There are many different types of cancer associated with the liver, only specific types may respond to surgery and/or chemotherapy.

The goal of this section is to present the concept of "regional chemotherapy" for patients that have developed spread to the liver of colon or rectal cancer; "regional chemotherapy" is almost entirely synonymous with the use of a device called a "hepatic artery infusion pump", (abbreviated as HAIP).

But before we embark on a technical discussion of surgical and chemotherapy treatments, it is important for you to have some basic information.


Secondary vs. Primary Liver Tumors

It is important to understand the difference between cancer that arises directly from liver cells (primary) and cancer that has spread (metastasized) to the liver from another site (secondary). The treatment options are different for a primary liver malignancy compared to one that has originated elsewhere and spread to the liver. In the United States, the vast majority of patients that have a malignancy in the liver have a secondary or metastatic cancer. Metastatic cancer began in another organ and spread to the liver. Even if the original tumor was completely removed, there is a risk based on having that initial tumor, for the cancer to spread to other organs. Colorectal cancer includes cancer of the colon (the large intestine) and rectum (the last part of the large intestine) and is a common cause of liver metastases in the Western world.


Colorectal Cancer

Colorectal cancer is one of the most common types of cancer spreading to the liver in the United States. Approximately 140-160,000 people will develop colorectal cancer and approximately 60-80% of them (84,000 to 128,0000) will develop metastatic disease (spread to other parts of the body). An operation to remove a colon cancer will also remove several lymph nodes. Lymph nodes are located throughout the body, and serve as local filters. Removing the lymph nodes is important because the local lymph nodes are the most common initial site for cancer to spread. If the lymph nodes that are removed contain cancer, then that patient has a higher risk to develop metastasis to other organs than a patient who does not have cancer in the resected lymph nodes.

Patients that have lymph node cancer metastases will usually be treated with systemic chemotherapy. This type of chemotherapy is administered through your veins ("systemic"), and is designed to destroy any microscopic remnants of tumor that may be within remaining lymph nodes, the blood or other organs after the initial tumor has been removed.

During and after completing a course of chemotherapy, which may be as short as 3-months or as long as year, depending on what your doctor recommends for you, you will begin the surveillance segment of your care.

Surveillance is necessary to identify the potential return of cancer, so that appropriate treatment(s) may be given. In general, surveillance for colorectal cancer patients involves having a CT scan once or twice a year, having your blood drawn every three months and colonoscopy or other means of examining the remaining large intestine.

The CT scan will enable your doctor to see if there is any tumor spread to the liver or within the inside of the abdomen. The blood that is drawn will be tested for "CEA" (carcino-embryonic antigen), a marker expressed by about 80% of colorectal cancers. If the CEA level begins to rise, then this may be an early warning sign for your doctor that there may be returning or spreading cancer somewhere in the body. A colonoscopy or examination of your remaining colon may be indicated to make sure that there isn't recurrence of the cancer in the intestine or at a new site. There is no "best" set of tests, however, surveillance will likely include some combination of the tests discussed above.


Hepatocellular Cancer

Hepatocellular carcinoma (HCC) is one of the most common malignancies worldwide, with approximately one million cases per year causing 250,000 deaths. Hepatocellular carcinoma is very common in Southeast Asia, Japan, and Africa, where it accounts for nearly 40% of all cancer. Although HCC comprises only 2-3% of cancers in the United States, this number is growing rapidly. Increased frequency of HCC in the United States is thought to be the result of the immigration of large numbers of people with chronic active hepatitis B and C as well as the increasing incidence of hepatitis C within the United States. At present, there are nearly four million people in the United States infected with hepatitis C, and 30,000 new cases are diagnosed per year.

In 1986, the National Institute of Health convened a consensus conference on HCC and concluded that "partial or total hepatectomy offers the only chance for long term disease-free survival." Unfortunately, only 10% of all patients with HCC are candidates to undergo surgical resection at the time of diagnosis.





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