Understanding Liver Cancer

sher Amna Sher, MD
Medical Oncologist
Stony Brook University Cancer Center

Amna Sher, MD, a medical oncologist on the Gastrointestinal Cancer Team at Stony Brook University Cancer Center, answers frequently asked questions about liver cancer. Dr. Sher, who specializes in gastrointestinal cancers, works with multiple specialists within one team, such as surgeons, radiation oncologists, interventional radiologists and oncology nurses, to treat patients with liver cancer.

What is liver cancer?
About 75 percent of primary liver cancer, which starts in the cells in the lining of the liver, is a type called hepatocellular carcinoma (HCC). Other, rarer forms of liver cancer develop in the bile duct or in other parts of the liver. Secondary, or metastatic liver cancer, is cancer that starts somewhere else in the body — most often in the colon or rectum for this type of cancer — and spreads (metastasizes) to the liver. For this article, my answers refer to the HCC type.

Who gets liver cancer?
Liver cancer occurs most frequently in people who are infected by hepatitis B or C, or who have cirrhosis of the liver caused by alcoholism or hepatitis. Unfortunately, individuals with a family history of liver cancer have a higher risk for developing it themselves.

How common is liver cancer?
We can look at the most recent data from the American Cancer Society for that number. Here, in the U.S, we expect about 42,000 new cases of liver cancer to be diagnosed this year. The frequency of liver cancer is expected to increase because the numbers of people with hepatitis C is growing.

How is liver cancer diagnosed?
One reason liver cancer is so serious is because it’s really hard to diagnose in the early stages. Most people don’t have any symptoms, or their symptoms are so vague that they could be caused by many conditions. When symptoms do appear, such as loss of weight for no reason, loss of appetite or upper abdominal pain, we use blood tests and imaging tests like CTs or MRIs to get more information. If a mass is found, we can perform a biopsy, which is used for diagnosis. At this time, there are no routine screening tests for liver cancer.

How is liver cancer treated?
At our Cancer Center, one team with multiple specialists — the Gastrointestinal Cancer team — treats patients with liver cancer. Because we specialize in this type of cancer, we have a combination of advanced therapies available for our patients. Since this type of cancer is most often diagnosed at an advanced stage, most treatments provide relief from symptoms and help extend lives, but do not provide a long-term cure.

Can you tell us about surgical treatment for liver cancer?
When we do find liver cancer in its earliest stages, like stage 1 or 2, surgery is considered the gold standard for treating these tumors. Our surgical team is highly experienced at both traditional, or open, surgery and minimally invasive surgery. The positive news is that when liver cancer is found in an early stage and the tumors are small, surgical resection can result in a good prognosis.

How are medical oncology and radiation therapy used to treat liver cancer?
Our medical oncology team treats liver cancer with hepatic (liver) artery infusion, or HAI, that allows direct infusion of high-dose chemotherapy into the liver through a pump that is surgically implanted in the liver. Usually, chemotherapy side effects are minimal. My colleagues in radiation oncology determine the best course of treatment for the individual and can use one of several types of radiation therapies that are precisely targeted to a tumor while protecting the delicate surrounding liver tissue.

What is Interventional radiology and how is it used to treat liver cancer?
Our interventional radiologists use x-rays, ultrasound and other imaging methods to guide minimally invasive, targeted treatments for liver cancer. Examples of these procedures are described here:

Ablation is a possible alternative for people who cannot undergo surgery. Ablation shrinks or destroys liver tumors, either with extreme cold, called cryoablation, or by heating the tumors with high-energy radio waves, called radiofrequency ablation (RFA).

Embolization is a targeted therapy that delivers treatments directly into the tumor through a catheter (narrow tube) inserted into an artery in the groin and threaded up to a blood vessel feeding the tumor.

Chemoembolization injects anti-cancer (chemotherapy) drugs directly into the blood vessel that feeds the tumor, and then adds an agent that stops the flow of blood into the tumor and traps the chemotherapy drug in the tumor.

Radioembolization delivers tiny beads of high-dose radioactive material directly into the tumor, sparing healthy liver tissue.

Why choose Stony Brook Cancer Center for liver cancer treatment?
At our Cancer Center, all patients are treated by a multidisciplinary team of specialists, so patients with liver cancer have the benefit of expertise from many different viewpoints. The team holds regular tumor board meetings to discuss a patient’s progress, modify the treatment if necessary, and to make sure that patients and their families understand and are comfortable with the care. We also are involved in clinical trial initiatives, and can offer appropriate trials to our patients, if they are beneficial.

For an appointment with a specialist in liver cancer, or another gastrointestinal cancer, call (631) SB-CANCER (722-2623).