Liver Cancer (cont.)
What is the natural history of liver cancer?
The natural history of liver cancer depends on the stage of the tumor and the severity
of associated liver disease (for example, cirrhosis) at the time of diagnosis. For
example, a patient with a 1 cm tumor with no cirrhosis has a greater than 50%
chance of surviving three years, even without treatment. In contrast, a patient with
multiple tumors involving both lobes of the liver (multicentric tumors) with
decompensated cirrhosis (signs of liver failure) is unlikely to survive more
than six months, even with treatment.
What are the predictors of a poor outcome? Our knowledge of the prognosis is
based on studying many patients with liver cancer, separating out their clinical
characteristics, and relating them to the outcome. Grouped in various
categories, the unfavorable clinical findings include;
- Population characteristics (demographics); male gender, older age, or alcohol consumption.
- Symptoms; weight loss or decreased appetite.
- Signs of impaired liver function; jaundice, ascites, or encephalopathy (altered mental state).
- Blood tests; elevated liver tests (bilirubin or transaminase), reduced albumin, elevated AFP, elevated blood urea nitrogen (BUN), or low serum sodium.
- Staging of tumor (based on imaging or surgical findings); more than one tumor, tumor over 3 cm (almost 1¼ inches), tumor invasion of local blood vessels
(portal and/or hepatic vein), tumor spread outside of the liver (to lymph nodes or other organs).
There are various systems for staging liver cancer. Some systems look at clinical
findings while others rely solely on pathological (tumor) characteristics. It
makes the most sense to use a system that incorporates a combination of clinical
and pathological elements. In any event, it is important to stage the cancer
because staging can provide guidelines not only for predicting outcome
(prognosis) but also for decisions regarding treatment.
The doubling time for a cancer is the time it takes for the tumor to double
in size. For liver cancer, the doubling time is quite variable, ranging from one
month to eighteen months. This kind of variability tells us that every patient
with liver cancer is unique. Therefore, an assessment of the natural history and the
evaluation of different treatments are very difficult. Nevertheless, in patients
with a solitary liver cancer that is less than 3 cm, with no treatment, we can expect
that 90% of the patients will survive (live) for one year, 50% for three years,
and 20% for five years. In patients with more advanced disease, we can expect
that 30% will survive for one year, 8% for three years, and none for five years.
Next: What are the treatment options for liver cancer? »
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