Cancer Education Slides

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Cancer Education Slides

• Liver Cancer

2009
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What is Cancer?

• A group of 100 different diseases
• The uncontrolled, abnormal growth of cells
• Cancer may spread to other parts of the body

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What is Liver Cancer?

• An estimated 22,620 people diagnosed in the
  United States in 2009
• Sixth most frequent cause of cancer-related death
  among men and the ninth most common among women
• A disease in which normal liver cells grow
  uncontrollably and form a tumor or tentacle-like
  growth
• Primary liver cancer is cancer that begins in the
  liver
• Three types of primary liver cancer
  hepatocellular carcinoma (HCC),
  cholangiocarcinoma (bile duct cancer), and
  angiosarcoma
• HCC accounts for 90 of primary liver cancer cases

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What is the Function of the Liver?

• Largest internal organ in the body
• Two main parts a right lobe and a smaller left
  lobe
• Vital to the digestion of food
• Collects and filters blood from the intestine
• Produces important proteins and some of the
  bodys blood clotting factors
• Removes toxic wastes from the body
• Helps maintain proper sugar level in the body

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What Are Factors that Increase the Risk for
Hepatocellular Carcinoma?

• Chronic viral hepatitis (two common types are
  hepatitis B and hepatitis C)
• Cirrhosis of the liver, often but not always
  caused by excessive alcohol consumption
• Age
• Gender
• Chemical exposure (less common in the United
  States)
• Eating foods contaminated with the mold aflatoxin
  (less common in the United States)

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Hepatocellular Carcinoma Prevention and Early
Detection

• Vaccination for hepatitis B
• Avoid intravenous (IV) drug use (commonly
  associated with the transmission of hepatitis C)
• Avoid alcohol abuse (increases the risk of
  cirrhosis)
• Certain medications may control hepatitis B or C
  infection, decreasing the risk of HCC
• People with cirrhosis of the liver or chronic
  viral hepatitis may need to be screened for liver
  cancer

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What Are the Symptoms of Hepatocellular Carcinoma?

• Pain at the top right side of the abdominal area,
  near the right shoulder blade or in the back
• Unexplained weight loss
• Weakness or fatigue
• Hard lump under ribs on the right side of the body

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Symptoms of Liver Failure

• Abdominal swelling due to ascites (abnormal
  buildup of fluid)
• Bleeding from the esophagus or stomach
• Jaundice (yellowing of the skin and whites of the
  eyes)
• Mental confusion (from severe liver damage)

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How is Hepatocellular Carcinoma Diagnosed?

• Diagnosis is often confirmed with a biopsy
• Diagnosis can sometimes be confirmed with blood
  or imaging tests
• Physical examination
• Blood test for alpha-fetoprotein (AFP) 50-70
  of people with primary liver cancer have elevated
  levels
• Ultrasound of the abdomen
• Computed tomography (CT or CAT) scan
• Magnetic resonance imaging (MRI)
• Angiogram
• Laparoscopy

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Hepatocellular Carcinoma Staging

• Staging is a way of describing a cancer, such as
  the size of a tumor and if or where it has spread
• Staging is the most important tool doctors have
  to determine a patients prognosis
• Staging is described by the TNM system the size
  and location of the Tumor, whether cancer has
  spread to nearby lymph Nodes, and whether the
  cancer has Metastasized (spread to other areas of
  the body)
• Treatment and prognosis (chance of recovery)
  depend on the stage of the cancer and the degree
  of liver dysfunction
• Recurrent cancer is cancer that comes back after
  treatment

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Stage I Hepatocellular Carcinoma

• Earliest stage of HCC
• Tumor is 2 centimeters (cm) or smaller
• No spread to the blood vessels, lymph nodes, or
  other parts of the body

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Stage II Hepatocellular Carcinoma

• The tumor involves nearby blood vessels
• No spread to the regional lymph nodes or other
  parts of the body

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Stage III Hepatocellular Carcinoma

• Stage III is divided into 3 groups
• IIIA cancer has not spread beyond the liver but
  the area of the cancer is larger than stage I or
  II and has invaded nearby blood vessels
• IIIB cancer has spread to nearby organs but not
  to nearby lymph nodes or other parts of the body
• IIIC cancer has spread to the regional lymph
  nodes but not to other parts of the body

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Stage IV Hepatocellular Carcinoma

• Cancer has spread to other parts of the body

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Hepatocellular Carcinoma Staging, continued

• Localized resectable cancer is in one place in
  the liver, can be removed through surgery and the
  other part of the liver is healthy
• Localized unresectable cancer is found in one
  part of the liver, but it cannot be removed by
  surgery
• Advanced cancer has spread throughout the liver
  and/or to other parts of the body, such as the
  lungs and bones
• Recurrent cancer has come back after treatment.
  It may recur in the liver or another part of the
  body

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How is Hepatocellular Carcinoma Treated?

• More than one treatment may be used
• Surgery, including liver transplantation
• Ablative therapies, including percutaneous
  ethanol injection and radiofrequency ablation
• Arterial chemoembolization
• Systemic chemotherapy
• Radiation therapy
• Targeted therapy
• Clinical trials

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Cancer Treatment Surgery

• Most successful in patients with small tumors
  (smaller than 5 cm) and with good liver function
• Hepatectomy portion of the liver is removed when
  the cancer is limited to one part of the liver
• Liver transplantation used to treat cancer
  confined to the liver if a suitable donor is
  found. Must fulfill strict criteria

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Cancer Treatment Radiation Therapy

• The use of high-energy x-rays to destroy cancer
  cells
• The use of high energy x-rays or other particles
  to destroy cancer cells
• Internal beam use of implants inside the body.
  Radioactive beads may be inserted into the artery
  that supplies the tumor with blood
• External beam outside the body rarely used for
  HCC
• Side effects can include fatigue, mild skin
  reactions, upset stomach and loose bowel movements

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Cancer Treatment Chemotherapy

• Use of drugs to kill cancer cells
• One or a combination of drugs may be used
• Side effects may include nausea and vomiting,
  loss of appetite, diarrhea, fatigue, and risk of
  infection
• Side effects often go away after treatment is
  finished

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Types of Chemotherapy

• Systemic chemotherapy is injected into a vein and
  travels through the bloodstream to the whole body
• Regional chemotherapy uses a small pump
  surgically placed in the body to deliver
  anticancer drugs directly to the blood vessels
  that feed the tumor
• Hepatic arterial infusion is chemotherapy
  injected into a catheter in the major artery
  supplying blood to the liver
• Chemoembolization is similar to hepatic arterial
  infusion except the flow of blood through the
  artery is blocked for a short time, so the
  anticancer drug stays in the tumor longer the
  blocking of the blood supply to the tumor also
  kills the cancer cells

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Cancer Treatment Targeted Therapy

• Targets faulty genes or proteins that contribute
  to cancer growth and development
• Sorafenib (Nexavar), an anti-angiogenic and
  anti-proliferative drug (starves the tumor by
  disrupting its blood supply), may be used to
  treat tumors that cannot be removed with surgery

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Other Treatment Options

• Radiofrequency ablation (RFA) uses heat to kill
  the cancer cells
• Percutaneous ethanol injection uses alcohol
  injected directly into the liver tumor to kill
  cancer cells
• Cryosurgery uses extreme cold to freeze and kill
  cancer cells
• Biologic therapy (also called immunotherapy) uses
  the body's own immune system to fight cancer

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Current Research

• Cancer vaccines use of the bodys immune system
  to recognize and attack HCC
• New combinations of chemotherapy
• Gene therapy changes to a gene that can then be
  used to treat cancer
• Anti-angiogenic drugs
• Combinations of different types of treatment
• Expanding the criteria for liver transplantation

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The Role of Clinical Trials for the Treatment of
Liver Cancer

• Clinical trials are research studies involving
  people
• They test new treatment and prevention methods to
  determine whether they are safe, effective, and
  better than the standard treatment
• The purpose of a clinical trial is to answer a
  specific medical question in a highly structured,
  controlled process
• Clinical trials can evaluate methods of cancer
  prevention, screening, diagnosis, treatment,
  and/or quality of life

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Clinical Trials Patient Safety

• Informed consent participants should understand
  why they are being offered entry into a clinical
  trial and the potential benefits and risks
  informed consent is an ongoing process
• Participation is always voluntary, and patients
  can leave the trial at any time
• Other safeguards exist to ensure ongoing patient
  safety

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Clinical Trials Phases

• Phase I trials determine the safety and dose of a
  new treatment in a small group of people
• Phase II trials provide more detail about the
  safety of the new treatment and determine how
  well it works for treating a specific type of
  cancer
• Phase III trials take a new treatment that has
  shown promising results when used to treat a
  small number of patients with cancer and compare
  it with the standard treatment for that disease
  phase III trials involve a large number of
  patients

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Clinical Trials Resources

• Coalition of Cancer Cooperative Groups
  (www.CancerTrialsHelp.org)
• CenterWatch (www.centerwatch.com)
• National Cancer Institute (www.cancer.gov/clinical
  _trials)
• EmergingMed (www.emergingmed.com)

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Coping with Side Effects

• Side effects are treatable talk with the doctor
  or nurse
• Fatigue is a common, treatable side effect
• Pain is treatable non-narcotic pain-relievers
  are available
• Antiemetic drugs can reduce or prevent nausea and
  vomiting
• For more information, visit www.cancer.net/sideeff
  ects

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After Treatment

• Talk with the doctor about developing a follow-up
  care plan
• Doctor may recommend regular physical
  examinations, imaging tests, and blood tests
• Fear of recurrence is common talk with your
  doctor about ways to cope

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Where to Find More InformationCancer.Net Guide
to Liver Cancer(www.cancer.net/liver)

• Overview
• Medical Illustrations
• Risk Factors
• Symptoms
• Diagnosis
• Staging
• Treatment

• Clinical Trials
• Side Effects
• After Treatment
• Current Research
• Questions to Ask the Doctor
• Patient Information Resources

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Cancer.Net (www.cancer.net)

• Comprehensive, oncologist-approved cancer
  information
• Guides to more than 120 types of cancer and
  cancer-related syndromes
• Coping resources
• Survivorship information
• Cancer information in Spanish
• Weekly feature articles
• The latest cancer news
• For patient information resources, please call
  888-651-3038