Treating Liver Cancer

Chronic hepatitis B infections are an important cause of hepatocellular carcinoma, or primary liver cancer, throughout the world. In parts of China and Taiwan, hepatitis B is the cause of 80 percent of the cases of liver cancer. Hepatocellular carcinoma is responsible for over 12,000 deaths per year in the United States. Worldwide, it causes over a million deaths per year, making it one of the most common malignancies in adults. It is more common in men than women, and in blacks than whites. It is especially prevalent in parts of Asia and Africa.

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In this country, primary liver cancer is often detected during screening for underlying liver disease. Most people with liver cancer have no symptoms until the disease is advanced.

Most hepatocellular carcinomas are first diagnosed with CT scans, magnetic resonance imaging (MRI), or ultrasound scans. These tests range from 60 to 100 percent accuracy, depending on the size of the tumor, with larger tumors being more visible. About 70 percent of patients with hepatocellular carcinoma have elevated blood concentrations of a tumor marker called alpha-fetoprotein; however, it is not specific for this condition. If there is doubt about the presence of liver cancer, the definitive diagnosis is made by liver biopsy.

Treatment of liver cancer is based on the size of the tumor, its location, and its spread to blood vessels and nearby or distant organs. Surgery, where a portion of the liver is removed, or "resectioned," offers the only cure for the disease and the best long-term chance of survival. Patients with smaller tumors and without cirrhosis or metastasis to other organs are the best candidates for liver resection. New techniques such as cryosurgery (freezing the tumor and tissue around it), radio frequency ablation (which destroys the tumor inside the liver with a heat probe), and chemoembolization (which destroys the tumor inside the liver with chemoagents) may work for some patients who are not good candidates for liver resection.

In patients with small tumors but advanced cirrhosis, liver transplantation is the treatment of choice. The tumor must be confined to the liver and without invasion into the surrounding blood vessels. Liver transplant is the only treatment option for patients with tumors that cannot be surgically or medically removed. However, larger or more extensive tumors have a high risk for early recurrence after liver transplantation.

Traditional chemotherapy and radiation have not been effective for treating liver cancer. The five-year survival rate for patients with liver cancer who have a liver transplant is now about 50 percent.

Early detection improves the chances of survival after treatment. Certain high-risk people with chronic hepatitis B--Asians and Africans over a certain age, people with cirrhosis, those with a family history of liver cancer, and people over age 40 who have persistently elevated liver enzymes and/or a high level of the hepatitis B virus in their body--should undergo liver cancer screening every six to 12 months with a blood test for tumor markers and a liver ultrasound. Universal hepatitis B vaccination may ultimately reduce the incidence of this often fatal cancer worldwide.