Liver cancer doesn't always mean death
Edward Pachasa had lost his left kidney to a tumor back in 1980. So he thought it odd when he felt a pain in his left side 28 years later.
“There’s nothing on my left side,” the High Point resident recalled thinking.
To find out what was going on, Pachasa underwent an MRI, which revealed a tumor on his liver. He then was referred to Dr. Perry Shen, a liver/pancreas cancer surgeon at Wake Forest Baptist Medical Center.
Shen told Pachasa, who was 81 at the time, that he would have to surgically remove 60 percent of the liver, an organ crucial to digestion, detoxification and synthesizing proteins.
“I said, ‘Doctor, I just bought a new set of golf clubs and I have a 10-year guarantee on them. And I expect a 10-year guarantee on this surgery you’re going to do on me, because I intend to wear those clubs out,’” Pachasa said.
“He thought for a minute and then he said, ‘How about five?’ I said, ‘I’ll take it.’”
That was in December 2008. Pachasa knows he is one of the lucky ones, having survived not only the loss of his kidney and the surgery on his liver, but also a second liver operation last year, following the discovery of a new tumor.
Now approaching his 86th birthday, Pachasa is healthy and vibrant, and his liver has even grown over time to function better. He plays golf and gets down on the floor to operate the model train set that takes up half the living room of his home.
“He’s a very special patient,” Shen said of Pachasa. “He really beat the odds.”
Liver cancer is not one of the most common forms of cancer in the United States. The American Cancer Society projects there will be more than 30,600 new cases in the country this year. By way of comparison, prostate cancer, one of the most common forms, is projected to account for more than 238,000 new cases in the United States in 2013.
But liver cancer has one of the lowest overall five-year survival rates of any cancer, approximately 15 percent. Part of the reason for this low survival rate is that most patients with liver cancer also have other liver problems, such as cirrhosis or a hepatitis infection. Another contributing factor is that surgery and transplantation, which are the most successful forms of treatment — with five-year survival rates of approximately 50 percent — are not options in the majority of cases.
Shen, who directs the Complex General Surgical Oncology Fellowship program at Wake Forest Baptist, said the symptoms of liver cancer are not easily recognizable, so that by the time tumors are diagnosed they frequently are too large or complicated to be removed. Determining how much of the liver would be left after the tumor’s removal is a key consideration in evaluating a patient’s suitability for surgery.
“You need at least 20 to 25 percent of the ‘normal’ liver to have adequate function,” Shen said.
Because liver cancer can be so difficult to treat, the American Cancer Society says clinical trials of newer treatments may offer a good option in many instances.
Wake Forest Baptist is currently part of one such trial, which is designed to see if localized chemotherapy to the liver, or chemoembolization, combined with the drug sorafenib can help liver cancer patients live longer.
In chemoembolization, a relatively large dose of chemotherapy is delivered directly to the tumor through a catheter in the groin artery that supplies blood to the liver. Particle agents added to the chemotherapy drug partially block blood vessels to starve the tumor of its blood supply. Sorafenib, meanwhile, is a medication that interferes with the growth and spread of cancer cells in the body.
“We’re hoping that if we combine chemoembolization and sorafenib early on, rather than doing chemoembolization first and holding off on sorafenib until the patient’s disease is more advanced, we can get more bang for the buck,” said Dr. Bert O’Neil, a gastrointestinal oncology specialist at the UNC Lineberger Comprehensive Cancer Center in Chapel Hill, another site for the national study.
Liver cancer facts
Although liver cancer is much more common in developing nations in Africa and East Asia than in the United States, it is still the fifth-leading cause of cancer death among men and the ninth-leading cause of cancer death among women in this country, according to the American Cancer Society.
Here are some other facts about liver cancer:
•In the United States in 2013, there are expected to be 30,640 new cases of liver cancer and 21,670 deaths.
•The five-year survival rate for people with liver cancer is approximately 15 percent. The survival rate jumps to 28 percent if the cancer is detected at an early stage.
•Men are more than twice as likely as women to have liver cancer.
•The average age of diagnosis is 62. More than 90 percent of cases are diagnosed when the patient is older than 45.
•Although the cause of liver cancer is not known, risk factors include cirrhosis of the liver (frequently caused by alcohol abuse), chronic infection with hepatitis B virus or hepatitis C virus (both of which lead to cirrhosis) and Type 2 diabetes. Obesity also is a risk factor.