Liver Cancer (cont.)
What are the treatment options for liver cancer?
The treatment options are dictated by the stage of liver cancer and
the overall condition of the patient. The only proven cure for liver cancer is
liver transplantation for a solitary, small (<3cm) tumor. Now, many physicians may dispute this
statement. They may argue that a small tumor can be surgically removed (partial
hepatic resection) without the need for a liver transplantation. Moreover, they
may claim that the one and three year survival rates for resection are perhaps
comparable to those for liver transplantation.
However, most patients with liver cancer also have cirrhosis of the liver and would
not tolerate liver resection surgery. But, they probably could tolerate the
transplantation operation, which involves removal of the patient's entire
diseased liver just prior to transplanting a donor liver. Furthermore, many
patients who undergo hepatic resections will develop a recurrence of liver
cancer
elsewhere in the liver within several years. In fact, some experts believe that
once a liver develops liver cancer, there is a tendency for that liver to develop other
tumors at the same time (synchronous multicentric occurrence) or at a later time
(metachronous multicentric occurrence).
The results of the various medical treatments (chemotherapy,
chemoembolization, ablation, and proton beam therapy) remain disappointing.
Moreover, for reasons noted earlier (primarily the variability in natural
history), there have been no systematic study comparisons of the different
treatments. As a result, individual patients will find that the various
treatment options available to them depend largely on the local expertise.
How do we know if a particular treatment worked for a particular patient?
Well, hopefully, the patient will feel better. However, a clinical response to
treatment is usually defined more objectively. Thus, a response is defined as a
decrease in the size of the tumor on imaging studies along with a reduction of
the alpha-fetoprotein in the blood, if the level was elevated prior to
treatment.
Next: Chemoembolization (trans-arterial chemoembolization or TACE) »
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