Hope For Cancer

General Information about the Lungs:

The paired lungs develop from lung buds in the human embryo during a period of rapid cell division. The main type of cell in the lungs is called “epithelial”, meaning a lining cell. Mucous is formed by “adeno”cells which fold into glands. Another type of cell, called the “type II” cell, secretes “surfactant” which provides the stiffness for lung tissue. All of these cells divide quickly during womb life, infancy and puberty, but growth slows dramatically by adulthood. In adults, the cells only divide to replace ones lost to injury or old age.

Air breathed in passes though the throat into the larynx, where the vocal cords can form sounds. Below the larynx is the trachea, a tube ringed with cartilage which helps keep it from collapsing. The trachea splits(“bifurcates”) in an upside-down “Y” with the arms of the “Y” going into each lung. The part of the trachea that actually enters each lung is called the “mainstem bronchus” ; there is a right and a left one to correspond with each lung. The area where the mainstem bronchi enter is called the “hilum” of each lung, the main blood vessels also enter at the hilum. The main bronchi branch out into smaller “lobar” and“segmental” bronchi to carry the air into the lungs. The right lung is made up of 3 lobes, and the left lung of 2 lobes. Each lobe is made up of smaller segments. The air breathed into the lungs ultimately gets to the tiny air sacs, called “alveoli”, which provides the surface for the oxygen in air to mix with the blood. Also, the alveoli allow the carbon dioxide in the blood to be released into the lungs to get exhaled. The lungs are surrounded by an outer membrane called the “pleura” — it is composed of 2 parts, an inner “visceral”pleura and an outer “parietal” pleura. There are bean-sized filters, called “lymph nodes” along the bronchi, which connect to each other via “lymph channels” . The lymph nodes contain lots of white blood cells and make up part of the immune system to help purify the blood. The lungs have a very rich blood supply, both from the blood they are oxygenating from the heart, which will be circulated to the rest of the body, and from the aorta, which provides nourishment for the lungs themselves. Thus, disease in the lungs, such as infection or cancer, can spread through the lymph channels and/or bloodstream to other areas of the body.

When people smoke tobacco over many years, the lungs lose their softness and start to become stiff. Then the lungs are more prone to infection and inflammation of the bronchi, called “bronchitis”, and produce soothing sputum. The air sacs are gradually destroyed, and stale air gets trapped in the lungs. This is called “emphysema” . It gradually destroys the interface between the air sacs and the bloodstream, compromising the ability of the lungs to oxygenate the blood and to release the built up carbon dioxide waste product. About 1 in 5 people with emphysema will eventually develop lung cancer.

What is Lung Cancer?

Normally, the division of cells in the adult lung to make new cells is under very tight
control. This control is exerted by the “genes” inside each cell, which are housed in long clumps forming“chromosomes”, which are visible under a light microscope. The genes themselves are made up ofDNA, the master genetic code material. If the genes are damaged, say by chemicals or radiation, the control over cell division may be lost in one particular cell. Ultimately, cancer is considered a disease of the DNA. Lung cancer starts in a single lung cell . That cell starts dividing haphazardly, making millions and billions of copies of itself. It takes up the nourishment needed by other cells, depriving them so the cancer can continue to grow. Quickly growing cells can clump up to form a “tumor” . A tumor simply means a swelling, it can be caused by inflammation or infection. A “benign” tumor only grows in it’s local area (although it may get quite large)– it cannot spread and is not cancer. By contrast, a tumor which can spread to other body areas is called “malignant” and this is cancer . The process of cancer spread to other areas is called “metastasis”, so only malignant tumors (i.e. cancer) can metastasize. Theoretically, cancer can spread to any area of the body, and it often grows better in it’s area of spread than in it’s area of origin (“primary site”) . It is this capacity for spread that makes cancer so dangerous. If not treated successfully, it ultimately kills by debility, anemia, infection, compromise of other organs and interference with normal body functions.

What are the Types of Lung Cancer?

Depending on which type of cell in the lung goes awry, different types of lung cancer may arise. Although mixed types may occur, lung cancer is commonly broken down into 4 basic categories, and a smattering of much less common types. The most common type is Squamous Cell Carcinoma (35% of cases). It starts from the cells lining the bronchi, especially when they have been repeatedly damaged by smoke or other irritation. Normally, squamous cells are the type that line the mouth, anus, vagina and skin– they are resistant to abrasion and heal quickly. Fascinatingly the normal “cuboidal” epithelium of the lung can start to turn into squamous cells with repeated irritation, a process called “dedifferentiation” . If this conversion is not totally successful, a cancerous squamous cell may arise.

The second most common type of lung cancer is Adenocarcinoma (30% of cases) which arises fromglands, and the cells lining the air sacs. It is usually found in the periphery of the lungs, as opposed to squamous cell which commonly has a more central location along the bronchioles (that is arises in the middle of the chest). This is the type common in non-smokers.

The third most common type is Small Cell Carcinoma, also called “oat cell” (20% of cases). It seems to arise from “neuroendocrine” cells, which produce small amounts of local hormones. The specific cell that small cell lung cancer arises from appears to be the “Kulchitsky” cell, a neuroendocrine cell within the lining of the bronchioles. There are 3 subtypes of small cell cancer– “Oat Cell”, “Intermediate” and “Combined” (mixed type). Over 90% of cases are the Oat Cell type, and it is the type that best responds to chemotherapy (although the others do also). The determination of which type of Small Cell cancer is present is made by a pathologist using a microscope, to see what the cells look like. A pathologist is a physician who specializes in diagnosing disease from tissue samples. However, pathologist’s won’t always agree on the exact subtype. However, over 90% of pathologists will concur that a “Small Cell component” exists when shown a questionable specimen, and if ANY EXISTS, THE PATIENT SHOULD BE TREATED FOR SMALL CELL CANCER. Treatment is much different than for the other types of“epithelial” lung cancer.

The fourth most common type is Large Cell carcinoma (15% of cases) which is actually a form of adenocarcinoma. Since the cells look much larger under a light microscope, however, it is given a separate category. It generally occurs in the periphery of the lung. Sometimes, the cancer does not look exactly like any of the above types, the cells are very primitive and aggressive looking. This is called“undifferentiated” cancer but careful analysis can often reveal the particular subtype. Nearly 30% of cancers may be “mixed”, especially if advanced. As mentioned, if there is any Small Cell Cancer present, it should be treated as such.

It is possible for other rare types of cancer to arise in or around the lungs. Examples are Lymphoma from the immune cells in the lung, Sarcoma from muscle, cartilage or fat, and Mesothelioma from the pleural lining of the lungs. Mesothelioma cancer can occur in the lining of the lungs, abdomen, or heart, and is only caused by previous exposure to asbestos. Mesothelioma has no known cure, and mesothelioma treatment options are unfortunately only a temporary means of controlling pain and symptoms. These conditions are all separate topics, with their treatment following that the the areas where they more commonly arise. Cancers from other areas may spread to the lungs, especially adenocarcinomas and sarcomas from other organs. The lungs are rich in blood and are a fertile area for other cancers to spread to. These are dealt with when considering the treatment for metastasis of these particular cancers.

How Common is Lung Cancer?

Each year there are about 170,000 new cases of lung cancer in the U.S.A. and 150,000 deathsattributable to this disease. Lung cancer is the most frequent fatal cancer, for both men and women, in the United States. Men are affected somewhat more frequently (100,000 cases/year) than women (70,000 cases/year). Worldwide, there are 1 million new cases per year. Over the past 5 decades the number of yearly cases has been increasing, and the worldwide incidence may double to 2 million per year in the coming decade. The average patient is 60 years old, and only 1% of cases are under 40 years old. Small Cell Cancer is the most rapidly increasing form of lung cancer and accounts for about 37,000 cases per year in the U.S.A . The proportion designated as Small Cell Cancer will vary in different studies depending on the methods of detection; in surgically treated patients the percentage is just 8% and in those diagnosed by fluid aspiration (“cytology”) of the lungs, 30%. This is because surgery is inappropriate for most Small Cell Cancer patients. About 90% of patients have historically died from their disease but survivals are improving with the latest effective therapy as we will see.

What Causes, or Increases the Risk For Small Cell Cancer?

1) Tobacco Smoking is the greatest risk factor for getting Small Cell Cancer, In large series of patients, fewer than 2% deny a history of heavy smoking. The risk begins to decline 5 years after quitting, and approaches normal at 20 years after quitting (but never exactly goes back to normal). Patients who quit smoking, even after diagnosis, tend to do better in treatment and live longer than those who continue smoking.
2) Radon Inhalation is associated with an increase in lung cancer. The radon breaks down into radioactive particles in the bronchi of the lungs, irritating the cells there, causing genetic damage, and leading them to divide. Radon tends to build up in unventilated Basements and Mine Shafts, uranium miners get more lung cancer; it is an occupational hazard.
3) Asbestos Inhalation in Mine workers, Pipe fitters, Shipbuilders, and people who worked with asbestos in insulation materials. The risk is especially high if patients both smoke tobacco and have asbestos exposure.

Can Small Cell Lung Cancer be Prevented?

Quitting smoking, and not being in close proximity of those who do, is the best way to prevent Small Cell Cancer. Even patients who have smoked for many years will see a decreased risk of heart attack from the day they quit smoking, and decreased risk of lung cancer after several years. A diet high in natural vitamins“A” and “E”, and relatively low in fat, may be preventative for many “aero-digestive” cancers (those arising in the nose, mouth, throat, lungs and digestive system). Regular screening Chest X-rays do succeed in diagnosing lung cancer at earlier “stages”, but have not been proven to increase survival from lung cancer. Nonetheless, it is reasonable for a person with high risk factors to get a chest X-ray as part of their annual physical, and to get one without delay if symptoms of lung cancer manifest.

Lung cancer has been one of the most dreaded diagnosis in medicine, and has increased dramatically in the 20th century. The paired lungs are obviously vital to life, providing a surface for the blood to mix with oxygen. A person can live (with limitations) with a single lung, but in any lung, or “pulmonary” disease, conservation of healthy lung tissue is essential. At the same time, full eradication of a cancer problem is crucial to prevent rapid demise of the patient.

It is critical to get proper treatment for a diagnosis of Small-Cell Lung Cancer, this can literally make the difference between life and death. Fortunately, new and better treatments are available, and particularly for Small Cell Lung Cancer new therapies are very encouraging. Understanding you options for a lung cancer problem will give you the peace of mind knowing that you have done everything possible for a happy outcome.

Lung cancers, like mesothelioma, are among the most devastating forms of cancer. If you think you’ve been exposed to asbestos, contact a mesothelioma attorney to see if you can be compensated for your medical bills from asbestos related cancers.

CancerAnswers’ material explains, in plain English, the definition, types, frequency, symptoms, evaluation, historical and latest treatment for Small-Cell Lung Cancer. We describe the roles of surgery, radiation, chemotherapy and tell you their side-effects and results. We tell you everything you need to know to help you make the right choices today for a Small-Cell Lung Cancer problem.

This is just an excerpt from our Complete Cancer Treatment Transcript. Much more, including latest treatments, can be sent to you by email when you order the complete transcript at a nominal cost.

General Information about the Lungs:

The paired lungs develop from lung buds in the human embryo during a period of rapid cell division. The main type of cell in the lungs is called “epithelial”, meaning a lining cell. Mucous is formed by “adeno” cells which fold into glands. Another type of cell, called the “type II” cell, secretes “surfactant” which provides the stiffness for lung tissue. All of these cells divide quickly during womb life, infancy and puberty, but growth slows dramatically by adulthood. In adults, the cells only divide to replace ones lost to injury or old age.

Air breathed in passes though the throat into the larynx, where the vocal cords can form sounds. Below the larynx is the trachea, a tube ringed with cartilage which helps keep it from collapsing. The trachea splits (“bifurcates”) in an upside-down “Y” shape with the arms of the “Y” going into each lung. The part of the trachea that actually enters each lung is called the “mainstem bronchus”; there is a right and a left one to correspond with each lung. The area where the mainstem brochi enter is called the “hilum” of each lung, the main blood vessels also enter at the hilum. The main bronchi branch out into smaller “lobar” and “segmental” bronchi to carry the air into the lungs. The right lung is made up of 3 lobes, and the left lung of 2 lobes. Each lobe is made up of smaller segments. The air breathed into the lungs ultimately gets to the tiny air sacs, called “alveoli”, which provides the surface for the oxygen in air to mix with the blood. Also, the alveoli allow the carbon dioxide in the blood to be released into the lungs to get exhaled. The lungs are surrounded by an outer membrane called the “pleura”– it is composed of 2 parts, an inner “visceral” pleura and an outer “parietal” pleura. There are bean-sized filters, called “lymph nodes” along the bronchi, which connect to each other via “lymph channels”. The lymph nodes contain lots of white blood cells and make up part of the immune system to help purify the blood. The lungs have a very rich blood supply, both from the blood they are oxygenating from the heart, which will be circulated to the rest of the body, and from the aorta, which provides nourishment for the lungs themselves. Thus, disease in the lungs, such as infection or cancer, can spread through the lymph channels and/or bloodstream to other areas of the body.

When people smoke tobacco over many years, the lungs lose their softness and start to become stiff. The air sacs are gradually destroyed, and stale air gets trapped in the lungs. This is called “emphysema”. It gradually destroys the interface between the air sacs and the bloodstream, compromising the ability of the lungs to oxygenate the blood and to release the built up carbon dioxide waste product. About 1 in 5 people with emphysema will eventually develop lung cancer.

What is Lung Cancer?

Normally, the division of cells in the adult lung to make new cells is under very tight control. This control is exerted by the “genes” inside each cell, which are housed in long clumps forming “chromosomes”, which are visible under a light microscope. The genes themselves are made up of DNA, the master genetic code material. If the genes are damaged, say by chemicals or radiation, the control over cell division may be lost in one particular cell. Ultimately, cancer is considered a disease of the DNA. Lung cancer starts in a single lung cell . That cell starts dividing haphazardly, making millions and billions of copies of itself. It takes up the nourishment needed by other cells, depriving them so the cancer can continue to grow. Quickly growing cells can clump up to form a “tumor” . A tumor simply means a swelling, it can be caused by inflammation or infection. A “benign” tumor only grows in it’s local area (although it may get quite large)– it cannot spread and is not cancer. By contrast, a tumor which can spread to other body areas is called “malignant” and this is cancer . The process of cancer spread to other areas is called“metastasis”, so only malignant tumors (i.e. cancer) can metastasize. Theoretically, cancer can spread to any area of the body, and it often grows better in it’s area of spread than in it’s area of origin (“primary site”). It is this capacity for spread that makes cancer so dangerous. If not treated successfully, it ultimately kills by debility, anemia, infection, and compromise of normal body functions.

What are the Types of Lung Cancer?

Depending on which type of cell in the lung goes awry, different types of lung cancer may arise. Although mixed types may occur, lung cancer is commonly broken down into 4 basic categories, and a smattering of much less common types. The most common type is squamous cell carcinoma (35% of cases). It starts from the cells lining the bronchi, especially when they have been repeatedly damaged by smoke or other irritation. Normally, squamous cells are the type that line the mouth, anus, vagina and skin– they are resistant to abrasion and heal quickly. Fascinatingly, the normal “cuboidal” epithelium of the lung can start to turn into squamous cells with repeated irritation, a process called “dedifferentiation”. If this conversion is not totally successful, a cancerous squamous cell may arise. The second most common type of lung cancer is adenocarcinoma (30% of cases) which arises from glands, and the cells lining the air sacs. It is usually found in the peripherapy of the lungs, as opposed to squamous cell which commonly has a more central location along the bronchioles. The third most common type is small cell carcinoma, also called “oat cell” (20% of cases). Its treatment is much different than for the other types of “epithelial” lung cancer, and it is considered a different topic. The fourth most common type islarge cell carcinoma (15% of cases) which is actually a form of adenocarcinoma. Since the cells look much larger under a light microscope, however, it is given a separate category. It generally occurs in the periphery of the lung. Sometimes, the cancer does not look exactly like any of the above types, the cells are very primitive and aggressive looking. This is called“undifferentiated” cancer but careful analysis can often reveal the particular subtype. Nearly 30% of cancers may be “mixed”, especially if advanced.

It is possible for other rare types of cancer to arise in or around the lungs. Examples are lymphoma from the immune cells in the lung, sarcoma from muscle, cartilage or fat, and mesothelioma from the pleural lining of the lungs. One of the rarest types of cancer, pleural mesothelioma, occurs in the lung cavity and is caused by previous asbestos exposure. These conditions are all separate topics, with their treatment following that the the areas where they more commonly arise. Cancers from other areas may spread to the lungs, especially adenocarcinomas and sarcomas from other organs. The lungs are rich in blood and are a fertile area for other cancers to spread to. These are dealt with when considering the treatment for metastasis of these particular cancers.

How Common is Lung Cancer?

Each year there are about 170,000 new cases of lung cancer in the U.S.A. and 150,000 deathsattributable to this disease. Lung cancer is the most frequent fatal cancer, for both men and women, in the United States. Men are affected somewhat more frequently (100,000 cases/year) than women (70,000 cases/year). Worldwide, there are 1 million new cases per year. Over the past 5 decades the number of yearly cases has been increasing, and the worldwide incidence may double to 2 million per year in the coming decade. The average patient is 60 years old, and only 1% of cases are under 40 years old. About 90% of patients have historically died from their disease but survivals are improving with the latest effective therapy.

What Causes, or Increases the Risk for Lung Cancer?

Like any cancer, the exact reason why one particular person gets lung cancer and another does not remains unknown. However, certain factors are strongly correlated with with an increase in lung cancer, when groups of patients are studied:

1) Tobacco Smoking is the best known risk factor for lung cancer. The risk goes up with the number of cigarettes smoked. Doctors calculate usage as “pack-years” which means multiplying average packs per day with number of years smoked. Increasing from one to two packs per day smoked increases the risk 4 times, (from 55 cases/100,000 smokers/year to 217 cases/100,000 smokers/year). It takes 5 years after quitting smoking for the risk to appreciably decrease, and at 15 years after the risk approaches the never-smoked level. Second hand smoke has gotten a lot of press lately, with some claims that the risk of cancer is up to 20 times greater than the smoker themselves! This is a distortion based upon the observation that unfiltered smoke from the tip of a cigarette has more cancer causing chemicals (“carcinogens”) than filtered smoke. Nonetheless, an higher risk for lung cancer amoung spouses of smokers and people who spent many years working in enclosed, smoke-filled offices is well-documented. However, the chance of getting lung cancer from occasional casual exposure to a smokers “second-hand” smoke is almost zero. Driving down a crowded freeway exposes our lungs to more carcinogens from auto exhaust than “second-hand” smoke. Inarguably, lung cancer has skyrocketed with the popularity of cigarettes. Before the year 1850, only about 200 cases of lung cancer were even known of!
2) Carcinogen Exposures besided tobacco smoke that are linked with lung cancer include asbestos, coal tar fumes, nickel, chromium, and arsenic. There is a higher risk in coal miners. There used to be a much higher risk in people who worked in talc and soap dust factories, before the air there was filtered. Any small particle that gets into the lungs and irritates over time, promoting cell division, increases the risk for lung cancer.
3) Radiation Exposure is the next highest risk factor for lung cancer. The most common type is radon, a radioactive gas given off when radium disintegrates. The problem is when this gas builds up in enclosed areas, like basements. When radon gets into the lungs it undergoes further disintegration with release of high-energy particles that damage the DNA in lung cells, possibly leading to uncontrolled division (cancer). Test kits are available to determine if radon is a problem in your home. Other forms of radiation to the lungs come from the “polonium” in tobacco smoke, from natural backround radiation (cosmic rays, radiation from mineral deposits in the earth, and some potassium-40 we all eat) and from medical procedures. The chance of getting lung cancer from a chest X-ray is less than 1 in a million. The best protection against lung radiation is to check our basements for radon, and not to smoke tobacco.
4) Miscellaneous Risks Factors include old scars in the lungs (such as from tuberculosis), the rheumatological disease scleroderma, and a slight familial tendency for susceptibility to getting lung cancer, especially after carcinogen exposure. Most cancers are a combination of some external hazard, such as a virus, chemical or radiation, in conjunction with a genetic susceptibility to developing a cancer when exposed to such hazards.

Does Screening Help for Lung Cancer?

A large National Cancer Institute study showed that when 30,000 male smokers had chest X-rays and sputum tests to look for lung cancer, more of them had the disease picked up early, but no survival benefit was seen from screening. Thus, we
don’t routinely screen for lung cancer in the absence of symptoms. Nevertheless, it
is reasonable to screen patients with high risk factors, to pick up the disease early. As we will see, early disease is much more successfully treated than advanced cancer.

What are the Symptoms of Lung Cancer?

Like any cancer, very early lung cancer has no symptoms, since there are too few cancer cells to interfere with normal body functioning. As the cancer gets larger, symptoms increase.

Lung cancer has mushroomed in the past 3 decades to become a major health problem. While once viewed as always fatal, new research has led to therapies that give some real hope to the lung cancer patient. It is crucial to be well-educated about this disease to help you choose the proper therapy.Selecting the right treatment can literally make the difference between life and death. It is important to have the peace-of-mind knowing that you have done everything possible to help fight lung cancer successfully.

CancerAnswers’s materials explain, in plain English, the definition, types, frequency, risk factors, symptoms, historic and latest effective treatment for lung cancer. We describe surgery, radiation, chemotherapy and immune therapies. We tell you everything you must know to help make the right choices today for a lung cancer problem.

This is just an excerpt from our Complete Cancer Treatment Transcript. Much more, including latest treatments, can be sent to you by email when you order the complete transcript at a nominal cost.

What does the Liver Do?

The liver is an organ in the abdomen which is necessarily to live . It is mostly located behind the right ribcage, and when it becomes enlarged it protrudes below the right ribcage (“right costal margin”). It is composed of right and left “lobes”, and a smaller “quadrate” lobe. Thegall bladder hangs down from the bottom of the liver, collecting greenish bile from it. The liver has as a major blood supply the “hepatic artery” which comes off of the aorta. The “hepatic vein” collects nutrients and drugs from the intestines and delivers them to the liver for processing. The liver drains blood via the large “inferior vena cava”, directly into the heart. There is also a system of draining “lymph glands” around the liver which help to purify the blood. These lymph glands are connected via “lymph channels” which ultimately drain back into the bloodstream via the “left thoracic duct”; they are important as they may serve as conduits for spread of infections or cancer. The liver has a “capsule” around it which contains nerve endings, accounting for pain when the liver enlarges and stretches its capsule. The damaged liver has an amazing ability to regenerateitself. The body needs only about 10% of the liver to live, and if a piece is cut out or injured, it can grow back. Sometimes, however, the liver gets chronic diseases which impair its ability to regenerate. It can become infiltrated with fat (“steatosis”), shrink from chronic alcohol or viral exposure (“cirrhosis”) or grow large from infection or a blocked blood drainage (“hepatomegly”) . Any inflammation of the liver, whether caused by germs, drugs, or radiation, is called hepatitis . A damaged liver may heal, or may slowly fail and require liver transplant to save the patient’s life The liver is an astounding laboratory sustaining metabolism. Among its functions are purification of the blood, removing poisonous ammonia from proteins, detoxifying alcohol and drugs, controlling the body’s sugar and cholesterol balance, making bile to digest fats, forming clotting factors for the blood and generating new blood cells. This myriad of functions makes clear why the liver is essential to life.

What is Liver Cancer?

The cells in the liver are meant to divide to replace those that die of injury or old age. Like all cell division in the body, this process is tightly controlled to proceed in an orderly manner, and controlled by the “genes” within each cell. Liver cancer starts within a single cell. Something changes the control mechanisms within this cell, and it starts dividing in a disorganized, uncontrolled manner. The abnormal cell makes millions of copies of itself, called “clones”. They fail to perform the normal functions of liver cells, but are only intent on dividing to make more copies of themselves. Eventually these abnormal cells form a clump, ortumor. A tumor is merely a swelling, and isn’t necessarily cancerous. A benign tumor just grows in its local area, and although it may become very large it doesn’t spread and isn’t cancer. By contrast, amalignant tumor is cancer and has a capacity to spread to any area of the body. This process of spread is called metastasis . It is this capacity to spread to other vital organs that makes cancer so dangerous.

How Common is Liver Cancer?

Liver cancer is fairly uncommon in the U.S.A. with20,000 new cases and 15,000 deaths each year in the United States. It represents about 2% of all new cancers. About 3000 of the cases are in the liver itself, the remainder are in the Gall Bladder and bile drainage ducts. However, in Asia and Africa liver cancers are one of the most common cancers. Males are effected slightly more commonly than females, and the average patient is 50 years old. By contrast, benign liver tumors are more common in females and tend to occur at a younger age. Overall the death rate from liver cancer has dropped in the U.S.A. over the past 50 years. This is both from a decline in the number of cases, and better treatment for the disease.

What are the Types of Liver Tumors?

The most common types of benign liver tumors are hemangiomas (which are a cluster of abnormal blood vessels forming a swelling), and adenomas (which are clumps or knots of liver tissue). The most commonmalignant liver cancers are hepatocellular carcinoma (80% of cases) which arises from the liver cells themselves, and is also known as ahepatoma (a poor name for liver cancer, since it sounds benign).Cholangiocarcinoma (15% of cases) arises from bile ducts in the liver as they proceed down toward the gallbladder. A Klatskin tumor is a cholangiocarcinoma located at where the gall bladder meets the liver. Rare types of liver cancer include the angiosarcoma (which arises from the blood vessels in the liver),lymphomas (from the immune cells in the liver) and carcinoids (from hormone making liver cells). The liver is a very common place for cancers originating in other body organs to spread to; since it offers a soft, spongy blood-rich surface for metastatic “seeds” to grow. If their are multiple areas of cancer in the liver, the chances are much higher that it began in some other organ and then spread to the liver. Bowel, lung, breast, bladder, prostate and esophagus cancers have particular propensities for liver spread. These are not considered “primary” liver cancer, and their treatment upon spread is discussed in their particular transcripts.

What Causes or Increases Risk for Liver Cancer?

As for any cancer, the exact reason why any one person gets liver cancer and another doesn’t remainsunknown . However, several things have been noted which increase the risk, called“risk factors”:

1. Chronic Hepatitis can lead to changes in the liver cells associated with the most common type of liver cancer, hepatocellular carcinoma (HCC).
a)Hepatitis B – evidence of prior infection is found in 75% of liver cancer patients worldwide. It can lead to cirrhosis, below. The more common Hepatitis A (spread by feces) isn’t associated with liver cancer.
b)Carcinogens (chemicals inducing cancer) such as aflatoxin food contamination (used by Iraq on the Kurds) and nitrosamines.

2. Cirrhosis of the liver (the liver can shrink up and become fibrous and fatty in response to chronic irritation). Causes of cirrhosis include:
a) Alcoholism– alcoholic cirrhosis leads to 5% of liver cancer.
b)Hemochromatosis is an overload of iron in the liver. 20% of patients who get cirrhosis from the overload may develop HCC.
c)Alpha1- antitrypsin deficiency is a rare condition where a necessary enzyme is lacking to break down waste products in the liver and lung. HCC can develop in 40% of patients who get this type of cirrhosis.

3. Miscellaneous irritants to the liver including:
a) Polyvinyl Chloride (PVC) is linked to angiosarcoma.
b)Liver flukes are linked with bile duct cancer in China.
c) Thorotrast is a contrast dye for radiology studies no longer used after being linked to angiosarcoma.
d)Radiation Exposure can lead to liver sarcomas, sometimes as long as 5 decades after the exposure.
The common thread to liver cancer risk factors is chronic irritation, which causes the liver cells to divide more quickly than they ordinarily would to repair perceived damage. The more often cells divide, the more the chance for a genetically abnormal one to arise, with the gene changes leading to its becoming cancerous.

What are the symptoms of Liver Cancer?

The most common symptoms of liver cancer are from a massive tumor growing in the liver, or even liver failure. A very early cancer will have no symptoms, since it is too small to cause any. As it enlarges, common symptoms include:

1.Pain in the right upper abdominal area caused by stretching of the liver’s capsule, which is rich in nerves. The liver may then extend below the right costal margin (“hepatomegaly”) and be painful to probe.
2. Weight Loss and loss of appetite; the liver is a digestive organ.
3. Swelling of the abdomen (called “ascites” pronounced a-site-ees) from the liver failing to produce the protein required to hold the blood’s fluid in the blood vessels, so it migrates out to fill the abdomen, scrotum and limbs.
4. Cirrhosis signs like breast swelling in males (from the liver failing to break down estrogens) and little spider shaped veins (angiomata) seen on the skin. Another sign of liver failure is very red palms (“palmar erythema”).
5. Blood clotting problems leading to intestinal bleeding and bruises on the skin. The liver normally uses vitamin K from the diet and intestinal bacteria sources to synthesize the clotting factor (“prothrombin”) necessary for life.
6.Fatigue and eventually coma from buildup of ammonia in the body.
7. Jaundice and light stools, from blockage of the bile draining system. Also looser and smellier stools may be seen, (“steatorrhea”) indicating poor breakdown of fats in the digestive tract. Jaundice normally produces itching (pruritis) when it becomes marked. The first area notable for jaundice, caused by the
liver’s failure to clear bilirubin, is the whites of the eyes (“scleral icterus”).
8. Paraneoplastic syndromes means unusual symptoms caused by chemical alterations in the body either from the liver failing or secretions from the tumor cells themselves. These include elevated blood calcium, low blood sugar, anemias, precocious puberty in children, intense flushing, and other metabolic
disturbances. These syndromes often will be alleviated with cancer shrinkage.
9. Signs of Distant Spread include bone pain, neurological symptoms from brain involvement, and intestinal blockage. These all indicate advanced disease.

How is Liver Cancer Diagnosed and Evaluated?

Since liver cancer is unusual, and its symptoms mimic many other conditions, there is commonly a delay in making the diagnosis while the cancer grows larger. Unfortunately, most patients have advanced disease by the time the diagnosis is made. Important steps to diagnosing liver cancer include:

1. A high“index of suspicion” in patients with a history of chronic hepatitis, alcoholic cirrhosis, toxin exposure, or the rare genetic diseases which increase risk.
2. A Complete Physical Exam especially looking for signs of a tumor in the upper right abdomen and signs of liver failure like body swelling and bruising. Other organs (i.e. rectum, prostate, breast) are examined to see if a primary tumor has arisen there, and possibly spread to the liver.
3. Blood Tests including a complete blood count (CBC) to look for anemia or infection, and a blood chemistry panel(SMA) which tells about liver function and general metabolism. The most commonly elevated blood tests with liver damage are AST, ALT, GGT and alkaline phosphatase . These are all enzymes that are released into the bloodstream when liver cells die. Also, a hepatitis panel is appropriate. Blood clotting studies (PT/PTT) are gotten both to assess liver function and a part of a pre-surgical screen if surgery is a possibility. There is a “tumor marker” to help diagnosis liver cancer. In HCC patients, especially younger ones, the “alpha-fetoprotein” (AFP) blood test is elevated in over 50% but it may represent some other malignancy besides liver cancer. If it is elevated, it will usually return to normal with successful treatment.
4. Radiologic Tests, include standard Chest X-ray to look for infection or tumor in the lungs. Ultrasound (US) remains useful for looking at the shape of the liver, identifying a tumor, and tracking the progress of therapy. Ultrasound doesn’t use any radiation (just sound waves) and is very safe in children and pregnant women. However, the results are very dependent upon the skill of the technician performing the test, and if something is found then a CT scan will be ordered anyway. A CT scan is very accurate for detecting tumors larger than 1 cm, it does use radiation like a series of multiple X-rays which are joined together. If contrast is injected into an arm vein for a CT scan, the blood vessel of the liver will be more clearly visible. It is best to ask for “omnipaque” or equivalent contrast, which is more expensive but less likely to cause an allergic reaction. The CT scan isn’t technician dependent, and is very good for showing extension of the tumor into nearby organs and enlarged lymph glands in the vicinity of the tumor, which can represent spread to them. Other tests to visualize cancer are arteriography, where some contrast dye is injected and special X-rays are taken that show the shape of the tumor’s blood vessels. Another test is the MRIscan which uses no radiation, shows the organs in the abdomen very clearly and is excellent for showing local spread and imaging nearby lymph glands. The MRI can also be given with contrast (“gadolinium”) to better show the blood vessels. However, it is expensive ($1000) and requires the patient to lie almost perfectly still for an hour to be accurate. These tests are gotten to evaluate a patient for possible surgery or check their response to therapy. Other more exotic tests, such as bone scans, liver-spleen scans, or CT scans of the brain are only gotten if their are symptoms is these particular areas, and the therapy will be changed depending upon the results of these tests.
5. The only way to absolutely diagnose any cancer is by getting a piece of it for analysis, that is a biopsyof the tumor. This biopsy may be obtained by a fine needle under local anesthesia, in the radiology department using ultrasound or CAT scan to guide the needle into the tumor. Several samples are usually taken for accuracy. Risks of biopsy include spilling the tumor or bleeding the from puncturing blood vessels in the tumor, this may require an emergency operation to stop bleeding. Overall fine-needle biopsy is safe and effective; it is a very common procedure in hospital Interventional Radiology Departments. The biopsy material is examined by a pathologist, a physician who specializes in diagnosing diseases from tissue samples. If cancer is detected, he will specify the particulartype, and the grade (I,II or III) which tells how aggressive the cancer is likely to be. Higher grade cancers (III ) look more “malignant” under the microscope, with numerous cell divisions and cells scantly resembling normal liver tissue. They tend to be more aggressive (likely to grow very quickly and spread). On the other hand, low grade (I ) tumors have fewer cell divisions and look much like the normal liver tissue they arose from. They are considered more “indolent” (slow growing) and less likely for early spread. Grade II tumors are considered intermediate in appearance and behavior.

There can be more than one grade (or even type) of cancer in a given specimen, this is called a “mixed tumor” . If there is any doubt, more than one pathologist should review the biopsy material, since pathologists do not always agree on the diagnosis. Pathologist’s themselves (obviously) know this and
will normally request a review upon any biopsy they are unsure of. It is also obviously important for the pathologist to state whether the tumor has arisen from the liver primarily, or has spread there from some other organ. Occasionally it is strongly felt the tumor did not arise in the liver, since it does not have a resemblance to liver tissue. On the other hand, it may be difficult or impossible to say just where it originated. This is called “cancer of unknown primary” and is thoroughly investigated with emphasis on re-examining the liver biopsy.

The liver is a digestive organ necessary for life. Besides helping produce bile for digestion, it produces clotting factors for the blood, essential proteins, regulates cholesterol and detoxifies drugs and poisons. The liver is very resilient, but when it develops cancer can fail quickly, leading to rapid demise of the patient.It is critical to get proper treatment for a diagnosis of liver cancer, this can literally make the difference between life and death. Understanding your options for liver cancer will give you the peace of mind knowing that you have done everything possible.

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