Liver & pancreatobiliary cancer

Patients with advanced liver cancer usually have the same symptoms as chronic liver diseases, such as jaundice, where there is a yellowing of the skin and eyes, and distension of the abdomen with fluid. Other symptoms of advanced liver disease, such as encephalopathy (altered mental state and delusions) and bleeding in the stomach and intestinal tract can indicate severe damage to the liver that can often develop into liver cancer.

Can We Screen for Liver Cancer?

Yes. Regular liver screening can help doctors find and treat liver cancer early, when the cancer is localised and more easily removed by surgery. Early detection can provide better treatment options and improve the chances of survival. Those with chronic hepatitis B infection and liver scarring (cirrhosis) due to hepatitis C or other causes are at increased risk and should be screened for liver cancer regularly.

Screening involves:

• A blood test for alpha-fetoprotein (AFP) every 3 – 6 months
• An ultrasound scan of the liver every 6 – 12 months

The following tests and procedures may be performed to diagnose liver cancer and show the stage of cancer development:

• Physical examination for general signs of health. An examination of the abdomen will also be performed to check for hard lumps in the liver and abdominal swelling.
• Blood tests to check liver function and the amount of alpha-fetoprotein (AFP), which can be higher in people with primary liver cancer (hepatocellular carcinoma).
• A liver ultrasound scan that uses sound waves to produce a picture of the liver. This is a painless test that usually takes several minutes to perform. The picture may reveal existing liver tumours.
• A computed tomography (CT) or magnetic resonance imaging (MRI) scan of the abdomen to visualise the 3-dimensional picture of liver. It can produce a more detailed picture that shows the size and position of a tumour, and whether it has spread.

Although a diagnosis of liver cancer can be made based on the amount of AFP in the blood and on dedicated MRI scans, a liver biopsy may sometimes be needed to be sure of the diagnosis. If the cancer has not already spread and if there is a chance it can be removed, then a biopsy might not be performed. This is due to the small risk of the cancer spreading along the path of the needle when the biopsy needle is removed. In this situation, the diagnosis is confirmed after an operation to remove the tumour.

The type of treatment for patients with liver cancer will depend on its stage (ie. its size and whether it has spread beyond its original site) and the patient’s general health. The main treatments used are surgery, tumour ablation, chemotherapy, targeted cancer therapy and radiotherapy.

Surgery

Surgery is potentially curative and is therefore the treatment of choice for patients with early stage liver cancer. If only certain parts of the liver are affected by cancer and the rest of the liver is healthy, then surgery may be possible to remove the affected part or parts. This type of surgery is called a liver resection.

Another form of surgery is a liver transplant. This involves the removal of the entire liver and replacement with a healthy donated liver. Such a major operation may be considered when the cancer is in the liver only, a donated liver is available, and in the opinion of the multi-disciplinary team the cancer is likely to be eradicated by surgery. A healthy liver is capable of regenerating, so a living donor liver transplant can also be performed where part of a healthy donor’s liver is removed and transplanted to the patient. In this case, both the remaining liver in the donor and the transplanted liver can regenerate fully if the procedure is successful. Anti-rejection drugs (immunosuppressants) will be required to prevent organ rejection after a liver transplant.

Tumour Ablation

Tumour ablation aims to destroy primary liver cancer cells using either heat (radiofrequency ablation – RFA) or alcohol (percutaneous ethanol injection – PEI). This procedure is usually done in the scanning department so that ultrasound or computerised tomography (CT) can help the doctor to guide a needle through the skin and into the cancer within the liver. A local anaesthetic will be given. RFA treatment uses laser light or radio waves passed through the needle to destroy cancer cells by heating them to a very high temperature. PEI treatment uses alcohol injected through the needle into the cancer to destroy the cancer cells. Tumour ablation may sometimes be repeated if the tumour grows again.

Chemotherapy

Chemotherapy is the use of anti-cancer drugs to destroy cancer cells or stop them from dividing. It can help to control symptoms by shrinking the cancer and slowing its progression. Chemotherapy drugs are usually given as injections into the vein (intravenously), although they can sometimes be given as tablets. Chemotherapy may also be administered as part of a treatment called chemo-embolisation. This involves the injection of chemotherapy drugs directly into the cancer in the liver, together with a gel or tiny plastic beads to block blood flow to the cancer (embolisation). Not everyone is suitable for chemotherapy as it can only be given if the liver function remains sufficiently good.

Targeted Cancer Therapy

Targeted cancer therapy uses drugs or other substances that block the growth and spread of cancer by interfering with specific molecules involved in cancer growth and progression. For example, a targeted drug called sorafenib may be used to treat patients with advanced liver cancer. This drug targets cancers by stopping them from growing their own blood vessels. As cancer cells need a blood supply to receive nutrients and oxygen, this may therefore limit the cancer’s ability to develop. It has been demonstrated in 2 large clinical studies to prolong survival in patients with advanced liver cancer, compared with supportive care alone. Sorafenib’s side effects include diarrhoea, tiredness, and high blood pressure.

Radiation therapy

Radiation therapy uses high-energy rays to destroy cancer cells or keep them from growing. External radiotherapy uses a machine outside the body to deliver radiation to the cancer. Such treatment is not often used to treat liver cancer because the liver cannot take very high doses of radiation. It may however be used to relieve pain, for example, in patients whose cancer has spread to the bone. Alternatively, internal radiation uses a radioactive substance delivered selectively to the cancer via the hepatic artery, a major blood vessel that carries blood to the liver.

Can Liver Cancer be Prevented?

Yes, there are several things we can do to prevent liver cancer. These include:

1. Vaccinate against the hepatitis B virus

2. Avoid heavy consumption of alcohol, which causes alcoholic fatty liver disease, a disease that can develop into liver cancer

3. Avoid heavy meat and animal fat intake. Avoid mouldy peanuts and grains

4. Go for regular screenings if you are in the high risk group