Liver

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Disease Progression/Prognosis

Unfortunately, primary liver cancer is not a simple disease. Several staging systems exist to determine the extent of HCC. The following is The International Union Against Cancer System’s guidelines used to distinguish the stages of liver cancer:

Stage I: Single tumor no larger than two centimeters (about ¾ inch), with no progression into the blood vessels. Patients with Stage I have the best prognosis.

Stage II: More advanced disease with vascular (blood vessel) involvement and/or tumor(s) larger than two centimeters (three-fourths inch) in diameter. Cancer in the blood vessels provides a route for malignant cells to move to other sites and has a significant negative effect on prognosis. Large tumors also are more likely to be associated with vascular involvement.

Stage III: Disease progression in which the tumors are large and may include lymph node and vascular involvement.

Stage IV: Widespread disease including vascular invasion and lymph node involvement. Prognosis for patients with this stage of the disease is poor. Few patients survive more than one year.

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Metastatic Liver Tumors

Defined as cancer that start in other organs and spread to the liver.

Metastatic Liver Cancer includes:

• Metastatic Colon or Rectal Cancers
• Non-Colorectal Metastatic Cancers
• Primary and Metastatic Neuroendocrine Cancer
• Metastatic Colon or Rectal Cancers

These start from a colon or rectal cancer that travels to the liver. Colorectal (colon, rectum or entire large bowel) cancer is the fourth most common cancer in the United States—behind lung, breast and prostate cancers. Worldwide, colorectal cancer is diagnosed in nearly 900,000 people each year, accounting for more than 500,000 annual deaths. Up to 70 percent of patients with colorectal cancer eventually develop liver metastases. In 30 to 40 percent of patients with metastases, the cancer can still be confined to the liver. Each year in the United States, approximately 15,000 new cases of colorectal metastases to the liver are diagnosed.

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Non-Colorectal Metastatic Cancers

These travel to the liver from other organs, kidney, stomach, breast, ovarian, cervical, ocular melanoma, bladder, lung, prostate and sometimes esophageal cancer. Resection and ablation therapy have traditionally been used to treat primary liver cancer and metastatic colorectal cancer. Treatment of metastatic cancer from non-colorectal cancers can benefit patient survival. Survival rates of 20 percent to 30 percent have been observed when treating this class of tumors. Included in this group are metastatic renal cell cancer, gastric cancer, esophageal cancer, ocular melanoma, head and neck tumor, breast, endometrial, ovarian, cervical cancer and sarcoma.

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Primary and Metastatic Neuroendocrine Cancer

These are tumors that arise from special tissue and often cause symptoms from the chemicals they release. One unique group is neuroendocrine (carcinoid) tumors. Less than five percent of these patients present with symptoms: including headache, flushing, shortness of breath, heart valve problems and diarrhea. These patients are often treated with sandostatin or octreotide. These drugs can often control the symptoms and may provide some tumor stabilization. Liver transplantation and expectant therapy result in a five year survival rate of 65 percent. However, preliminary results indicate characinoid tumors—with long, disease-free intervals—achieve a higher disease-free survival rate.

Benign Tumors of the Liver

Defined as tumors that are not cancerous.

Benign Liver Tumors include:

Solid Lesions, such as: Hemangiomas: Vascular tumors that can remain small or grow to watermelon sizes.

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Adenomas: Vascular tumors associated with birth control that can become malignant.

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Focal nodular hyperplasia (FNH): Benign tumors that are associated with a central scar.

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Cystic Lesions that include simple cysts, complex cysts and a cyst that can develop malignant (cancerous) portions.

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