Advanced Liver Cancer Explained
- For advanced liver cancer that has spread beyond the liver, surgery is usually not an option.
- Advanced liver cancer is a challenging diagnosis but your doctor may consider treatments such as chemotherapy, radiation, or immunotherapy.
- Advanced liver patients should consider joining a clinical trial to gain access to the latest advancements in care.
- Palliative care, which focuses on managing symptoms, is a compassionate approach that includes emotional support and pain management.
Even a late-stage diagnosis has an open door to a range of effective treatments. Medicine has made huge strides that can help patients live longer, healthier lives.
Read MoreWhat is advanced liver cancer?
Advanced liver cancer refers to a stage of liver cancer where the disease has progressed quite far, often involving significant liver damage or spreading beyond the liver. It often stems from chronic liver diseases, such as hepatitis B and C infections, cirrhosis, or exposure to toxins called aflatoxins found in contaminated foods and mold.
Risk factors include excessive alcohol consumption, obesity, and diabetes.
Determining the advancement of liver cancer means assessing the size, location, and spread of tumors, as well as the liver’s functionality and the presence of cancer in nearby lymph nodes or distant organs.
Staging liver cancer
Staging helps doctors understand the extent of the cancer and plan the best treatment approach.
The most commonly used system is the TNM system, which considers:
(T) Size and number of tumors
(N) Spread of the cancer to nearby lymph nodes (the bean-shaped glands that play a key role in the immune system)
(M) Metastasis, or spread, to other parts of the body
Advanced liver cancer typically corresponds to higher TNM stages, indicating larger or multiple tumors, cancer that has spread to lymph nodes, or to distant organs elsewhere in the body.
Screening for liver cancer is crucial, especially for individuals at high risk, such as those with the chronic infection known as hepatitis B or C, cirrhosis (scarring of the liver), or a family history of the disease.
Regular screenings may involve blood tests to measure alpha-fetoprotein (AFP) levels, a protein produced in the liver that is often higher in people with liver cancer, and imaging tests like ultrasound, CT scans, or MRIs to visualize the liver.
Early detection through these screenings can be challenging, as symptoms often do not appear until the cancer is advanced, underscoring the importance of regular monitoring for at-risk individuals.
Assessing liver function
An assessment scale known as the Child-Pugh score is another crucial factor in determining the stage of liver cancer, particularly in assessing the liver’s function and the patient’s prognosis. This scoring system evaluates the severity of cirrhosis, which is a significant risk factor for liver cancer.
It takes into account several clinical and laboratory parameters, including:
- The level of bilirubin, the yellow pigment produced when red blood cells breakdown. Its levels indicate how effectively the liver can excrete bile, a fluid produced in the liver that aids in digestion.
- Albumin levels, reflecting the liver’s ability to process proteins.
- The prothrombin time, measuring the liver’s ability to produce blood clotting factors.
- The presence and severity of ascites, which is the accumulation of fluid in the abdomen due to liver failure.
- Hepatic encephalopathy which assessed the brain functions affected by liver disease.
The Child-Pugh score categorizes liver disease into classes:
- A (least severe)
- B (moderately severe)
- C (most severe).
This classification helps doctors determine the liver’s functional capacity and guide treatment decisions, as the liver’s ability to withstand certain treatments is variable.
For patients with advanced liver cancer, a higher Child-Pugh score might limit treatment options due to the liver’s reduced ability to recover from aggressive therapies, emphasizing the need for a balanced approach that considers both cancer treatment and liver function support.
Dr. Jaffe says there is reason for hope, even in advanced liver cancer.
“There are an increasing number of options. We may be able to convert a patient from having extensive disease to potentially curable disease. So that’s been a really exciting a really exciting aspect in the field,” she says.
Related: SurvivorNet Guide to Immunotherapy
Treatment options
According to the National Comprehensive Cancer Network (NCCN), a non-profit alliance of major cancer centers through the country, surgery for liver cancer is not always possible because of the location of the tumors or because the liver is not healthy enough.
A tumor that cannot be removed with surgery is called unresectable.
NCCN guidelines recommend a liver transplant for patients who meet the criteria for one. After a liver transplant, you will undergo “surveillance” which means testing on a regular basis to watch out for tumor growth.
If a liver transplant is not an option, or to prevent the tumor from growing then your doctor may recommend other therapies that may help manage the disease and provide relief from symptoms.
“So we basically we now have some first line agents, and they have shown a significant survival benefit where people are living closer to the two year mark. And even in a subset of patients, like not an insignificant portion are actually, entering complete remission, which is really unheard of,” Dr. Jaffe says.
These treatment options may include:
- Chemotherapy: Uses of powerful medications to target and kill cancer cells. While it may not cure advanced liver cancer, it can help shrink tumors, alleviate symptoms, and improve quality of life.
- Targeted Therapy: These are drugs that work by targeting specific abnormalities within cancer cells, disrupting their growth and survival. An example of a targeted drug for advanced liver cancer is Cabometyx. It is a medication that has been successful in helping some liver cancer patients live longer by slowing down the growth of their tumors. It works by blocking special proteins known as enzymes hat help cancer cells grow.
- Immunotherapy: Immunotherapy harnesses the body’s immune system to help fight cancer. It can be used to treat some cases of advanced liver cancer by boosting the immune response against cancer cells. A combintaion of two drugs (Imfinzi and Imjudo) is an option for the treatment of advanced liver cancer. Ideal candidates for taking this combo include patients with inoperable liver cancer and positive genetic biomarkers for specific proteins.
- Radiation Therapy: Radiation therapy uses high-energy beams to target and destroy cancer cells. While it’s less commonly used for advanced liver cancer, it can be effective in relieving symptoms and shrinking tumors in certain situations.
- Clinical Trials: Participation in clinical trials may offer access to new treatments and therapies that are not yet widely available. These trials are essential for advancing our understanding and treatment of advanced liver cancer.
Looking to the near future
In a recent phase 3 trial called Phase 3 CheckMate -9DW, researchers found that using a combination of two drugs, Opdivo and Yervoy, helped people with advanced HCC live longer compared to the usual treatments like Nexavar (sorafenib) or Lenvima (lenvatinib).
This combo extended the lives of patients with advanced liver. They were also found to be found safe and didn’t cause any new problems.
Specific details from the study aren’t yet available. The makers of the drug are conducting a full evaluation and will present their results at an upcoming medical conference sometime in the near future.
With the possibility of an effective new treatment on the horizon, this news presents an exciting update for advanced liver patients.
Liver Cancer Clinical Trials
The uptick in clinical trials research offers cancer patients with advanced disease new options, including new drugs and new combination therapies. Benjamin G. Neel, MD, PhD, director of NYU Langone’s Perlmutter Cancer Center, explains the importance of these clinical trials and what they can do to help patients.
“There is an incredible bevy of new therapies being developed,” Dr. Neel says. “If I were a cancer patient with a widely spread metastatic cancer, I would want to be on a clinical trial.”
Although some drugs tested in trials will fail, they increase the odds for a successful outcome.
Related: Related: SurvivorNet Clinical Trail Finder
Clinical Trial Phases
There are four different phases in an interventional cancer clinical trial, each with a specific goal:
- Phase I – The first phase of the trial it’s initiated after a drug is approved and aims to find a safe dose for and determine the optimal method for drug administration. This phase involves a small number of volunteers (15-30 participants).
- Phase II – The second phase of the trial is initiated after a safe dose of the drug has been determined from the first phase, and it aims to test the effectiveness of the treatment. This phase involves around 100 volunteers or less.
- Phase III – In stages I and II, a drug has shown promising results. Phase III is initiated on a much larger scale and aims to compare a new treatment with traditional treatments. This phase involves from one hundred to several thousand volunteers.
- Phase IV – This phase starts after the approval of the drug and lasts for several years to make sure that there are no long-term effects or adverse events for the drug that hasn’t been shown in the previous phase. This phase is also known as the post-marketing phase.
However, these phases are not written in stone. Some researchers can design protocols that merge phase I with II or phase II with III; this depends on the study design and research question originally put in place by the principal investigator.
Why clinical trials are important for advanced liver cancer patients
Taking part in a clinical trial may allow liver cancer patients to access the most recent and cutting-edge treatments years before they’re available, and these treatments can include immunotherapy, targeted therapy, gene therapy, or even a new combination of currently used treatments like surgery, chemotherapy, or radiation therapy.
“The National Comprehensive Cancer Network believes that the best management for any patient with cancer is in a clinical trial,” Dr. Miriam Eskander, a surgical oncologist and Assistant Professor of Surgery at the Rutgers Cancer Institute of New Jersey tells SurvivorNet.
“But clinical trials are not the last resort – they can actually be a first resort. And so I bring them up early. I include them in the list of treatment options I have for a patient<‘ she adds.
Although there’s no guarantee that this newly offered treatment will produce great results in curing liver cancer, at the very least, it can ensure proper care and follow-up from the healthcare team running the trial.
There’s also the knowledge that you’ll be helping doctors make ground-breaking discoveries and produce much-needed treatments empowering other liver cancer patients like you.
Additionally, many of the fees or added costs that are directly related to the trial will be covered by insurance or the trial, so you will no longer have to pay to get treated.
Coping With Late Stage Liver Disease
In addition to medical treatments, there are various ways to cope with the challenges of advanced liver cancer and maintain hope:
- Seek Support: Surround yourself with a strong support network of friends, family, and healthcare professionals who can provide emotional support and practical assistance throughout your journey.
- Educate Yourself: Knowledge is empowering. Take the time to learn about your diagnosis, treatment options, and available resources. Ask questions and advocate for yourself in your healthcare journey.
- Practice Self-Care: Taking care of yourself physically, mentally, and emotionally is crucial. Eat a balanced diet, engage in regular exercise if possible, and explore relaxation techniques such as meditation or yoga to help manage stress and anxiety.
- Find Joy in Everyday Moments: While living with advanced liver cancer can be challenging, it’s important to find moments of joy and gratitude in everyday life. Cherish time spent with loved ones, pursue hobbies and interests, and focus on the present moment.
- Stay Hopeful: Although the journey may be difficult, advances in medical research and treatment options offer hope for the future. Maintain a positive outlook and believe in the possibility of better outcomes and new opportunities.
Palliative care
As the disease progresses, managing symptoms and maintaining quality of life become increasingly important aspects of care. This is where palliative care plays a vital role.
Palliative care is a specialized medical approach focused on providing relief from the symptoms, pain, and stress of a serious illness, such as advanced liver cancer. It aims to improve the overall quality of life for both patients and their families by addressing physical, emotional, and spiritual needs throughout the course of the illness.
For those facing advanced liver cancer, palliative care offers a range of supportive services, including:
- Pain Management: Advanced liver cancer can cause significant pain and discomfort. Palliative care specialists work closely with patients to develop personalized pain management plans, utilizing a variety of medications, therapies, and interventions to alleviate symptoms and improve comfort.
- Symptom Management: In addition to pain, advanced liver cancer can present with a range of distressing symptoms such as nausea, fatigue, loss of appetite, and difficulty breathing. Palliative care teams are skilled in managing these symptoms effectively, helping patients to maintain dignity and quality of life.
- Emotional and Psychological Support: Coping with a diagnosis of advanced liver cancer can evoke a wide range of emotions, including fear, anxiety, sadness, and uncertainty. Palliative care providers offer emotional support, counseling, and resources to help patients and families navigate these complex feelings and cope with the emotional impact of the illness.
- Spiritual Care: For many individuals facing advanced liver cancer, spiritual and existential concerns become increasingly significant. Palliative care teams can provide spiritual support and guidance, helping patients find meaning, peace, and comfort in their journey, regardless of their religious or spiritual beliefs.
- Communication and Advance Care Planning: Palliative care specialists facilitate open and honest communication between patients, families, and healthcare providers, ensuring that treatment goals and preferences are understood and respected. They also assist with advance care planning, helping individuals make decisions about their future care and end-of-life wishes.
Palliative care does not mean giving up hope; rather, it focuses on living as fully and comfortably as possible, embracing each day with dignity and resilience.
Question to ask your doctor
- What stage is my cancer and how well is my liver functioning?
- What is the best treatments available?
- What outcomes can I expect from treatment?
- Is there a clinical trial I could enroll?
- What will insurance cover and how much can I expect to pay out of pocket for my care?
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