In 2022, more than 4,400 Texans are expected to be diagnosed with liver cancer. In fact, liver cancer is now a leading cause of cancer-related deaths worldwide, with cases more than tripling since 1980. Liver cancer can be difficult to diagnose at early stage, and many patients show little to no symptoms until the later stages when treatment can become more complex to treat.
In recognition of Liver Cancer Awareness Month, Lokesh Bathla, M.D., FACS, Hepato-Pancreatico-Biliary (HPB) surgeon at Texas Oncology Surgical Specialists–San Antonio Medical Center and San Antonio Northeast, discusses available liver cancer treatment options, including clinical trials, and the important role a Hepato-Pancreato-Biliary (HPB) surgeon plays in a liver cancer patient’s care team.
What is the most common cause of liver cancer and who is at risk?
Most liver cancer cases arise in the background of cirrhosis, a disease that manifests as scarring of the liver. Cirrhosis can develop as a result of fatty liver disease, heavy alcohol use, hepatitis C, and at times, hepatitis B. Rare causes of cirrhosis include primary biliary cirrhosis, autoimmune hepatitis, hemochromatosis, and primary sclerosing cholangitis (PSC). If a patient has more than one of these conditions, they are at a higher risk of developing cirrhosis. Treatments, to date, are limited when it comes to remission and slowing the progression of liver cancer. However, patients can reduce their risk by lowering their alcohol intake, getting early treatment for hepatitis, and treating cirrhosis as advised by their physician.
How has the progression toward using minimally invasive surgical techniques improved patients’ quality of life or outcomes?
Minimally invasive surgery for liver cancer continues to evolve but is only serviced at high-volume cancer centers nationwide. These techniques allow patients to return to daily life faster while increasing their productivity and basic physical activity. Patients also have a lowered risk of post- operative complications. Many liver cancer patients with underlying cirrhosis have poor muscle mass, a compromised immune system, and are malnourished, which can prolong recovery and make patients highly susceptible to complications. Therefore, taking a minimally invasive approach to surgery can significantly lower their risk and help avoid postoperative risks.
When are liver cancer patients eligible for a liver transplant? If that is not an option, which therapies have been most effective?
Generally, patients with cirrhosis are placed on the liver transplant waitlist based on their blood and model for end-stage liver disease (MELD) tests. The United Network for Organ Sharing (UNOS) has established criteria that helps to determine a patient’s position on the list and eligibility. These guidelines focus on those with non-resectable liver cancer and exclude patients who have too large of a tumor or multiple tumors. If a patient is ineligible, there are a variety of therapies such as resection, ablation, embolization, and chemotherapy. It is also important that treatment is individualized per patient based on tumor size, number, severity of the underlying liver disease, and overall health.
As a surgeon, why is it important for liver cancer patients to have an integrated and multidisciplinary treatment plan?
For most liver cancer patients, surgical resection is the standard form of care if applicable. It is one of the few cancer types where the patient may require multimodality treatment. Therefore, having a multidisciplinary team is crucial, as patients may require surgery, interventional radiology, chemotherapy, and other liver disease-related therapies to achieve the best possible outcome.
What advice would you give patients deciding on a course of treatment for liver cancer?
Liver cancer can be complex and requires a diverse treatment plan. I would advise patients to include a HPB-surgeon as a part of their care team and treatment planning. Additionally, those with underlying cirrhosis are at risk of developing new tumors over time, so it is important to continue monitoring long-term post treatment.
Are there any current clinical trials offered for liver cancer?
There are several clinical trials available. Patients who are not a candidate for liver-directed therapies, such as resection or embolization, are eligible. Each trial has set criteria, so I suggest patients consult with their physician to see if they are eligible to enroll and if this option is a good fit for their specific liver cancer.