Liver Cancer Treatment
The purpose of this document is to describe the treatment available at the Hammersmith Hospital to help combat liver cancer and to help you and your family to prepare for the operation. If there are any further questions that come to mind after reading this leaflet, please raise them with a member of the team or your own GP.
The Liver:
The liver is the largest organ in the body. It lies on the right side of the body under the ribcage. It is the powerhouse for producing energy for the body and for breaking down toxins.
What is Liver Cancer?
You will have been told that you have unfortunately developed a tumour or tumours in your liver. The majority of liver tumours are malignant and can be divided into two main groups:
- those arising from the liver, termed primary liver cancer, and
- those spreading to the liver from other organs or systems in the body by either the blood or lymphatic system, termed secondary or metastatic liver cancer.
Primary Liver Cancer
Primary liver cancer is called hepatocellular carcinoma, which is nearly always caused as a result of long term insult to the liver from either viral infections, such as hepatitis B and hepatitis C, or alcoholism. In Western countries hepatocellular carcinoma is less common than secondary liver cancer and is usually due to liver cirrhosis (hardening of the liver) from the prolonged over consumption of alcohol.
Secondary Liver Cancer
Secondary liver cancer is largely from the spread of cancer often from cancer of the large bowel (colorectal cancer). This form of liver cancer is the commonest of all liver cancers in Western countries. The frequency of liver metastases from colorectal cancer is as high as 30%. There is a rising incidence of colorectal cancer and thus the incidence of secondary liver cancer is also increasing. The natural history of liver metastases suggests that patients with untreated liver metastases from colorectal cancer have an extremely poor life expectancy of perhaps only 6 to 18 months.
It is not uncommon for patients to present in our clinic with multiple tumours in the liver. We provide two treatments to help patients whose tumours cannot be surgically removed in their entirety. Neither is curative: both are offered primarily in the expectation that they will be palliative. This means that we hope they will relieve symptoms such as pain and so diminish or postpone the need for opiate analgesia and that they will enable chemotherapy to have a better chance of delaying the progress of the cancer. We cannot tell you what the five year survival rate may be: you should realise it is likely to be very small. There is no evidence presently available that either treatment will increase the five-year survival rate.
Liver Resection
The best treatment for liver cancer, either primary or secondary, is to undergo a liver resection. This is the surgical removal of the part of the liver that is affected by the tumour. There are other treatments for cancer, such as chemotherapy and radiation therapy, but these are largely ineffective for most types of liver cancer.
Without surgery the cancer will continue to grow and in most cases death will normally ensue within six to twelve months. However, with liver resection for colorectal metastases 38% of patients will survive for five years.
Liver surgery is complex and dangerous. At the Hammersmith Hospital our statistics show that 2% of patients will not survive the post-operative period and 20% of patients will develop serious complications. These include bleeding, the need for re-operation, bile leak, abscess, chest infection, liver failure, heart failure, renal failure, thrombosis and wound healing problems.
Thermal Ablative Therapy
At the Hammersmith Hospital we also offer treatment to help patients with liver cancer whose tumours are not suitable for complete resection.
The treatment is called thermal ablation and it uses heat to kill the tumour cells to prevent them from spreading. It is a new experimental procedure and so we do not have long-term data to say how effective it is, although some patients have benefited from the procedure. Again, the same reservations apply: this treatment is palliative rather than curative. It is offered in the hope that it will relieve symptoms and enable the oncological therapy to delay the progress of your disease. There is as yet no evidence that it will be effective.
Furthermore, this procedure is not without risk. In our short experience of the treatment 2% of patients will die in the postoperative period and 10% of patients will develop complications from the procedure. The complications include haemorrhage, infection, disturbed wound healing and the need for re-operation. On one occasion the machine developed technical faults, which caused no harm to the patient, but did not allow the planned operation to proceed.
In some cases of thermal ablation we have been able to operate laparoscopically. This results in a much smaller incision, a shorter hospital stay and less invasive management post-operatively. However the operation is just as major internally and the complications which may ensue, although different, can be every bit as serious.
Your Hospital Stay
Prior to surgery various blood tests, X-rays and scans are performed usually as an outpatient. You will be admitted to hospital the day before the operation.
The operation lasts between two and ten hours depending on the complexity of the procedure. Our average operating time is about five hours and 90% of patients will require blood transfusion.
Following the operation you will be transferred back to the surgical ward where your care will be continued. You will probably be discharged on the seventh day after the operation. Of course, your hospital will be longer if you develop any complications.
Following the operation you will have a large incision, which will be covered with a dressing and you will have a variety of tubes attached to you including:
- a nasogastric tube that enters your nose to drain the contents of your stomach, until your gut starts to work again
- a urinary catheter in the bladder
- two wound drains
- two intravenous drips (one in the neck and one in the arm).
Pain relief will be administered either as an epidural in the spine or as PCA (patient controlled analgesia). As a routine precaution against infection you will be prescribed a course of antibiotics.
You will be encouraged to get out of bed and move around as much as possible to prevent post-operative complications, such as chest infection and thrombosis. The sutures will be removed on about the twelfth day.
On average the total hospital stay is around seven days. You will be followed up very closely in the out patient clinic for as long as is necessary.