Frequently, patients with liver tumours have no symptoms. Eventually
however, people will develop symptoms such as pain, abdominal fullness,
fever and/or jaundice.
Most hepatocellular carcinomas are first suspected based on the results
of CAT scans or ultrasound scans.
A blood test called “Alpha – fetoprotein” is a useful
marker for the diagnosis of HCC and about 70% of patients with liver
cancer have elevated blood alpha-fetoprotein levels. Although by no
means conclusive, a rising blood alpha-fetoprotein concentration (persistently
over 500ug/ml) in someone with chronic liver disease suggests the development
Can liver cancer be cured?
Treatment of secondary liver cancer varies with the underlying disease,
the extent of spread in the liver and other organs.
Some of the less common cancers such as testicular cancer involving
the liver can be cured with combination chemotherapy. Breast carcinoma
and lung cancer patients will often have a partial remission of the
cancer with chemotherapy. Bowel cancer may spread solely or mainly to
the liver, making treatment a viable option.
Surgery in some suitable cases of liver cancer can be curative. In
primary liver cancer, the cure rate for small cancers by surgery is
quite good (five year survival is more than 50%) but an ongoing problem
is the formation of new cancers in the highly diseased, cirrhotic liver.
Also, in advanced liver disease there can be many contraindications
to major surgery.
These considerations have led to increased interest in liver transplantation
to treat small liver cancers. However, there remains the difficulty
of finding sufficient numbers of organ donors.
Conventional chemotherapy has very little to offer someone with HCC.
Remissions are achieved in less than one-third of those treated and
are almost always of short duration (3-9 months), while the drugs that
can produce remission are very toxic.
is a specialised type of chemotherapy delivered into the branch of the
hepatic artery that supplies the tumour. It represents another way to
achieve local control of liver tumours by limiting the spread of HCC
cells into the bloodstream. In general, chemoembolisation is reasonably
Ablation therapy is a method of treating liver cancer using a variety
of techniques to shrink the tumour and slow the spread. At present,
in Australia the most promising
approach is RFA or radiofrequency ablation.
All local therapies can potentially remove smaller tumours or shrink
and temporarily control larger ones but there are limitations:
• Treatment may require several sessions
• Procedures performed through the skin can cause severe pain
• Formation of new tumours is almost inevitable within five years
Palliative care – alleviating symptoms
Unfortunately, only a small proportion of cases of liver cancer can
be cured. In the remaining cases, symptoms are likely to occur sooner
Pain is the most common symptom and is due to local invasion of the
liver capsule and neighbouring structures hat contain pain fibres.
The approach to pain control is similar to other cancers. Simple analgesics
should be used first, moving to opiates as indicated and using doses
and routes of administration that are appropriate to individual needs.
Fatigue, lethargy and weakness are the other common disabling symptoms
with liver cancer. Loss of appetite is also common and may be helped
by eating frequent, small carbohydrate-rich meals.
As well as the family doctor, the assistance of a pain clinic or palliative
care team linked to a community service is invaluable to provide the
best of care to someone with terminal liver cancer.
Acknowledgments: Hepatitis C, liver disorders and liver health –
Hepatocellular Carcinoma – Howard J. Worman MD – Dept gastroenterology,