Understanding Liver Cancer and the Importance of Second Opinions
- Larry Sullivan was diagnosed with “terminal” liver cancer in 2019. But now, thanks to an individualized treatment approach curated by multiple doctors, he’s feeling better than he has in a long time with his cancer nearly gone.
- Liver cancer begins in the liver an organ located beneath the diaphragm and above the stomach. The most common form of the disease is hepatocellular carcinoma, but there are other types of liver cancers as well.
- One of the greatest cancer researchers of our time tells SurvivorNet that people should get "multiple" opinions following a cancer diagnosis.
"It's so amazing and unexpected for me," he said of where he’s at today. "It's been a hard journey but I'm doing really well."
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After that course of treatment, doctors could no longer see the cancer in Sullivan’s lungs and bones. On top of those treatments, Sullivan also underwent surgery and radiation therapy to his spine.
Now, Sullivan is feeling good and back to working as a school psychologist part-time. He’s also enjoying time with his family, traveling and even restoring boats.
"I'm very lucky. I never imagined even six months ago this happening." Sullivan said. "It's been hard at times, but now I can do things again and have some joy in my life. I'm really excited to have more time with my family."
Understanding Liver Cancer
Liver cancer begins in the liver an organ located beneath the diaphragm and above the stomach. The American Cancer Society estimates that about 41,260 new cases (28,600 in men and 12,660 in women) of primary liver cancer and intrahepatic bile duct cancer will be diagnosed in 2022. The most common form of the disease is hepatocellular carcinoma, but there are other types of liver cancers as well.
Several risk factors can increase a person's chance of developing hepatocellular carcinoma (HCC) including, but not limited to, the following:
- Gender (Hepatocellular carcinoma is much more common in men than in women)
- Race/ethnicity (In the United States, Asian Americans and Pacific Islanders have the highest rates of liver cancer, followed by Hispanics/Latinos, American Indians/Alaska Natives, African Americans, and whites)
- Chronic viral hepatitis
- Cirrhosis (a disease in which liver cells become damaged and are replaced by scar tissue)
- Heavy alcohol use
- Tobacco use
- Obesity
- Type 2 diabetes
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Blood tests, ultrasounds, CT scans (X-ray images), MRIs (medical imaging) and angiograms are generally used to confirm a liver cancer diagnosis. A liver biopsy, where a small piece of tissue is removed and analyzed for cancerous cells, may also be performed.
Oftentimes, a liver transplant is considered the best plan when the patient is eligible. For cases of recurrent liver cancer and cancer that has spread throughout the body, your doctor may consider targeted therapy, immunotherapy or chemotherapy as the next step.
The Importance of Getting a Second Opinion
After receiving a cancer diagnosis, it's important to remember that you can, and should, talk to other cancer specialists about your disease.
"If I had any advice for you following a cancer diagnosis, it would be, first, to seek out multiple opinions as to the best care," National Cancer Institute Chief of Surgery Steven Rosenberg told SurvivorNet in a previous interview. "Because finding a doctor who is up to the latest of information is important."
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As we highlight in several areas of SurvivorNet, highly respected doctors sometimes disagree on the right course of treatment, and advances in genetics and immunotherapy are creating new options. Also, in some instances the specific course of treatment is not clear cut. That's even more reason why understanding the potential approaches to your disease is crucial.
At the National Cancer Institute, there is a patient referral service that will "guide patients to the right group depending on their disease state so that they can gain access to these new experimental treatments," Rosenberg says.
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Furthermore, getting another opinion may also help you avoid doctor biases. For example, some surgeons own radiation treatment centers. "So there may be a conflict of interest if you present to a surgeon that is recommending radiation because there is some ownership of that type of facility," Dr. Jim Hu, director of robotic surgery at Weill Cornell Medical Center, tells SurvivorNet.
Other reasons to get a second opinion include:
- To see a doctor who has more experience treating your type of cancer
- You have a rare type of cancer
- There are several ways to treat your cancer
- You feel like your doctor isn't listening to you, or isn't giving you good advice
- You have trouble understanding your doctor
- You don't like the treatment your doctor is recommending, or you're worried about its possible side effects
- Your insurance company wants you to get another medical opinion
- Your cancer isn't improving on your current treatment
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Bottom line, being proactive about your health could be a matter of life or death. Learn as much as you can from as many experts as you can, so that you know that you did your best to take control of your health.
Contributing: Marisa Sullivan
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