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Cancer of the LiverDr Kingsley’s comments Cancer of the liver can be divided into two groups, the most common by far is a spread to the liver from another cancer, such as from anywhere in the bowel or from the breast or prostate. Primary cancer of the liver is uncommon in the so-called West, but is the most common form of cancer in certain parts of Africa. Risk Factors. There is a clear link to the hepatitis B virus, and people who have had it have a 100-fold increased risk of developing primary cancer of the liver. There is also a connection with a toxin from mouldy food, called aflatoxin, which is a common problem in Asia and Africa. Otherwise it is associated with alcoholic cirrhosis. Signs and Symptoms. In primary cancer of the liver, if a person is an alcoholic and is known to have cirrhosis of the liver, the signs and symptoms tend to be insidious, i.e. there is a general deterioration in the person’s overall health. Otherwise there may be pain in the liver area, under the ribs on the right hand side, or jaundice might well be the first sign. When the condition has become more established, there may be swelling of the abdomen from enlargement of both the liver itself and the spleen. There may also be a collection of fluid in the tummy, called ascites. On rare occasions, cancer of the liver may present with a major bleed inside the abdomen, with pain, distension and anaemia. It may strangely present with episodes of low blood sugar, or a high blood calcium may be found in a routine blood sample, as may raised liver enzymes. Secondary liver cancer may be discovered from any of the above features, but it is often found on a routine scan when the person is already known to have cancer elsewhere, especially in an organ that regularly spreads to the liver. Investigations. An ultrasound of the liver is the simplest way of detecting cancer of the liver. A biopsy may well be carried out for specific reasons, often to try to identify where the primary might be, if that is not already known, as spread to the liver can sometimes be the first sign of there being cancer somewhere else in the body. This will then help the doctor to advise on the most appropriate treatment plan. Conventional Treatment. If there is a solitary tumour, surgery is sometimes possible, but it is only practical in about 10% of cases. Various other ‘surgical’ procedures are being tried, but they are only worthwhile trying in very carefully selected cases. Removal of the whole liver plus a liver transplant has resulted in the occasional long-term survivor. There is no value in trying radiotherapy, but chemotherapy is sometimes tried. Secondary spread to the liver from somewhere else often alters the treatment of the primary, as by then, any form of heroic treatment may well be considered a waste of time. Primary cancer of the liver has a 4% 5-year survival, although that can go up to 15% in cases where resection is possible and there is no cirrhosis. An Explanation by Dr Kingsley Before Your Consultation about your Liver Cancer Most consultations with doctors are fairly quick affairs, lasting perhaps five minutes, even if you are suspected of having liver cancer. You may be lucky to have more time spent on you, but when you have your consultation with me, I will spend as much time as you want. There is no time limit. We will take as long as you want. Often when I see some people for the first time, they are in a state of panic. They haven’t a clue what it is all about. No one has explained anything to them. Perhaps in the past they have been admitted for an emergency operation, or they had simply been told to come into hospital on such-and-such a day when they were either operated on or started a course of chemotherapy or radiotherapy. Once in hospital some sort of explanation may have been given, and you were probably seen by a junior doctor who not only took a short history of any symptoms you had, but also examined you to look for any signs of your cancer in your liver, but, by then, you were already captive and didn’t really have much choice in the matter. To be fair to doctors, they assume that their advice is the best on offer. After all, they are the experts. Virtually all doctors would treat your condition in roughly the same way, so it seldom occurs to them that you just might not want to follow their advice. In any case, most patients have been frightened by their diagnosis and want to get on with the treatment, assuming that the doctor can deal with it for them. Most people put their faith in their doctor, assuming he knows what he is doing. There is absolutely no intention on my part to tell you whether to follow your doctor’s advice of not. That is a decision you have to make. No one can make it for you, but I will help you make up your mind. The Consultation The virtual consultation with me has been planned as though you are with me in my consulting room. I will go though your history, or the history that I come across so often, explaining the parts of it that give me clues to the cause of people’s problems. The chances are that, having taken a medical history from many thousands of patients over nearly forty years of medical practice, especially in the detail that I find so valuable, it is likely that much of it will be appropriate to you. The consultation is one of the longest parts of this programme, as you would imagine, and it is full of fascinating information. Periodically I lecture to medical colleagues on the subject of ‘What a clinical history and the clinical examination can tell me’. All this information is the result of my many years of listening to patients, letting them tell their stories, believing in their observations that have often been ignored, and learning by experience. So, enjoy yourself, feel enlightened, smile, be happy and radiate confidence in what you are going to do. Be positive and forget the doom and gloom merchants. If someone has given you a poor prognosis, forget it. You no longer fit into their statistics. You are going to do something for yourself. You are now in charge. ---------------------------------------- What you do now is in your own hands. We would like you to take advantage of all the benefits of becoming a member of our Cancer Help Centre, which is free to join, so please look at the Members’ Area Overview, where you will find a summary of all that is on offer. |
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(c) 2006 |
