Liver Cancer
Liver cancer include tumors that develop from liver cells (primary liver cancer) and tumors that develop somewhere else in the body and spread to the liver (metastatic liver cancer). Hepatocellular carcinoma is the most common type of primary liver cancer. Colorectal carcinoma is the most common source of metastatic liver cancer. The exact cause of primary liver cancer is not known, but alcohol use, hepatitis infections, exposure to toxins and the use of anabolic steroids may increase a person's risk of developing the disease. The liver is a common site of spread from non-liver tumors. This is because the liver's large size and high blood flow make it a prime target for tumor cells traveling through the bloodstream.
At Sinai Hospital,  a dedicated team of surgeons, radiologists, pathologists and medical oncologists  meet weekly to plan the best treatment for individual patients with liver tumors. Each liver tumor is different, and our treatment planning reflects this. We study the unique biological features of each patient's tumor so that treatment can be tailored for best results.

Incidence
The American Cancer Society estimates that 18,920 new cases of primary liver cancer and bile duct cancer will be diagnosed in the United States during 2004. It is about twice as common in men as in women. About 14,270 people will die of liver cancer in the United States during 2004.

In contrast to many other types of cancer, the number of people who develop liver cancer and die from it is increasing.

Symptoms
The following symptoms  could be caused by liver cancer, but they can also be caused by other cancers or conditions. Still, if you have any of the following problems, see a doctor right away

• Weight loss (for no known reason and without trying to lose weight)
• On going lack of appetite
• Feeling very full after a small meal
• Liver swelling or a mass that can be felt in the area of the liver
• Ongoing stomach pain
• Swelling in the area of the stomach
• Yellow-green color to the skin and eyes (jaundice)
• Becoming sicker if you have chronic hepatitis or cirrhosis

Diagnosis
Biopsy: Although other tests can suggest that a liver cancer is present, in most cases the only way to be certain is to take a sample of the tumor (biopsy) and look at it under a microscope. There are several different methods that might be used to obtain the tissue sample.

Treatment
In many instances, individual cases are discussed at a multi-disciplinary conference. Doctors from all the relevant specialties (surgery, medical oncology, radiation oncology, gastroenterology, diagnostic radiology and pathology) review the main information on the case and make a recommendation on the appropriate multidisciplinary management. The treatment recommended will depend on the extent of the disease, the specific type of liver cancer (primary or metastatic)and general health.  Test results will help your doctor plan a treatment program that is best suitable for you. There are five forms of treatment for liver cancer. One or a combination of these treatments may be used.

Surgery:
If the tumor has not spread outside of the liver and if it is localized, then surgery may be recommended. Surgery may include:

• Removing the area of the liver containing the tumor
• Using a special needle that destroys the tumor with heat (called radiofrequency ablation)
• Placing an infusion pump to give chemotherapy directly to the liver
• Any combination of the above

Interventional Radiological Procedures:
These procedures use X-ray imaging to guide the delivery of agents used to kill cancer cells. During embolization, a catheter is inserted into a blood vessel supplying the tumor. The cancer cells are then killed by injection of blocking agents to obstruct the blood supply to the tumor. A catheter may also be used to deliver chemotherapeutic drugs into blood vessels that directly supply the tumor. With ablation, a needle (for the delivery of drugs) or other therapeutic device is placed through the skin, into the tumor, to kill the cancer cells.

Chemotherapy:
This therapy uses drugs to kill cancer cells. The drugs are usually given intravenously (through a vein into the bloodstream). Some patients receive chemotherapy via a hepatic artery infusion pump. During surgery, a pump is placed under the skin of the abdomen and filled intermittently with chemotherapy agent(s). The tip of the pump catheter is placed in the hepatic artery to directly infuse treatment into the liver.

Radiation Therapy:
Radiation therapy is not used as commonly in the treatment of liver cancer as are surgery and chemotherapy. Sometimes radiation is given together with chemotherapy or during surgery.

CyberKnife® (Stereotactic Radiosurgery)
CyberKnife® stereotactic radiosurgery uses radiation waves to kill liver cancer cells. CyberKnife® targets the  specific area of the liver to be treated without damaging surrounding health, tissue. Following planning with computer simulation, treatments are usually delivered on an outpatient basis for two  to five days.This treatment differs from conventional radiation therapy, which is given in 15 to 28 days. Since the treatment is directed to the tumor area only with extreme  accuracy , the side effects are minimal. This  form of treatment is particularly useful in tumors that reoccur after surgery or radiofrequency ablation.

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