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Cancer of the liver
The most commonly encountered cancer of the liver in Western society is that of metastatic (secondary) disease from other organs (usually the colon). Worldwide (and most commonly in the Far East and Africa) primary or hepatocellular cancer predominates.
The cause in 90% of these cases is infection with the Hepatitis B or C virus. Cancers of the bile duct system draining the liver (cholangiocarcinoma) are a separate clinical entity in their own right.
Hepatocellular (Primary) Liver Cancer
These tumours may be identified as an incidental finding during radiological investigation for unrelated conditions or for abnormal blood tests of liver function. Should symptoms of the tumour occur they may cause abdominal pain, tiredness, weight loss and poor appetite.
Since most patients with hepatocellular carcinoma have cirrhotic disease that appears as a result of their hepatitis infection before developing a cancer, only liver transplantation offers a chance of a cure. For those without cirrhosis, resection of part of the liver may be undertaken. Other treatments such as destruction with cryotherapy and embolisation (blocking of blood-flow) of cancers may be simpler but are less effective.
Metastatic (Secondary) Liver Cancer
Most patients diagnosed with metastatic cancer to the liver are detected on routine follow up imaging of the liver by ultrasound or CT scanning arranged before or after treatment of the primary disease. Most give no symptoms and do not alter blood tests of liver function.
The common sites of origin of liver metastases where surgical excision is undertaken are:
- Colon and Rectum
- Skin (Melanoma)
- Surgical resection
- Radiofrequency Ablation
- Microwave ablation
All treatment modalities require accurate prior staging usually with CT, MRI and often PET scanning. Of all these treatments only surgical excision offers the possibility of cure.
Surgical Resection of Colorectal Metastases
20-25% of patients will have metastatic disease in the liver at the time of diagnosis with colorectal cancer. It is for this reason that whenever possible CT scan assessment of the liver is made prior to undergoing operation.
In the relatively recent past the presence of colorectal liver metastases was considered a hopeless situation. In the last fifteen years or so the benefits or chemotherapeutic drugs and crucially the development of safer and more extensive liver resection have become clear. Happily continuing improvements in survival are being recognised and as a result more and more patients considered for potentially curative treatment.
Currently around 20% of patients with liver metastases due to colorectal cancer are suitable for surgical resection. This percentage rises when patients are included who become suitable for surgery after treatment with chemotherapy and embolisation (blocking blood-flow) of certain parts of the liver.
What allows surgeons to perform resections removing up to 75% of the liver is the over capacity of function that usually exists within an individual liver and the ability the liver has to regenerate. Surgery may be undertaken as a two stage procedure or repeated at a later date after liver re-growth has occurred.
Survival rates after surgery commonly reported are up to 40% at five years and 25% at ten years.
These are rare tumours affecting any part of the bile duct system both within the liver and without. They are potentially curable only with surgery and reconstruction of the liver’s drainage system. Their diagnosis in late stage means that this is usually not possible.
Relieving blockages within the duct system using self expanding metal cages (stents) treats the jaundice which is the usual presenting feature of the disease. Chemotherapy has not been shown to be of use in the setting of palliative treatment.