CANCER STORY: Success & Hard Truth

1.      About 90% to 95% of primary liver tumours are hepatocellular carcinoma (HCC) and they arise from the parenchyma cells within the liver.

2.      Cancers that arise from other primary sites (such as colon, rectum, pancreas, breasts, ovaries and stomach) may end up in the liver, giving rise to metastatic liver cancer. Metastatic liver cancer is thirty to forty times more common than HCC.

3.      Liver cancer represents 7.8% of the cancer cases we have seen. It ranked the fourth most common cancer we encountered. About one third (37.5%) of the patients who came to us were given three to six months to live or were advised to go home and do nothing or find some herbs to take.

Review of Medical Literature on HCC

v      HCC is remarkably resistant to cure and essentially there is NO cure with chemotherapy.

v      HCC formation is a multi-step process. It starts off from a chronic liver injury or chronic liver inflammation. For example, this could be due to hepatitis B or C virus or excessive alcohol consumption. The injury or inflammation leads to liver regeneration and later dysplastic lesion. An early carcinoma develops and progresses to an advanced stage. 

Surgery for HCC

v      HCC is curable by surgical excision. But unfortunately only 10% to 15% (another source indicated 15 % to 30%) of newly diagnosed patients are candidates for resection.

v      So, surgery is NOT indicated for all patients. It is only for patients with small peripheral tumours, and those with preserved liver function. The best chances are those with single tumour less than 3 cm in diameter.

v      Surgical resection is often fruitless if there are many tumours (i.e., multifocal) or if there is underlying cirrhosis. In this situation, prognosis is extremely poor.

v      Three problems are associated with surgical resection:

1) Patients may die,

2) Patients may suffer complications after the surgery

3) The tumour may recur after an apparent successful surgery.

v      Studies have shown that 85% of patients suffered recurrence within two years after surgery.

v      Approximately 70 % of patients will have metastasis to the lungs.

Chemotherapy for HCC 

v      Cytotoxic chemo-drugs do not improve survival of liver cancer patients and their effectiveness is miserably poor.

Transarterial chemoembolization (TACE)

v      Problems associated with chemoembolizaton are abdominal pains, vomiting and fevers.

v      Three randomized trials have failed to confirm survival benefits from   chemoembolization.

v      TACE delays tumour growth, but it may also promote tumour dissemination.

Percutaneous ethanol injection (PEI)

v      This procedure requires the injection of absolute ethanol (alcohol) into the tumour mass to kill the cancer cells.

v      PEI is most effective on solitary tumour less than 5 cm in diameter, or two or three tumours each less than 4 cm in diameter. Tumours more than 5 cm in diameter are often not effectively ablated.

Cryoablation

v      This procedure is to freezing the tumour with the hope of killing the cancer cells.

v      Problems associated with cryoablation are: Patients suffer from: 1) pleural effusion (fluid in the lungs), 2) abnormal increase in white blood cell or leukocytosis, 3) how transient elevation of liver function for about 5 days after treatment, 4) suffer from high temperatures, as high as 39° C for a few days, 5) Suffer from serious complications such as: haemorrhage,  bile duct fistula, formation of pus, d) presence of muscle protein in the urine.

v      Patients may suffer from tumour recurrence after cryoablation. 

Radiofrequency ablation (RFA) 

v      RFA is able to ablate a larger tumour and results in lower tumour recurrence.

v      Have less complications compared to cryoablation.

v      RFA therapy is recommended for patients with single tumour less than 3.5 cm in diameter.

Survival Without Treatment

v      Median survival of untreated patients ranges from one to four months.

v      A study showed that patients with alpha-fetoprotein (AFP) level greater than 10,000 ng/ml at diagnosis had a mean survival of 7.6 months.

v      Patients with AFP level below 200 ng/ml have well differentiated carcinoma and the mean survival is 33.9 months.

v      A study in Hong Kong with 104 patients who had HCC with tumour size larger than 6 cm showed that the median survival is three and half weeks.

v      Generally, mean survival after diagnosis of large tumours, with no treatment, is less than six months.