November 1, 2016 | by Abe Rosenberg
Your liver is an amazing three-pound superachiever that filters toxins from your body, produces bile to help digest fats and even helps make sure your blood clots properly. Although liver cancer is relatively rare, the numbers are rising. By 2030, liver cancer is expected to be the third most common cancer killer.
City of Hope is a leader in liver cancer detection and treatment. Here, surgeon and researcher Susanne Gray Warner, M.D., an associate professor in the Department of Surgery at City of Hope, explains how to better understand how this cancer works, where it comes from and how it is treated.
What causes liver cancer?
The No. 1 culprit is chronic inflammation, which can be present for 10 to 20 years before cancer develops. Hepatitis is a major cause of this inflammation. As such, liver cancer is common in parts of the world where hepatitis B and C are prevalent. Fortunately, however, new treatments are enabling many hepatitis patients to prevent liver cancer, when the infection is caught early.
In the U.S., the leading cause of liver cancer is cirrhosis - a liver disease triggered by excessive drinking. Too much alcohol stresses the liver, forcing the organ to work harder, Warner explained. “This causes injuries, which harden into scar tissue as the liver tries to heal. Over time, the liver cells, so preoccupied with healing, may no longer receive the message to stop growing,” she said.
Who gets liver cancer and what are the symptoms?
Because it can take many years for the disease to develop, liver cancer usually is seen in older patients. Most are men, and the average age is around 67.
People who abuse alcohol and IV drug users need to be extra vigilant about liver cancer, Warner said. Men who consume five to seven alcoholic drinks a day (three to five per day for women) are prime candidates for cirrhosis, and a small percentage of them will develop liver cancer.
“The liver is a large organ that does many things, so you may not see symptoms early,” she explained. “However, if you're in that high-risk group because of your alcohol habits, and you experience swelling of the abdomen or the legs, abdominal pain, or yellowing of your skin or eyes, those could be warning signs.”
How is liver cancer treated?
Surgery is the best option for curing liver cancer. “Depending on the condition of the liver, and how advanced the cancer is, we can remove the tumors or use ablation techniques to destroy them,” Warner said. “Some of these procedures can be done with minimally invasive robotic surgery. Some patients with single or small tumors are good candidates for a liver transplant, but those with large or multiple tumors don't generally fare as well so they don’t meet transplant criteria.”
Are there other treatments?
“We've been looking for a long time for chemotherapy drugs for liver cancer, and unfortunately, so far we've come up short,” Warner explained. “Right now we resort to chemo only in cases where surgery is not possible. However, we are very excited about new ways of using chemo, as well as the potential of immunotherapy treatments such as CAR-T cells, and oncolytic or cancer-killing viruses, which are showing tremendous promise in blood cancers, brain tumors and other solid tumors, including those affecting the liver.
“As surgeons, we all hope to someday become obsolete,” Warner continued. “I don't think that will happen during the course of my career. But I do believe we'll make exponentially greater progress in this decade than we ever have before.”
What are the most important things that patients should remember?
Two things: If you think you're at high risk because of hepatitis or heavy drinking, talk to your doctor," Warner advised. “Have the conversation,” she said. "The earlier you stay on top of this, the better your odds.”
Second, if you are diagnosed, be sure to consult with a comprehensive cancer center where liver cancer is treated on a regular basis. “City of Hope has the resources, the experience and, perhaps most important, the collaboration among experts in multiple disciplines to craft the best possible treatment for the best possible results,” Warner said.
Learn more about liver cancer. If you are looking for a second opinion or consultation about your treatment, request an appointment online or contact us at 800-826-HOPE. Please visit Making Your First Appointment for more information.