17.3 PTC Cancer Life Phases: Treatment of Liver Cancer

Ok, you understand the higher risk for cancer that an organ transplant recipient has, you know what to LOOK for by way of symptoms and testing especially for the type of organ transplant you received, so once DIAGNOSED, what TREATMENT options by cancer type are available?

After a cancer diagnosis — whether it's your own or that of a loved one — the right information can be one of your most powerful weapons. Here's what you need to know about cancer treatment and management. 

 Doctors will help figure out with you what the best treatment is for you. For each type of cancer, there are lots of different ways that it might be treated, depending on things about you and things about your cancer like how far along it is. It can be overwhelming to decide which treatment to go with, if you have options. Some things to consider according to the American Cancer Society are your age and how long you expect to live, other health conditions you have and how that matters for risk or how well the treatment will work, the stage of your cancer, if surgery will remove the cancer, the chances that the treatment will cure cancer or if it will help with symptoms, and your feelings about the side effects of that treatment. Some people have also said that even though the following things don’t actually help to treat their cancer, they might help cope with the experience: art therapy, physical activity when possible, meditation, music therapy, acupuncture and massage.

Cancer in the simplest terms is the abnormal growth of cells somewhere in the body. Each year, more than a million people receive a cancer diagnosis, and the most common types of cancer include skin cancer, breast cancer, prostate cancer, lung cancer, and colorectal cancer. In addition to the three major types of cancer treatment — surgery, chemotherapy, and radiation therapy — researchers are working to find new and more effective ways of fighting cancer. Some cancers can't be prevented, but other types can be avoided by living a healthy lifestyle.

While surgery, radiation, and chemotherapy are still the first-line treatments for most cancers, there are also new and emerging approaches. When you are learning about cancer and evaluating what cancer treatment to undergo, it's important to understand your options and the benefits and risks that each offers.  Generally, cancer patients receive one of three types of cancer treatment: surgery, chemotherapy, or radiation therapy. It's also possible to receive a combination of any of those three types, in hopes of increasing the odds of getting rid of the cancer cells.

Treatment Considerations

Different liver cancer treatment options and their pros/cons

There are lots of different ways your doctor may recommend treating your liver cancer. It is important to also think about how liver cancer can be stressful, scary and other kinds of emotions. You can use palliative care (specialized medical care for people living with a serious illness) to help with the emotional side of having liver cancer. Some things that palliative care might do are things like teaching you relaxation techniques, emotional coping support, spiritual support and maybe diet changes. Some of the ways that your doctor might treat your cancer are:

• Surgery: According to the American Cancer Society, the best option to treat liver cancer is with surgery to take out the tumor, or get a liver transplant. Some surgeries take out part of the liver, and this works for people with good liver function and who have only one tumor that hasn’t grown into blood vessels. The cons of this are that this is a major surgery that can cause bleeding, infections, blood clots, pneumonia, complications with the anesthesia, or even new liver cancer.
  
  
• Ablation: This treatment is usually used for people who can’t have surgery, because surgery is better for curing cancer than this treatment. Ablation is only for tumors smaller than an inch across (3 cm). They can be used for people who are waiting for a liver transplant too. For this treatment, the doctor puts a needle right into the skin aimed at the tumor and kills the tumor but doesn’t take it out. The doctor will use some kind of imaging technique to aim the needle. Sometimes you have to go under anesthesia (you are asleep) for the doctor to do it.
  
  
• Embolization: This treatment is when the doctor puts things right into the blood vessel that blocks or reduces the amount of blood flow to the tumor to starve it. This can be tricky because the goal is to starve the tumor but not the healthy parts of the liver. This option is usually used when people can’t have surgery, or with tumors that are too big for ablation. This treatment isn’t good for people who have other liver damage. Usually, you don’t have to stay overnight in the hospital to get this treatment. Side effects of this treatment are belly pain, fever, nausea, infection in the liver, and blood clots. Recovery can take 4-6 weeks.
  
  
• Chemotherapy: This is when doctors give you drugs that destroy cells that are growing out of control like cancer cells. The drugs can be given through your veins or taken as a pill, or put right into the blood vessel that leads to where the tumor is depending on what kind they give you. One commonplace they put it is in a place called the hepatic artery. Chemo for liver cancer is used for people who can’t have surgery, embolization or ablation hasn’t worked, and when targeted therapy isn’t working. Chemo drugs don’t usually work that well for liver cancer though. They usually only shrink some tumors and even when they do, they don’t work for very long. The other cons of chemo are that you may lose your hair, get mouth sores, lose your appetite, have nausea and vomiting, diarrhea, higher risk of infection, easy bruising or bleeding and being really tired.
  
  
• Radiation: This is when doctors use high-powered energy beams like x-rays to kill cancer cells. Radiation could happen in two different ways. One way is where your doctor gives you radiation using a machine outside of your body. It takes about 15 minutes each session and people usually have sessions 5 times a week for about 3-9 weeks. This kind doesn’t usually hurt. The other kind of radiation is inside of your body and they put temporary and/or permanent radioactive things in the hepatic artery. You might have to stay in the hospital briefly for a few of these treatments, and they might give you anesthesia (the thing that makes you go to sleep for surgery). Radiation is not a good idea for people with liver damage, but it can be helpful for people who can’t get surgery, embolization or ablation, or if their cancer has spread to other areas of their body. It can also help people with pain from larger liver tumors or people who have tumors blocking the portal vein. Radiation treatment might make you feel tired, have sensitive skin where the radiation happens, and like any type of cancer, it can be stressful.
  
  
• Targeted therapy: Doctors have been looking into this more since chemo doesn’t really work for liver cancer very well. These treatments try to target the genes, proteins or tissues that let cancers grow and live. Some of these try to stop the process of making new blood vessels to starve the tumor of the nutrients that blood brings to the tumor. Some of these try to make liver cancer cells not grow as fast, and some of them combine medicines to try to get your immune system to target the cancer cells. Some of the side effects of these drugs include feeling really tired, losing your appetite, redness and irritation in the hands and feet called hand-foot syndrome. High blood pressure, losing weight, diarrhea and belly pain.
  
  
• Immunotherapy: This treatment is sometimes also called biologic therapy. This treatment is when your doctor gives you things that help boost your body’s defenses to fight cancer. It helps your immune system to do its job. Some of the ones used for liver cancer are called PD-1 inhibitors, and CTLA-4 inhibitors. The cons of this treatment are the side effects like feeling tired or weak, fever, cough, nausea, itching, skin rash, losing your appetite, muscle or joint pain, and constipation or diarrhea.

Prognosis

Here are some numbers that tell you about what percent of people survive liver cancer, compared to people who don’t have cancer survive at least 5 years after being diagnosed. These numbers don’t tell us anything about what specific treatments people had, they only give us a big-picture idea of surviving five years. These numbers group people into three stages which are localized where there is no sign that cancer has spread outside of the liver, regional which is when cancer has spread from the liver into nearby places like lymph nodes, and distant where cancer has spread to faraway parts of the body like lungs or bones. These stages are when you are diagnosed, which might be different from what stage you are currently in. People in the localized stage of liver cancer are 33% as likely to live at least 5 years after diagnosis as people who don’t have cancer. People in the regional stage of liver cancer are 11% as likely to live at least 5 years after diagnosis as people who don’t have cancer. People in the distant stage of liver cancer are 2% as likely to live at least 5 years after diagnosis as people who don’t have cancer. Having surgery is the treatment that increases survival rates the most. For people with early-stage liver cancer, if they get a liver transplant, they are 60-70% as likely as someone without cancer to live at least 5 years after diagnosis.

Planning and Preparing

Facing cancer is a difficult experience. Knowing what to expect and understanding how to navigate this journey can help make this stressful time easier. There are actions you can take at every step of the journey that may help you feel more in control of your health. Use these treatment tips offered by the American Institute for Cancer Research (AICR), for before, during and after cancer treatment below.

Click here to link to the full AICR article.

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