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Treatment of liver cancer abroad

Liver cancer is a dangerous malignant illness with bad prognosis. Cancer basically develops as a result of viral hepatitis or cirrhosis. Pathology incidence differs considerably in various countries.

 

In England, USA, and Balkan States liver cancer is as frequent as 2-3 cases per 100,000persons per year. Meanwhile, the incidence of liver cancer is 10-20 cases per 100,000 persons per year in Asia and Africa.

 

Liver cancer

 

Causes of liver cancer

Liver cancer more frequently appears due to other pathological processes. Pre-cancerous illnesses and conditions are:

  • Viral hepatitis B and C
  • Cirrhosis
  • Nodular hyperplasia of the liver
  • Hepatocytes dysplasia

 

Risk factors of the disease are:

  • Alcohol addiction
  • Male sex (men get liver cancer 3 times more often than women)
  • Exposure to aflatoxin (produced by molds)
  • Schistosomiasis, opisthorchosis (parasitic diseases)
  • Exposure to the synthetic carcinogens (nitrosamines, chlorinated pesticides)

 

85% of patients have liver cancer because of viral hepatitis B and C. Other reasons are met much rarely.

 

Liver cancer symptoms

 

Symptoms of liver cancer

Clinical manifestations depend on the tumor size, spread of the pathological process and morphological form of cancer. Following symptoms are met most often:

  • Pain
  • Intoxication
  • Hepatomegaly

 

Pain is less expressed in the beginning stage of the illness than in the advanced stages. Painis locatedintheright hypochondrium and is constant. Pain doesn’t depend on the food intake.

Intoxication syndrome. Liver cancer causes the general weakness, low appetite, weight loss up to cachexia (on the advanced stages). Some patients have fever.

Liver enlargement is observed among the majority of patients. Liver goes off the costal arch limits. It is nodular while palpation, though several patients have it smooth. This depends on the location of the malformation.

Jaundice can occur among 30% of patients. Probability of jaundice doesn’t depend on the tumor size. An obstructive jaundice occurs as a result of biliary ducts compression by the enlarged lymph nodes or tumor (rarely).

Ascites. Liquid in the abdominal cavity accumulates in 50% of patients. Symptom is determined by the compression of the portal vein. Condition more often appears among the patients who have live cancer as a result of the cirrhosis.

 

Many patients notice varicose veins in the esophagus area.  They can bleed and it ends up in the patient’s death in the majority of cases.

 

Liver cancer diagnostics

 

Diagnostics of liver cancer

Disorders in the liver function can be detected with the help of biochemical blood test. Also, following techniques help to diagnose liver cancer:

  • Visualization methods (ultrasound, CT) give a chance to detect the tumor-like formation
  • Blood test for the level of α-fetoprotein (Abelian-Tatarinov reaction). Fetoprotein increase indicayes liver cancer in 80% of cases
  • Fine-needle biopsy is performed percutaneously. It helps to take the material for cytology
  • Laparoscopy is a surgical method with the intervention into the abdominal cavity. It gives a chance to assess the spread of the pathological process and do the targeted biopsy for the further histological testing of biological material
  • Angiography (vascular X-ray examination) is performed to identify the peculiarities of liver blood supply and to evaluate the tumor

 

Blood level of α-fetoprotein is checked for the screening diagnostics. Analysis is done every six months for the people in the risk group for the liver cancer.

 

Liver cancer treatment abroad

 

Treatment of liver cancer abroad

Basic method of treatment is surgery. During the procedure surgeon removes liver tissues, where tumor formation was detected. Radical surgical treatment requires removing no less than 2 cm of healthy, unchanged tissues.

 

Volume of the intervention depends on:

  • Size of the tumor
  • Spread of the oncological process
  • Morphological type of tumor
  • Location of the liver blood vessels
  • Condition of the patient (if he is able to undergo a surgery, and if yes, then which capacity he is able to go through)

 

Surgical treatment includes:

  • Segmentectomy (the minimum amount of intervention, carried out for liver cirrhosis, when the patient cannot tolerate extensive resection)
  • Hemihepatectomy is a removal of half  of the liver
  • Expanded hemihepatectomy is a removal of the other liver half fragment

 

Liver transplantation can be performed among no more than 10% of patients having this organ cancer. There is no use to do such a surgery if tumor is large and there are regional and distant metastases.

 

Liver cancer latest treatment methods

 

Latest treatment methods of liver cancer

New treatment techniques are being constantly developed that help to lengthen patients’ lives. Many of them have been already implemented into the practice. Some of them are used instead of the operation if tumor is irresectable and others are applied as an addition to the surgical treatment.

 

Chemoembolization is based on the insertion of cytostatics mixed with the microembolisms into the liver artery. It presupposes the influence of the chemicals on the tumor within 30 days. Procedure allows achieving two-year survival in about 30% of patients even without a surgery.

Cryosurgery. Tumor is cooled to the low temperature with the help of liquid nitrogen. Method is applied if tumor size is no more than 5 cm. Three-year survival of the patients is about 20%.

Alcohol tumor block. Ethanol is introduced into the nodules under the ultrasound control. Several sessions are required for the treatment effect. Lethal results is in 1.8% cases while complications is in 1.5%. Five-year-survival of the patients is 30% which is compared to the surgical treatment.

Brachytherapy. The main problem of the radiation therapy is its negative influence on the healthy liver tissues. Brachytherapy presupposes the insertion of the thin catheters into the tumor tissues. Then, the source of radiation is placed inside. Thus, gamma rays affect only malignant cells, but not the healthy ones.

Targeted therapy. Angiogenesis inhibitors are applied here like sorafenib, regorafenib. They block growth of the new vessels that feed the tumor. Drugs are prescribed in combination with the surgery and chemoembolization.

Viral therapy. JX-594 virus is a modified pox virus that destroys the cancerous cells when inside the body, but it doesn’t touch the healthy tissues. Medicine called “Pex-Vec” on the basis of JX-594 virus is now in the clinical trials, but it has already showed promising results. It is assumed, that it will be possible to lengthen lives of those who suffer from liver cancer for more than a year.

 

Liver cancer prognosis

 

Liver cancer - Prognosis

Unfortunately, liver cancer doesn’t give favourable prognosis in the majority of cases. There is a five-year survival statistics, depending on the spread of the oncological process:

  • Localized liver cancer (stage 1,2 and partially in patients with stage 3) – 30%
  • If having regional metastases (stage 3 and 4A) – 11%
  • If having distant metastases (stage 4B) – 3%

 

General statistics proves that five-year survival is on the low level. This is associated with the patients’ cirrhosis or viral hepatitis. Only some of them can receive surgical treatment.

Five-year survival is much higher among those who underwent the surgical treatment. It goes over 50%.

 

Best prognosis is given for those who had liver transplantation. Life expectancy of the patients increases considerably.

 

Five-year survival after liver transplantation depending on the cancer stage is:

  • Stage 1 – 75%
  • Stage 2 – 68%
  • Stage 3 – 52%
  • Stage 4 – 11%

 

Worse prognosis is observed among the patients with irresectable tumor. If patients don’t apply any treatment their average survival rate is 7 months.

 


 

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