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Gaining ground against liver cancer

Liver cancer, though rare in the U.S., is an especially difficult disease to treat. For one thing, the illness is not well understood. Second, tumors often aren’t found until the cancer has progressed too far for surgery—still the first line of treatment in most cases.

Until resection (surgical removal) became available in the early 1980s, liver cancer patients seldom lived more than a few months after being diagnosed. Even today, their odds of survival are often disheartening. Still, with better tools and therapies, doctors are slowly making headway, and survival times are finally inching up.

Signs of trouble

This year, [2008] according to the American Cancer Society (ACS), about 21,370 new cases of liver cancer will be diagnosed, mostly in men, and about 18,410 patients will die of the disease. It’s most often caused by chronic hepatitis B or C infection or by alcohol abuse that leads to cirrhosis, or scarring of the liver. Symptoms include a hard lump directly below the right side of the rib cage, pain in the right shoulder or right side of the abdomen, yellowing skin (jaundice), fever and weight loss. Many patients have no symptoms; their illness is found during a routine physical exam or procedure.

Operating challenges

The ACS says surgery offers the only chance to cure liver cancer. The procedure is often difficult. The organ is large, dense and delicate; it tears readily and bleeds heavily when injured. Many times, surgeons can’t remove all the cancer and still leave enough healthy liver for the patient to survive.

That’s why researchers are experimenting with these nonsurgical ways to attack inoperable liver tumors:

    Ablation. These techniques leave the liver intact and may shrink tumors enough so they can be removed. Surgeons are testing cryosurgery to kill tumors with extreme cold, radiofrequency to kill them with heat and ethanol injections to poison them.

    Artery infusion. Liver cancer resists standard chemotherapy, so oncologists are testing ways to directly infuse the cancer-killing drug doxorubicin into the artery that carries blood to the liver.

    Embolization. To “starve” tumors, doctors plug the artery that supplies their blood. Using a hybrid technique called chemoembolization, doctors seal the artery first, then infuse the tumor with doxorubicin.

    Radiation. External beam radiation focused on the tumor shrinks it without harming nearby healthy tissue.

    Regeneration. Because the liver can regenerate itself, surgeons are testing ways to redirect blood flow inside diseased livers to make the healthy parts grow larger before surgery. That way, the cancer can be removed, leaving enough healthy organ tissue.

Experts note that relapse is still common and liver transplants are often too risky. Nonetheless, some patients who respond to therapy are now living as much as two years longer—a vast improvement from just a generation ago.