Is there hope after your cancer has spread?
Treating liver cancer originating from another part of your body.
Monday, 29 May 2006
Liver cancer comes in two forms - primary liver cancer (originating from the liver itself) and secondary or metastatic liver cancer (originating from another site). In Asia, primary liver cancer (HCC) is the 3 rd commonest cancer. Secondary metastatic liver cancer, especially from a colorectal cancer is becoming increasingly more common, especially since colorectal cancer is one of the commonest cancers in this region as well.
Colorectal cancer is now the most common cancers is many countries in Asia. Up to 80% of colorectal cancer patients will develop metastases of which half of these occur in the liver as secondary liver cancer. This form of secondary liver cancer is also known as colorectal cancer metastases to the liver (CRM).
Spotting the symptoms and diagnosing the disease
Secondary liver cancer or CRM is often difficult to diagnose as the symptoms are vague. Most patients complain of a general feeling of ill health, such as loss of appetite, weight loss, fever, fatigue and weakness. Rarely, patients may experience pain that begins in the upper abdomen on the right side and reaches into the back and shoulder. Most patients present with symptoms of the primary colon cancer and the metastases to the liver are detected as part of staging or follow up.
As the cancer progresses, the tumours can cause damage to the liver, leading to liver malfunction and resulting in abnormal liver function test results. Unfortunately, because the cancer is diagnosed at such a late stage, few patients survive beyond several months.
At the National Cancer Centre Singapore, a high-quality quaternary specialty center servicing multidisciplinary cancer care, diagnosis of metastatic liver cancers usually involves computerized tomography (CT) scan, magnetic resonance imaging (MRI) or PET scan.
A/Prof London Lucien Ooi, Head of Surgical Oncology and Chief of Hepatobiliary Surgery in NCCS, said, “Although CRM is considered stage IV advanced disease, new treatment methods that combine chemotherapy and advanced liver surgery can change survival outcomes and offer some chance of cure.”
Treating secondary liver cancer from colorectal cancer
Chemotherapy drugs may be used to temporarily control the tumour and prolong life. Newer agents may actually improve outcome by reducing tumour size, but these do not provide a cure.
However, the best hope for a cure is resection (or surgical removal) of liver metastases. This is the only treatment that offers survival beyond a few years.
The goal of liver resection is to completely remove the tumor and the surrounding liver tissue without leaving any tumor behind. The liver is able to regrow after surgery, hence, it does not matter even when a large portion of it has been removed. In patients suitable for surgery, metastases may sometimes also have to be reduced in size through chemotherapy before surgery can take place.
Mr Sim (not his real name) a patient at NCCS was a victim of metastatic liver cancer. Although the discovery of his tumour happened at an advanced stage, doctors have managed to prolong his life with surgical help.
Prof Ooi, who treated Mr Sim (not his real name), said that doctors would not have been able to help patients with such large tumours ten years ago, because they were not able to remove the tumour surgically. However, current medical advances have made it possible to successfully remove huge tumours.
How common is it to treat such complex cases?
Since 1996, National Cancer Centre has performed more than 400 surgeries to remove liver tumours. The tumour size ranged from 2 cm to 30 cm, with an average of 8 cm. Each surgery took an average of 150 minutes, and the average length of hospital stay was five days.
Upon diagnosis, a team sub-specialising in liver cancer will evaluate the best possible way to achieve surgically acceptable tumour size with the use of r chemotherapy. The surgical team works with medical oncologists to derive optimal course of treatment for the individual patient.
With the high volume of patients and sub-specialising experts, the team at NCCS has yielded high results of up to 45% five-year survival rate. This figure is comparable to the outcomes at world class centres such as the United States and in Europe.
About National Cancer Centre Singapore
The National Cancer Centre Singapore (NCCS) is a national and regional centre directed at the prevention and treatment of different cancers including thoracic, hepatobiliary, pancreatic, head and neck cancers . Structurally and operationally designed to provide integrated and holistic patient-centred clinical services, it allows cross-consultation among cancer experts of different specialties. Patients can, therefore, enjoy personalised, prompt and customised cancer treatment recommended by a team of radiation, surgical and medical oncologists (cancer experts) during the same visit and in the same clinic.
As a one stop specialist centre housing Singapore's largest pool of oncologists, it has state of the art equipment and employs the latest therapies including mini transplants and targeted therapies which maximise outcomes and minimise undesirable side effects. NCCS also conducts clinical and basic research as well as public cancer education programmes wholly directed at the prevention and treatment of cancer.
Readers can visit www.nccs.com.sg or call +65 6436 8000 to find our more about NCCS
For more details, photos and media interviews on the above, please click [here].
|
