Medical terms related to the liver often start in hepato- or hepatic from the Greek word for liver, hēpar (ἡπαρ).

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1 Cancer Assciatin f Suth Africa (CANSA) Fact Sheet n Liver Cancer Intrductin The liver, hepar, is a vital rgan present in vertebrates and sme ther animals. It has a wide range f functins, including detxificatin, prtein synthesis, and prductin f bichemicals necessary fr digestin. The liver is necessary fr survival; there is currently n way t cmpensate fr the absence f liver functin in the lng term, althugh new liver dialysis techniques can be used in the shrt term. [Picture Credit: Liver] This rgan plays a majr rle in metablism and has a number f functins in the bdy, including glycgen strage, decmpsitin f red bld cells, plasma prtein synthesis, hrmne prductin, and detxificatin. It lies belw the diaphragm in the abdminal-pelvic regin f the abdmen. It prduces bile, an alkaline cmpund which aids in digestin via the emulsificatin f lipids. The liver's highly specialized tissues regulate a wide variety f high-vlume bichemical reactins, including the synthesis and breakdwn f small and cmplex mlecules, many f which are necessary fr nrmal vital functins. Medical terms related t the liver ften start in hepat- r hepatic frm the Greek wrd fr liver, hēpar (ἡπαρ). Liver Cancer Liver cancer (hepatcellular carcinma) is a cancer arising frm the liver. It is als knwn as primary liver cancer r hepatma. The liver is made up f different cell types (fr example, bile ducts, bld vessels, and fat-string cells). Hwever, liver cells (hepatcytes) make up 80% f the liver tissue. Thus, the majrity f primary liver cancers (ver 90%-95%) arises frm liver cells and is called hepatcellular cancer r carcinma (MedicineNet). Researched and Authred by Prf Michael C Herbst [D Litt et Phil (Health Studies); D N Ed; M Art et Scien; B A Cur; Dip Occupatinal Health] Apprved fr Distributin by Ms Elize Jubert, Acting CEO May 2015 Page 1

2 Incidence f Liver Cancer in Suth Africa Accrding t the Natinal Cancer Registry (2009) the fllwing number f liver and bile duct cancer cases were histlgically diagnsed in Suth Africa during 2009: Grup - Males N f Cases Lifetime Risk 2009 All males 243 1:701 Asian males 4 1:1 135 Black males 167 1:809 Clured males 22 1:536 White males 50 1:522 Grup - Females N f Cases Lifetime Risk 2009 All females 175 1:1 155 Asian females 5 1:773 Black females 118 1:1 285 Clured females 20 1:734 White females 32 1:1 045 The frequency f histlgically diagnsed cases f liver and bile duct cancer in Suth Africa fr 2009 were as fllws (Natinal Cancer Registry, 2009): Grup - Males All males Asian males Black males Clured males White males Grup - Females All females Asian females Black females Clured females White females N.B. In the event that the ttals in any f the abve tables d nt tally, this may be the result f uncertainties as t the age, race r sex f the individual. The ttals fr all males and all females, hwever, always reflect the crrect ttals. Causes f Liver Cancer Hepatitis B can be caused by cntaminated bld prducts r used needles r sexual cntact but is frequent amng Asian children frm cntaminatin at birth r even biting amng children at play. The rle f hepatitis B virus (HBV) infectin in causing liver cancer is well established. Several lines f evidence pint t this strng assciatin. As nted earlier, the frequency f liver cancer relates t (crrelates with) the frequency f chrnic hepatitis B virus infectin. In additin, the patients with hepatitis B virus wh are at greatest risk fr liver cancer are men with hepatitis B virus cirrhsis (scarring f the liver) and a family histry f liver cancer. Perhaps the mst cnvincing evidence, hwever, cmes frm a prspective (lking frward in time) study dne in the 1970s in Taiwan invlving male gvernment emplyees ver the age f 40. In this study, the investigatrs fund that the risk f Researched and Authred by Prf Michael C Herbst [D Litt et Phil (Health Studies); D N Ed; M Art et Scien; B A Cur; Dip Occupatinal Health] Apprved fr Distributin by Ms Elize Jubert, Acting CEO May 2015 Page 2

3 develping liver cancer was 200 times higher amng emplyees wh had chrnic hepatitis B virus infectin as cmpared t emplyees withut this infectin. Hepatcellular carcinma accunts fr mst liver cancers. This type f cancer ccurs mre ften in men than wmen. It is usually seen in peple age 50 r lder. Hwever, the age varies in different parts f the wrld. The disease is mre cmmn in parts f Africa and Asia than in Nrth r Suth America and Eurpe. Hepatcellular carcinma is nt the same as metastatic liver cancer, which starts in anther rgan (such as the breast r cln) and spreads t the liver. In mst cases, the cause f liver cancer is usually scarring f the liver (cirrhsis). Cirrhsis may be caused by: Alchl abuse Autimmune diseases f the liver Hepatitis B r C viral infectins Inflammatin f the liver that is lng-term (chrnic) Irn verlad in the bdy (haemchrmatsis) (MedicineNet; PubMed Health). Risk Factrs fr Liver Cancer Factrs that increase the risk f primary liver cancer include: Gender research shws that men are mre likely t develp liver cancer than are wmen Age - in Nrth America, Eurpe and Australia, liver cancer mst cmmnly affects lder adults. In develping cuntries f Asia and Africa, liver cancer diagnsis tends t ccur at a yunger age between 20 and 50 Chrnic infectin with hepatitis B virus (HBV) r hepatitis C virus (HCV) - chrnic infectin with HBV r HCV increases the risk fr liver cancer even if there is n develpment f cirrhsis Cirrhsis - this prgressive and irreversible cnditin causes scar tissue t frm in the liver and increases the chances f develping liver cancer Certain inherited liver diseases - liver diseases that can increase the risk fr liver cancer include haemchrmatsis (a disease that causes the bdy t stre t much irn in the liver and ther rgans, als smetimes referred t as irn strage disease ) and Wilsn's disease Diabetes - peple with this bld sugar disrder have a greater risk f liver cancer than d peple wh dn't have diabetes Nn-alchlic fatty liver disease - an accumulatin f fat in the liver increases the risk f liver cancer Expsure t aflatxins - cnsuming fds cntaminated with fungi that prduce aflatxins greatly increases the risk f liver cancer. Crps such as crn and peanuts can becme cntaminated with aflatxins and is mre cmmn in parts f Africa and Asia Obesity - having an unhealthy bdy mass index increases the risk f liver cancer. Excessive alchl cnsumptin - cnsuming mre than a mderate amunt f alchl daily ver many years can lead t irreversible liver damage and increase the risk f liver cancer. Wmen shuld nt cnsume mre than ne standard alchlic Researched and Authred by Prf Michael C Herbst [D Litt et Phil (Health Studies); D N Ed; M Art et Scien; B A Cur; Dip Occupatinal Health] Apprved fr Distributin by Ms Elize Jubert, Acting CEO May 2015 Page 3

4 drink per day and men shuld nt cnsume mre than tw standard alchlic drinks per day. A standard alchlic drink cmprises: 340ml beer (average 5% alchl by vlume) 120ml wine 25ml liqueur 50ml sherry 25ml spirits (such as brandy, whiskey, gin, vdka and cane). (May Clinic; ScienceDaily; Natinal Cancer Institute; Life is Beautiful) Signs and Symptms f Liver Cancer Mst peple dn't have signs and symptms in the early stages f primary liver cancer. When signs and symptms d appear, it may include: lsing weight nt assciated with changes in diet lss f appetite upper abdminal pain nausea and vmiting general weakness and fatigue an enlarged liver enlarged spleen which is felt as a mass under the ribs n the left side f the abdmen abdminal swelling yellw disclratin f yur skin and the whites f the eyes (jaundice) dark urine white, chalky stls easy bruising r bleeding enlarged abdmen fever (May Clinic; Cancer Treatment Centers f America; Canadian Cancer sciety; WebMD; Natinal Cancer Institute). Diagnsis f Liver Cancer The fllwing prcedures cntribute twards the diagnsis f liver cancer: Ultrasund - This test uses sund waves t lk fr masses in the liver Cmputed tmgraphy (CT) - The CT scan is an x-ray test that prduces detailed crsssectinal images f yur bdy. A CT scan f the abdmen is very useful in identifying many types f liver tumurs. It can prvide precise infrmatin abut the size, shape, and psitin f any tumurs in the liver r elsewhere in the abdmen, as well as nearby bld vessels. CT scans can als be used t guide a bipsy needle precisely int a suspected tumur (called a CT-guided needle bipsy). If smene is fund t have liver cancer, a CT f the chest may als be dne t lk fr pssible spread f the cancer t the lungs Instead f taking ne picture like a standard x-ray, a CT scanner takes many pictures as it rtates arund the patient. A cmputer then cmbines these int detailed images f slices f the part f the bdy that is being studied. Researched and Authred by Prf Michael C Herbst [D Litt et Phil (Health Studies); D N Ed; M Art et Scien; B A Cur; Dip Occupatinal Health] Apprved fr Distributin by Ms Elize Jubert, Acting CEO May 2015 Page 4

5 Fr this test, the patient may be asked t drink 450ml t 1 000ml f a liquid called ral cntrast. This helps utline the intestine s that certain areas are nt mistaken fr tumurs. The patient may als receive an IV (intravenus) line thrugh which a different kind f cntrast (IV cntrast) is injected. This helps better utline structures in the bdy. The injectin can cause sme flushing (redness and warm feeling). Sme peple are allergic and get hives r, rarely, mre serius reactins like truble breathing and lw bld pressure. The presiding dctr will usually enquire abut any pssible allergies r a previus reactin t any cntrast material used fr x-rays. If a dctr suspects that a patient may have liver cancer, ne set f CT scans may be requested f the patient s abdmen befre taking a secnd set with IV cntrast. Other sets f scans may then be taken ver the next several minutes as the cntrast passes thrugh the liver and ther parts f the bdy. These sets f scans (tgether knwn as a 4-phase r multiphase CT scan) can help spt different types f liver tumurs. CT scans take lnger than regular x-rays. The patient needs t lie still n a table while the scans are being dne. During the test, the table slides in and ut f the scanner, a ringshaped machine that cmpletely surrunds the table. Sme patients might feel a bit cnfined by the ring they have t lie in while the pictures are being taken. Spiral CT (als knwn as helical CT), which uses a faster machine and yields mre detailed pictures, is nw used in many medical centres. Magnetic Resnance Imaging (MRI) - Like CT scans, MRI scans prvide detailed images f sft tissues in the bdy, but use radi waves and strng magnets instead f X-rays. The energy frm the radi waves is absrbed and then released in a pattern frmed by the type f bdy tissue and by certain diseases. A cmputer translates the pattern int a very detailed image f parts f the bdy. When MRI is used t lk at liver tumurs, several sets f images may be taken. After the first set is dne, a cntrast material called gadlinium is injected int a vein t help see details mre clearly. Then ther sets f images are taken ver the next several minutes as the cntrast mves thrugh the liver and ther parts f the bdy. This is knwn as dynamic cntrast-enhanced MRI. MRI scans can be very helpful in lking at liver tumurs. Smetimes it can tell a benign tumur frm a malignant ne. It can als be used t lk at bld vessels in and arund the liver and can help shw if liver cancer has spread t ther parts f the bdy. MRI scans may be a little mre uncmfrtable than CT scans and it ften takes lnger. The patient may be placed inside a narrw tube, which is cnfining and can upset peple with a fear f enclsed spaces. Newer, mre pen MRI machines are nw available. The MRI machine als makes buzzing and clicking nises that sme patients may find disturbing. Sme places will prvide earplugs t help blck these nises ut. Angigraphy - An angigram is an x-ray test fr lking at bld vessels. Cntrast medium, r dye, is injected int an artery t utline bld vessels while x-ray images are taken. Angigraphy can be used t shw the arteries that supply bld t a liver cancer, which can help dctrs decide if a cancer can be remved and t help plan the peratin. It can als be used t help guide sme types f nn-surgical treatment, such as emblisatin. Researched and Authred by Prf Michael C Herbst [D Litt et Phil (Health Studies); D N Ed; M Art et Scien; B A Cur; Dip Occupatinal Health] Apprved fr Distributin by Ms Elize Jubert, Acting CEO May 2015 Page 5

6 Angigraphy can be uncmfrtable because the dctr ding the test has t put a small catheter (a flexible hllw tube) int the artery leading t the liver t inject the dye. Usually the catheter is put int an artery in the inner thigh and threaded up int the liver artery. A lcal anaesthetic is ften used t numb the area befre inserting the catheter. Then the dye is injected quickly t utline all the vessels while the x-rays are being taken. Angigraphy may als be dne with a CT scanner (CT angigraphy) r an MRI scanner (MR angigraphy). These techniques are ften used instead f x-ray angigraphy because it can give infrmatin abut the bld vessels in the liver withut the need fr a catheter in the artery. The patient may still need an IV line s that a cntrast dye can be injected int the bldstream during the imaging. Bne scan - A bne scan can help lk fr cancer that has spread t bnes. Dctrs dn't usually rder this test fr peple with liver cancer unless they have symptms such as bne pain, r if there's a chance that they may be eligible fr a liver transplant t treat the cancer. Fr this test, a small amunt f lw-level radiactive material is injected int a vein (IV). The substance settles in areas f damaged bne thrughut the entire skeletn ver the curse f a cuple f hurs. The patient then lies n a table fr abut 30 minutes while a special camera detects the radiactivity and creates a picture f the skeletn. Areas f active bne changes appear as ht spts n the skeletn that is, it attracts the radiactive substance. These areas may suggest the presence f cancer, but ther bne diseases can als cause the same pattern. T distinguish between these cnditins, ther imaging tests such as plain x-rays r MRI scans, r even a bne bipsy might be needed. Other Prcedures Other types f tests may be dne if the dctr thinks the patient might have liver cancer but the imaging test results aren t cnclusive. Laparscpy - in this prcedure, a dctr inserts a thin, lighted tube with a small vide camera n the end thrugh a small incisin (cut) in the frnt f the abdmen t lk at the liver and ther internal rgans. (Smetimes mre than ne cut is made.) This prcedure is dne in the perating rm. The patient is usually under general anaesthesia (in a deep sleep), althugh in sme cases the patient may nly be sedated (made sleepy) and the area f the incisin will be numbed. Laparscpy can help plan surgery r ther treatments and can help dctrs cnfirm the stage (extent) f the cancer. If needed, dctrs can als insert instruments thrugh the incisins t remve bipsy samples, which are then lked at under a micrscpe t make r cnfirm the diagnsis f cancer. Laparscpy is usually dne at an utpatient surgery centre. Because the surgen nly makes a small incisin t insert the tubes, the patient shuld nt have much pain after surgery. Such patients shuld be able t g hme after they recver frm the anaesthesia. Bipsy - a bipsy is the remval f a sample f tissue t see if there is cancer present. Smetimes, the nly way t be certain that liver cancer is present is t take a bipsy and lk at it under a micrscpe. Researched and Authred by Prf Michael C Herbst [D Litt et Phil (Health Studies); D N Ed; M Art et Scien; B A Cur; Dip Occupatinal Health] Apprved fr Distributin by Ms Elize Jubert, Acting CEO May 2015 Page 6

7 But in sme cases, dctrs can be fairly certain that a persn has liver cancer based n the results f imaging tests such as CT and MRI scans. In these cases, a bipsy may nt be needed. Dctrs are ften cncerned that sticking a needle int the tumur r therwise disturbing it withut cmpletely remving it might help cancer cells spread t ther areas. This is a majr cncern if a liver transplant might be an ptin t try t cure the cancer, as any spread f the cancer might make the persn ineligible fr a transplant. Needle bipsy - fr a needle bipsy, a hllw needle is placed thrugh the skin in the abdmen and int the liver. The skin is first numbed with lcal anaesthesia befre the needle is placed. Different sized needles may be used, namely: fr a fine needle aspiratin (FNA) bipsy, tumur cells are sucked int a very thin needle with a syringe a cre needle bipsy uses a slightly larger needle t get a bigger sample There are prs and cns t bth types f needle bipsies. Fine needle aspiratins can usually cnfirm a cancer, but smetimes it desn't prvide enugh infrmatin t be sure abut the type f cancer. Sme dctrs prefer a cre needle bipsy ver an fine needle aspiratin, as it prvides a larger sample and therefre, mre infrmatin abut the tumur. The risk f cmplicatins is lwer with a fine needle aspiratin, especially when tumurs are near large bld vessels. The dctr may use ultrasund r CT scanning t guide the needle int the tumur. With this apprach, the dctr slwly advances the needle while its psitin is checked by ne f these imaging tests. When the images shw that the needle is in the tumur, a sample is remved and sent t the lab t be lked at under a micrscpe. Laparscpic bipsy - bipsy specimens can als be taken during laparscpy. This lets the dctr see the surface f the liver and take samples f abnrmal-appearing areas. Surgical bipsy - in sme cases, a bipsy sample may nt be btained until surgery that is meant t treat the tumur. An incisinal bipsy (remving a piece f the tumur) r an excisinal bipsy (remving the entire tumur and sme surrunding nrmal liver tissue) can be dne during an peratin since dctrs ften prefer t knw the exact type f tumur befre surgery, ther types f bipsy methds may als be used. Labratry Tests The treating dctr may rder lab tests fr a number f reasns: t help diagnse liver cancer t help determine what might have caused yur liver cancer t learn hw well the liver is wrking, which may affect what types f treatments the patient can have t get an idea f the patient s general health and hw well the ther rgans are wrking, which als may affect what types f treatments the patient can have t see hw well treatment is wrking t lk fr signs that the cancer has cme back after treatment Researched and Authred by Prf Michael C Herbst [D Litt et Phil (Health Studies); D N Ed; M Art et Scien; B A Cur; Dip Occupatinal Health] Apprved fr Distributin by Ms Elize Jubert, Acting CEO May 2015 Page 7

8 Alpha-fetprtein bld (AFP) test this is a bld test t lk fr alpha-fetprtein (AFP) in the bld. AFP is nrmally made by a fetus's liver. It is the main prtein during the first three mnths f develpment. AFP greatly decreases by age 1 and shuld nly be fund in adults in very lw levels. It is ne f several tumur markers. Tumur markers are mlecules in the bld that are higher when a persn has certain cancers. AFP is fund mainly in liver cancer and nn-seminmatus germ cell tumurs, which are rare. These are fund in the pineal gland (a small endcrine gland) in the brain. Sme peple with cirrhsis r chrnic active hepatitis als have higher bld levels f AFP. It can be helpful in determining if a liver mass might be cancer. A lw r nrmal value n this test means it is less likely that the patient has liver cancer, while a high value makes it mre likely. This test is nt always accurate, s ther test and examinatin results als have t be taken int accunt. This test can als be useful in peple already diagnsed with liver cancer. The AFP level can help determine what treatment ptins might be apprpriate. During treatment, the test can be used t help give an idea f hw well it is wrking, as the AFP level shuld g dwn if treatment is effective. The test can be used after treatment as well, t lk fr pssible signs that the cancer has cme back (recurred). Other Bld Tests Liver functin tests (LFTs) - liver cancer ften develps in livers already damaged by hepatitis and/r cirrhsis, therefre, dctrs need t knw the cnditin f the patient s liver befre starting with treatment. A series f bld tests can help assess the cnditin f the part f the liver nt affected by the cancer. They measure levels f certain substances in the bld that shw hw well the liver is wrking. If the liver is nt healthy, the patient might nt be able t have surgery t try t cure the cancer, as the surgery might require remval f a large part f the liver. This is a cmmn prblem in peple with liver cancer. Bld cltting tests - the liver als makes prteins that help bld clt when ne is bleeding. A damaged liver may nt make enugh f these cltting factrs, which culd increase the risk f bleeding. The treating dctr may rder bld tests such as a prthrmbin time (PT) t help assess this risk. Tests fr viral hepatitis - if liver cancer has nt yet been diagnsed, the dctr may rder bld tests t check fr hepatitis B and C. Results shwing that a patient has been infected with either f these viruses may make it mre likely that the patient has liver cancer. These tests are als dne in peple newly diagnsed with liver cancer, if nt dne previusly. Kidney functin tests - tests f bld urea nitrgen (BUN) and creatinine levels are ften dne t assess hw well the patient s kidneys are functining. Cmplete bld cunt (CBC) - this test measures levels f red bld cells, white bld cells (which fight infectins) and platelets (which help with bld clt). It gives an idea f hw well the bne marrw, where new bld cells are made, is functining. Researched and Authred by Prf Michael C Herbst [D Litt et Phil (Health Studies); D N Ed; M Art et Scien; B A Cur; Dip Occupatinal Health] Apprved fr Distributin by Ms Elize Jubert, Acting CEO May 2015 Page 8

9 Bld chemistry tests and ther tests - bld chemistry tests check the levels f a number f minerals and ther substances in the bld, sme f which might be affected by liver cancer. Fr example, liver cancer can cause bld levels f calcium t rise, while bld glucse levels may fall. Liver cancer may als cause chlesterl levels t g up, s it needs t be checked as well. (American Cancer Sciety) Staging f Liver Cancer Staging is a way f describing where the cancer is lcated, if r where it has spread, and whether it is affecting the functins f ther rgans in the bdy. Dctrs use diagnstic tests t determine the cancer's stage, s staging may nt be cmplete until all f the tests are finished. Knwing the stage helps the dctr decide what kind f treatment is best and can help predict a patient's prgnsis (chance f recvery). Fr liver cancer, the staging infrmatin belw is specifically fr hepatcellular carcinma (HCC), based n whether a tumur can be surgically remved, called resectable. When resectin is nt an ptin, the dctr will use additinal factrs, such as verall liver functin, t determine the treatment plan and predict prgnsis. Lcalised resectable: cancer is in ne place in the liver and the ther part f the liver is healthy. The cancer is resectable, meaning it can be remved thrugh surgery. Lcalised unresectable: cancer is fund in ne part f the liver, but it cannt be remved by surgery (unresectable). A smaller tumur may nt always be remvable by surgery because the liver itself is seriusly damaged (usually with cirrhsis) and there wuld nt be enugh f the liver left after the peratin t keep a persn healthy. Advanced: cancer has spread thrughut the liver and/r t ther parts f the bdy, such as the lungs and bnes. Recurrence: recurrent cancer is cancer that cmes back after treatment. If there is a recurrence, the cancer may need t be staged again (called re-staging). T describe the stage in mre detail, dctrs smetimes use the TNM system, utlined belw. This staging system is mst useful fr patients whse tumur can be surgically remved. This system judges three factrs: the tumur itself, the lymph ndes arund the tumur, as well as if the tumur has spread t the rest f the bdy. The results are cmbined t determine the stage f cancer fr each persn. There are fur stages: stages I thrugh IV (ne thrugh fur). The stage prvides a cmmn way f describing the cancer, s dctrs can wrk tgether t plan the best treatments. TNM is an abbreviatin fr tumur (T), nde (N) and metastasis (M). Dctrs lk at these three factrs t determine the stage f cancer: Hw large is the primary tumur and where is it lcated? (Tumur, T) Has the tumur spread t the lymph ndes? (Nde, N) Has the cancer metastasised t ther parts f the bdy? (Metastasis, M) Researched and Authred by Prf Michael C Herbst [D Litt et Phil (Health Studies); D N Ed; M Art et Scien; B A Cur; Dip Occupatinal Health] Apprved fr Distributin by Ms Elize Jubert, Acting CEO May 2015 Page 9

10 Tumur. Using the TNM system, the T plus a letter r number (0 t 4) is used t describe the size and lcatin f the tumur. Sme stages are als divided int smaller grups that help describe the tumur in even mre detail. If there is mre than ne tumur, the lwercase letter m (multiple) is added t the T categry. Specific tumur stage infrmatin fr HCC is listed belw. TX: The primary tumur cannt be evaluated T0: There is n evidence f a primary tumur T1: The tumur is 2 centimeters (cm) r smaller. It des nt invlve nearby bld vessels T2: Either f these: Any tumur that invlves nearby bld vessels Mre than ne tumur, but nne larger than 5 cm T3a: There is mre than ne tumur and at least ne is larger than 5 cm T3b: The tumur (f any size) invlves the majr veins arund the liver T4: Either f these: The tumur has spread t the rgans near the liver (except the gallbladder) The tumur has brken thrugh the visceral peritneum (layer f tissue that lines the abdmen) Nde. The "N" in the TNM staging system stands fr lymph ndes, the tiny, bean-shaped rgans that help fight infectin. Lymph ndes near the liver are called reginal lymph ndes. Lymph ndes in ther parts f the bdy are called distant lymph ndes NX: The reginal lymph ndes cannt be evaluated N0: Cancer has nt spread t the reginal lymph ndes N1: The cancer has spread t the reginal lymph ndes Distant Metastasis. The M in the TNM system indicates whether the cancer has spread t ther parts f the bdy. MX: The tumur cannt be evaluated M0: The cancer has nt spread t ther parts f the bdy M1: The tumur has spread t anther part f the bdy Cancer Stage Gruping Dctrs assign the stage f the HCC by cmbining the T, N, and M classificatins Stage I: This is the earliest stage f HCC. The tumur has nt spread t the bld vessels, lymph ndes, r ther parts f the bdy (T1, N0, M0 Stage II: The tumur invlves nearby bld vessels, but it has nt spread t the reginal lymph ndes r ther parts f the bdy (T2, N0, M0) Stage IIIA: The cancer has nt spread beynd the liver, but the area f the cancer is larger than stage I r II (T3a, N0, M0) Stage IIIB: The cancer invlves a majr vein arund the liver, but it has nt spread t nearby lymph ndes r ther parts f the bdy (T3b, N0, M0) Stage IIIC: Any tumur that has spread t the rgans near the liver (except the gallbladder), r if the tumur has brken thrugh the visceral peritneum. There is n spread t nearby lymph ndes r ther parts f the bdy (T4, N0, M0) Researched and Authred by Prf Michael C Herbst [D Litt et Phil (Health Studies); D N Ed; M Art et Scien; B A Cur; Dip Occupatinal Health] Apprved fr Distributin by Ms Elize Jubert, Acting CEO May 2015 Page 10

11 Stage IVA: Any tumur that has spread t the reginal lymph ndes but nt t ther parts f the bdy (any T, N1, M0) Stage IVB: Any tumur that has spread t ther parts f the bdy (any T, any N, M1) (Cancer.Net). Treatment f Liver Cancer The treatment will depend n the size, lcatin and stage f the tumur and whether it has spread. Surgery - surgery ften ffers the best chance fr a cure. Surgery may invlve remving (resecting) the diseased part f the liver t eliminate the cancer r transplant surgery t remve the liver and replace it with a dnr's healthy liver. Aggressive surgery r a liver transplant can successfully treat small r slw-grwing tumurs if they are diagnsed early. Hwever, few patients are diagnsed early. Chemtherapy chemtherapy which is delivered straight int the liver with a catheter can help, but it will nt cure the disease. Srafenib tsylate (Nexavar), an ral medicine that blcks tumur grwth, is nw apprved fr patients with advanced hepatcellular carcinma. Radiatin therapy radiatin treatments in the area f the cancer may als be helpful. Hwever, many patients have liver cirrhsis r ther liver diseases that make these treatments mre difficult. (PubMed Health; MedicineNet; May Clinic). Prgnsis fr Liver Cancer Patients The utcme f liver cancer is extremely variable and depends as much upn the state f the liver and the persn's health as n any characteristic f the cancer itself. Patients with mre than a slitary tumur in the setting f cirrhsis might nt live fr six mnths, while thse able t underg surgery f transplant might be fully cured. Therapies such as radifrequency ablatin, chem-emblisatin, cry-ablatin, radisurgery, radiemblisatin, and systemic therapy are frequently perfrmed sequentially ver a patient's lifetime, depending upn the changes as the disease prgresses. Average survival fr patients wh are able t be treated with these methds is between ne and tw years. Despite these grim statistics, there is still rm fr ptimism in this disease. Creative use f multiple techniques can lead t significant prlngatin f a patient's life, while keeping them feeling as well as pssible. Experimental drugs are becming increasingly cmmn as researchers have recgnised the mlecular defects causing this cancer and using this knwledge t develp new targets. The evlutin and imprvement in radilgic and interventinal technlgy fr treating lcalised tumurs has meant that millins f peple wh wuld previusly never have been treated have experienced meaningful prlngatin f their lives. In fact, the chance f living fr mre than tw years with liver cancer has mre than dubled since the early 1990s. (emedicinehealth). Researched and Authred by Prf Michael C Herbst [D Litt et Phil (Health Studies); D N Ed; M Art et Scien; B A Cur; Dip Occupatinal Health] Apprved fr Distributin by Ms Elize Jubert, Acting CEO May 2015 Page 11

12 The curse and utcme f liver cancer is dependent n several factrs: Type and lcatin f tumur hepatic tumurs are easily seen and smetimes cured cmpared t malignancies that riginates frm the bile ducts and bld vessels Stage the extent t which the cancer has spread and the degree f damage it has dne t the bdy Grade the severity f the malignancy based n the degree f cell abnrmality and hw fast the cancer is spreading Age n average lder individuals shw increased mrtality rates cmpared t yung adults Alpha-fetprtein (AFP) levels AFP is a plasma prtein prduced by the fetus, particularly in the liver. Levels are high during the fetal stage. AFP greatly decreases by age 1 and shuld nly be fund in adults in very lw levels. In adults, AFP is prduced by primary liver tumurs and germ cell tumurs (Liver Cancer Prgnsis Center). Cmplicatins f Liver Cancer The cmplicatins f liver cancer include: Budd-Chiari syndrme - hepatic vein bstructin prevents bld frm flwing ut f the liver and back t the heart. This blckage can cause liver damage. Obstructin f this vein can be caused by a tumur r grwth pressing n the vessel, r by a clt in the vessel (hepatic vein thrmbsis). Hepatic vein bstructin is the mst cmmn cause f Budd-Chiari syndrme cancer spread t ther rgans internal bleeding - gastrintestinal bleeding liver failure tumur rupture. Clinical Trials Clinical trials are research studies that invlve peple. They are the final step in a lng prcess that begins with research in a lab. Mst treatments used tday are the results f past clinical trials. Cancer clinical trials are designed t test new ways t: treat cancer find and diagnse cancer prevent cancer manage symptms f cancer r side effects frm its treatment Every trial has a persn in charge, usually a dctr, wh is called the principal investigatr. The principal investigatr prepares a plan fr the trial, called a prtcl. The prtcl explains what will be dne during the trial. It als cntains infrmatin that helps the dctr decide if this treatment is right fr a particular patient. Researched and Authred by Prf Michael C Herbst [D Litt et Phil (Health Studies); D N Ed; M Art et Scien; B A Cur; Dip Occupatinal Health] Apprved fr Distributin by Ms Elize Jubert, Acting CEO May 2015 Page 12

13 The prtcl includes infrmatin abut: the reasn fr ding the trial wh can jin the trial (called eligibility requirements ) hw many peple are needed fr the trial any drugs that will be given, hw they will be given, the dse, and hw ften what medical tests will be dne and hw ften what types f infrmatin will be cllected abut the peple taking part Fr sme patients, taking part in a clinical trial may be the best treatment chice. Clinical trials are part f the cancer research prcess. Many f tday's standard treatments fr cancer are based n earlier clinical trials. Patients wh take part in a clinical trial may receive the standard treatment r be amng the first t receive a new treatment. Patients wh take part in clinical trials als help imprve the way cancer will be treated in the future. Even when clinical trials d nt lead t effective new treatments, they ften answer imprtant questins and help mve research frward. Patients can enter clinical trials befre, during, r after starting their cancer treatment. Sme clinical trials nly include patients wh have nt yet received treatment. Other trials test treatments fr patients whse cancer has nt gtten better. There are als clinical trials that test new ways t stp cancer frm recurring (cming back) r reduce the side effects f cancer treatment. (Natinal Cancer Institute). Medical Disclaimer This Fact Sheet is intended t prvide general infrmatin nly and, as such, shuld nt be cnsidered as a substitute fr advice, medically r therwise, cvering any specific situatin. Users shuld seek apprpriate advice befre taking r refraining frm taking any actin in reliance n any infrmatin cntained in this Fact Sheet. S far as permissible by law, the Cancer Assciatin f Suth Africa (CANSA) des nt accept any liability t any persn (r his/her dependants/estate/heirs) relating t the use f any infrmatin cntained in this Fact Sheet. Whilst the Cancer Assciatin f Suth Africa (CANSA) has taken every precautin in cmpiling this Fact Sheet, neither it, nr any cntributr(s) t this Fact Sheet can be held respnsible fr any actin (r the lack theref) taken by any persn r rganisatin wherever they shall be based, as a result, direct r therwise, f infrmatin cntained in, r accessed thrugh, this Fact Sheet. Researched and Authred by Prf Michael C Herbst [D Litt et Phil (Health Studies); D N Ed; M Art et Scien; B A Cur; Dip Occupatinal Health] Apprved fr Distributin by Ms Elize Jubert, Acting CEO May 2015 Page 13

14 References and Surces American Cancer Sciety Canadian Cancer Sciety y%20liver%20cancer.aspx?sc_lang=en Cancer.Net Cancer Treatment Centers f America emedicinehealth Liver ZA490ZA490&biw=1821&bih=815&tbm=isch&prmd=imvns&tbnid=WZ_EXrPyI9YM5M:&imgr efurl= /liver.jpg&w=400&h=320&ei=xwphuowjilb0qx1v4dgag&zm=1&iact=hc&vpx=819&vp y=122&dur=3543&hvh=201&hvw=251&tx=114&ty=103&sig= &p age=3&tbnh=146&tbnw=183&ndsp=46&ved=1t:429,r:21,s:82,i:71]. Liver Cancer Prgnsis Center May Clinic MedicineNet Natinal Cancer Institute PubMed Health ScienceDaily WebMD Researched and Authred by Prf Michael C Herbst [D Litt et Phil (Health Studies); D N Ed; M Art et Scien; B A Cur; Dip Occupatinal Health] Apprved fr Distributin by Ms Elize Jubert, Acting CEO May 2015 Page 14