Prevention
Worldwide, the majority of liver cancer is associated with chronic
hepatitis B virus infection.
Today, however, all newborns are vaccinated against hepatitis B in China and
other Asian countries. Therefore, the frequency of chronic hepatitis B virus in future
generations will decrease. Eventually, perhaps in three or four generations,
hepatitis B virus
will be totally eradicated, thereby eliminating the most common risk factor for
liver cancer.
Some retrospective (looking back in time) studies suggest that patients with
chronic hepatitis C who were treated with interferon were less likely to develop
liver cancer than patients who were not treated. Interestingly, in these studies,
interferon treatment seemed to provide this benefit, even to patients who had
less than an optimal antiviral response to interferon. Still, it remains to be
seen whether the risk of developing cirrhosis and liver cancer is significantly decreased
in prospectively (looking ahead) followed patients who responded to interferon.
One Japanese study has reported that a retinoid derivative (a compound
related to vitamin A) was effective in preventing recurrence of liver cancer after
resection of the liver. As of now, this compound is not available in the U.S. It
would be of great interest to study the use of this compound in conjunction with
other palliative therapy for liver cancer.
Treatment
Unfortunately, there have been no significant new developments in the
treatment of liver cancer. Medical therapy remains a disappointment. Scientists are
working hard, however, to address this problem. For example, anti-angiogenesis
compounds, which inhibit blood vessel formation, may hold promise in the
treatment of liver cancer since this tumor depends on a rich blood supply. Also,
different ways to deliver drugs or treatment to the tumors are being
investigated. This includes attaching radioactive material to antibodies that
are directed at specific targets in liver cancer cells (immunotherapy).
- Liver cancer is the fifth most common cancer in the world and
the majority of patients with liver cancer will die within one year as a result of the
cancer.
- In the U.S., patients with associated cirrhosis
caused by chronic hepatitis B or C infections, alcohol, and hemochromatosis
are at the greatest risk of developing liver cancer.
- Patients with chronic liver disease (for example, hepatitis C virus, hepatitis B
virus,
or hemochromatosis) should avoid drinking alcohol, which can further increase
their risk of developing cirrhosis and liver cancer.
- Many patients with liver cancer do not develop symptoms until
the advanced stages of the tumor. When the patient does develop symptoms, the
prognosis is usually poor.
- The combination of an imaging study (ultrasound, CT,
or MRI scans) and an elevated blood level of alpha-fetoprotein most
effectively diagnoses liver cancer.
- A liver biopsy can make a definitive diagnosis of
liver cancer, but the procedure requires an expert liver pathologist and is not
necessary for all patients.
- The natural history of liver cancer is quite variable, and
depends on the stage of the tumor and the severity of the associated
cirrhosis.
- Medical treatments for liver cancer, including chemotherapy,
chemoembolization, ablation, and proton beam therapy, are not very effective.
- Surgical resection (removal) of the tumor may be very
effective for a select group of individuals with liver cancer, specifically for those
with small tumors and excellent liver function.
- For patients with small liver cancer and significant associated liver disease,
liver transplantation offers the best chance for cure.
REFERENCES: Garden OJ, Rees M, Poston GJ, Mirza D, Saunders M, Ledermann J, Primrose JN, Parks RW.
Guidelines for resection of colorectal cancer liver metastases.
Gut. 2006 Aug;55 Suppl 3:iii1-8.
Brown DB, Geschwind JF, Soulen MC, Millward SF, Sacks D.
Society of Interventional Radiology position statement on chemoembolization of hepatic malignancies.
J Vasc Interv Radiol. 2006 Feb;17(2 Pt 1):217-23.
Bruix J, Sherman M; Practice Guidelines Committee, American Association for the Study of Liver Diseases.
Management of hepatocellular carcinoma.
Hepatology. 2005 Nov;42(5):1208-36.
Medically Reviewed by Paul Oneill, MD,
Board Certified Oncology
Last Editorial Review: 4/13/2007
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