While October is nationally recognized as being breast cancer awareness month, it serves a dual purpose as also being liver cancer awareness month.
Over the last several decades, the percentage of Americans developing liver cancer has been slowly rising. The American Cancer Society estimates that about 30,640 new cases (22,720 in men and 7,920 in women) will be diagnosed with primary liver cancer and intrahepatic bile duct cancer in the United States in 2013 and about 21,670 people (14,890 men and 6,780 women) will die of these cancers.
In April of this year, at the age of 55, my father died from liver cancer. Just two short weeks after he was first diagnosed, despite being given four to six months to live, his cancer was too aggressive and took over his body. Not knowing much about the disease, or the impact it has on families across the nation, I made it my mission to spend October learning all I can about liver cancer and doing my part to help make others better aware of the signs, symptoms and treatment associated with the cancer.
Liver cancer is predominantly found in men, and over an average man's lifespan, the American Cancer Society has found that men have a one in 81 chance of being diagnosed with either liver or intrahepatic bile duct cancer. Females have a one in 196 chance.
While my father was diagnosed at 55 years old, the average age at diagnosis is 63, with more than 95 percent of people who are diagnosed with liver cancer being over the age of 45 years old. Three percent of those who are diagnosed are between the ages of 34 and 44 and around two percent are younger than 35.
Types of liver cancer
There are four types of primary liver cancer. Hepatocellular carcinoma (HCC) is the most common type of liver cancer in adults with four out of five primary liver cancers being HCC.
HCC can have different growth patterns, with some beginning as single tumors that grow later and the second type starting as many small cancer nodules throughout the liver. The second type of HCC, which is the type my father had, is seen most often in people with chronic liver damage or cirrhosis and is the most common growth pattern in the country.
By the time the doctors found my father's cancer, the growth nodules had fully consumed his liver and had begin spreading to the ducts leaving his liver.
Intrahepatic cholangiocarcinoma (bile duct cancer) accounts for about 10 to 20 percent of cancers that start in the liver. These types of cancers start in the cells that line the small bile ducts (tubes that carry bile to the gallbladder) within the liver.
Angiosarcoma and hemangiosarcoma are rare cancers that begin in cells lining the blood vessels of the liver. People who have been exposed to vinyl chloride or to thorium dioxide (Thorotrast) are more likely to develop these cancers.
Hepatoblastoma is a very rare kind of cancer that develops in children, usually in those younger than four years old. The cells of hepatoblastoma are similar to fetal liver cells. About two out of three children with these tumors are treated successfully with surgery and chemotherapy, although the tumors are harder to treat if they have spread outside the liver.
Liver cancer risk factors
Gender: Liver cancer is much more common in males than in females.
Race/ethnicity: In the United States, Asian Americans and Pacific Islanders have the highest rates of liver cancer, followed by American Indians/Alaska Natives and Hispanics/Latinos, African Americans, and whites.
Cirrhosis: Cirrhosis is a disease in which liver cells become damaged and are replaced by scar tissue. People with cirrhosis have an increased risk of liver cancer.
Chronic viral hepatitis: Worldwide, the most common risk factor for liver cancer is chronic (long-term) infection with hepatitis B virus (HBV) or hepatitis C virus (HCV). These infections lead to cirrhosis of the liver and are responsible for making liver cancer the most common cancer in many parts of the world.
Heavy alcohol use: Alcohol abuse is a leading cause of cirrhosis in the United States and is linked to an increased risk of liver cancer.
Obesity: Being obese increases the risk of developing liver cancer, most likely because it can result in fatty liver disease and cirrhosis.
Type 2 diabetes:Type 2 diabetes has been linked with an increased risk of liver cancer, usually in patients who also have other risk factors such as heavy alcohol use and/or chronic viral hepatitis. This risk may be increased because people with type 2 diabetes tend to be overweight or obese, which in turn can cause liver problems.
Inherited metabolic diseases: Certain inherited metabolic diseases can lead to cirrhosis. People with hereditary hemochromatosis absorb too much iron from their food. The iron settles in tissues throughout the body, including the liver, and can lead to cirrhosis and liver cancer.
Vinyl chloride and thorium dioxide (Thorotrast): Exposure to these chemicals raises the risk of angiosarcoma of the liver. It also increases the risk of developing cholangiocarcinoma and hepatocellular cancer, but to a far lesser degree.
Anabolic steroids: Anabolic steroids are male hormones used by some athletes to increase their strength and muscle mass. Long-term anabolic steroid use can slightly increase the risk of HCC.
Arsenic: Drinking water contaminated with naturally occurring arsenic, such as that from some wells, over a long period of time increases the risk of some types of liver cancer.
Infection with parasites: Infection with the parasite that causes schistosomiasis can cause liver damage and is linked to liver cancer. This parasite is not found in the U.S., but infection can occur in Asia, Africa, and South America.
Liver cancer signs and symptoms
Although my dad died within two weeks of being diagnosed, his cancer was not sudden. He showed signs and symptoms of liver cancer, but we didn't realize that is what was wrong. We thought he had stomach pains, maybe due to ulcers from taking too much of one type of medicine. If we knew more about the cancer, maybe we could have caught the cancer earlier.
Signs and symptoms of liver cancer often do not show up until the later stages of the disease. The sooner you go to the doctor when you first notice symptoms, the sooner the cancer might be diagnosed, and the sooner you can start treatment. By the time they found my dad's cancer, it was too late for treatment.
Signs and symptoms include: Weight loss (unintentional), loss of appetite, feeling very full after a small meal, nausea or vomiting, an enlarged liver, felt as a mass under the ribs on the right side, an enlarged spleen, felt as a mass under the ribs on the left side, pain in the abdomen or near the right shoulder blade, swelling or fluid build-up in the abdomen, itching, and yellowing of the skin and eyes (jaundice). Other symptoms that can occur include fever, enlarged veins on the belly that become visible through the skin, and abnormal bruising or bleeding.
The five-year survival rate refers to the percentage of patients who live at least five years after their cancer is diagnosed. While people do live longer than five years, the relative five-year survival rate from liver cancer is about 15 percent, because most patients also have other liver problems such as cirrhosis, which itself can be fatal.
In general, survival rates are higher for people who can have surgery to remove their cancer, regardless of the stage. Studies have shown that patients with small, resectable (able to be surgically removed) tumors who do not have cirrhosis or other serious health problems are likely to do well if their cancers are removed. Their overall five-year survival is over 50 percent. For people with earlystage liver cancers who are able to have a liver transplant, the fiveyear survival rate is in the range of 60 percent to 70 percent.
After liver cancer is diagnosed and staged, a cancer care team will discuss your treatment options with you. In creating your treatment plan, important factors to consider include the stage (extent) of the cancer and the health of the rest of your liver. But you and your cancer care team will also want to take into account the possible side effects of treatment, your overall health, and the chances of curing the disease, extending life, or relieving symptoms. Based on these factors, your treatment options may include: Surgery (partial hepatectomy or liver transplant); tumor ablation; tumor embolization; radiation therapy; targeted therapy; or chemotherapy.
In some cases, doctors may recommend combining more than one of these treatments. It is important to discuss all of your treatment options, including their goals and possible side effects, with your doctors to help make the decision that best fits your needs.
I would give anything in the world to have my dad back. I would give anything to have more time with him; just one more day. But because that is not possible, I want to make it my mission to do what I can to prevent other families from going through the same thing that I have and the best way to do that is to spread awareness and to get families informed.
The facts and figures used in this article courtesy of the American Cancer Society