Liver Cancer Essay

I have been lucky enough to live past 80, and the 15 years allotted to me beyond Hume’s three score and five have been equally rich in work and love. In that time, I have published five books and completed an autobiography (rather longer than Hume’s few pages) to be published this spring; I have several other books nearly finished.

Hume continued, “I am ... a man of mild dispositions, of command of temper, of an open, social, and cheerful humour, capable of attachment, but little susceptible of enmity, and of great moderation in all my passions.”

Here I depart from Hume. While I have enjoyed loving relationships and friendships and have no real enmities, I cannot say (nor would anyone who knows me say) that I am a man of mild dispositions. On the contrary, I am a man of vehement disposition, with violent enthusiasms, and extreme immoderation in all my passions.

And yet, one line from Hume’s essay strikes me as especially true: “It is difficult,” he wrote, “to be more detached from life than I am at present.”

Over the last few days, I have been able to see my life as from a great altitude, as a sort of landscape, and with a deepening sense of the connection of all its parts. This does not mean I am finished with life.

On the contrary, I feel intensely alive, and I want and hope in the time that remains to deepen my friendships, to say farewell to those I love, to write more, to travel if I have the strength, to achieve new levels of understanding and insight.

This will involve audacity, clarity and plain speaking; trying to straighten my accounts with the world. But there will be time, too, for some fun (and even some silliness, as well).

I feel a sudden clear focus and perspective. There is no time for anything inessential. I must focus on myself, my work and my friends. I shall no longer look at “NewsHour” every night. I shall no longer pay any attention to politics or arguments about .

This is not indifference but detachment — I still care deeply about the , about global warming, about growing inequality, but these are no longer my business; they belong to the future. I rejoice when I meet gifted young people — even the one who biopsied and diagnosed my metastases. I feel the future is in good hands.

I have been increasingly conscious, for the last 10 years or so, of deaths among my contemporaries. My generation is on the way out, and each death I have felt as an abruption, a tearing away of part of myself. There will be no one like us when we are gone, but then there is no one like anyone else, ever. When people die, they cannot be replaced. They leave holes that cannot be filled, for it is the fate — the genetic and neural fate — of every human being to be a unique individual, to find his own path, to live his own life, to die his own death.

I cannot pretend I am without fear. But my predominant feeling is one of gratitude. I have loved and been loved; I have been given much and I have given something in return; I have read and traveled and thought and written. I have had an intercourse with the world, the special intercourse of writers and readers.

Above all, I have been a sentient being, a thinking animal, on this beautiful planet, and that in itself has been an enormous privilege and adventure.

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Correction: February 26, 2015

Because of an editing error, Oliver Sacks’s Op-Ed essay last Thursday misstated the proportion of cases in which the rare eye cancer he has — ocular melanoma — metastasizes. It is around 50 percent, not 2 percent, or “only in very rare cases.” When Dr. Sacks wrote, “I am among the unlucky 2 percent,” he was referring to the particulars of his case. (The likelihood of the cancer’s metastasizing is based on factors like the size and molecular features of the tumor, the patient’s age and the amount of time since the original diagnosis.)

Liver cancer is a type of cancer that starts in the liver. Some cancers develop outside the liver and spread to the area. However, only cancers that start in the liver are described as liver cancer.

The liver, which is located below the right lung and under the ribcage, is one of the largest organs of the human body. It has a range of functions, including removing toxins from the body, and is crucial to survival.

Liver cancer consists of malignant hepatic tumors in or on the liver.

In the United States, around 22,000 men and 9,000 women are diagnosed with liver cancer every year. It is fatal in around 17,000 men and 8,000 women per year.

Fast facts on liver cancer
  • Liver cancer has a low survival rate
  • Major risk factors include excessive alcohol intake, hepatitis, and diabetes.
  • Symptoms generally do not appear until the cancer is advanced.
  • Treatment options for liver cancer include surgery and liver transplant.

Symptoms


Liver cancer is extremely serious, and symptoms are often not obvious until a later stage.

The signs and symptoms of liver cancer tend not to be noticed until the cancer reaches an advanced stage.

Liver cancer may trigger the following effects:

Stages

Staging a cancer allows a doctor to decide the course of treatment.

Liver cancer is categorized into four stages:

  • Stage I: The tumor is in the liver and has not spread to another organ or location.
  • Stage II: Either there are several small tumors that all remain in the liver, or one tumor that has reached a blood vessel.
  • Stage III: There are various large tumors or one tumor that has reached the main blood vessels. Cancer may have also reached the gallbladder.
  • Stage IV: The cancer has metastasized. This means that it has spread to other parts of the body.

Once the stage has been found, a course of treatment can begin.

Treatment

For people who have early-stage liver cancer that can be treated, only surgery that removes the tumors completely will lead to a chance of recovery.

Surgical options include the following:

Partial hepatectomy

When the tumor is small and occupies a small part of the liver, that part of the liver can be surgically removed.

However, in the U.S., many people with liver cancer have cirrhosis. This means that a hepatectomy needs to leave behind enough healthy tissue for the liver to perform its necessary functions after the procedure.

It may be decided during surgery that this will not be the case, and the procedure may be canceled halfway through if the risk to the patient is deemed to be too great.

Partial hepatectomy is only considered for people with otherwise healthy liver function. This procedure is often not an option, as the cancer has spread to other parts of the liver or other organs in the body.

Liver surgery of this scale can lead to excessive bleeding and blood-clotting issues, as well as infections and pneumonia.

Liver transplant

Candidates for a liver transplant cannot have a tumor larger than 5 cm or several tumors larger than 3 cm. The risk of the cancer returning is too great to justify a procedure as risky as a transplant if the tumor is larger than this.

With a successful transplant, the risk of cancer returning is greatly reduced, and normal function can be restored.

However, the immune system can 'reject' the new organ, attacking it as a foreign body, and there are limited opportunities to carry out transplants. Only around 6,500 livers are available each year, and many are used to treat diseases other than liver cancer.

The drugs that suppress the immune system to accommodate a new liver can also lead to serious infections and, on occasion, even the spreading of already metastasized tumors.

Treatment for incurable tumors

Advanced liver cancer, on the other hand, has an extremely low survival rate. However, there are steps a medical team can take to treat cancer symptoms and slow the growth of the tumor.

  • Ablative therapy: Substances are injected directly into the tumor, such as alcohol. Lasers and radio waves can also be used.

  • Radiation therapy: Radiation is directed at the tumor or tumors, killing a significant number of them. Patients may experience nausea, vomiting, and fatigue.

  • Chemotherapy: Medications are injected into the liver to kill cancer cells. In chemoembolization, the blood supply to the tumor is blocked surgically or mechanically, and anti-cancer drugs are administered directly into the tumor.

  • Volunteer for clinical studies: When trials reach the human stage they are called clinical trials. Ask your doctor whether there are any available in which you may be able to take part.

Treatment options may vary, depending on the type of liver cancer.

Causes


People with diabetes who drink excessive amounts of alcohol face an increased risk of liver cancer.

The exact cause of liver cancer is not known.

However, most cases are linked to scarring of the liver, also referred to as cirrhosis.

According to the American Cancer Society, hepatitis C is the most common cause of liver cancer in the U.S.

People with both hepatitis B or C have a significantly higher risk of developing liver cancer than other healthy individuals, as both forms of the disease can result in cirrhosis.

Some inherited liver diseases, such as hemochromatosis, cause cirrhosis and also increase the risk of liver cancer.

Other risk factors for liver cancer development include:

Type 2 diabetes: People with diabetes, especially if they also have hepatitis, or regularly consume a lot of alcohol, are more likely to develop liver cancer.

Family history: If a person's mother, father, brother, or sister has had liver cancer, the person has a higher risk than others of developing the cancer themselves.

Heavy alcohol use: Consuming alcohol regularly and in excessive amounts is one of the leading causes of cirrhosis in the U.S.

Long-term exposure to aflatoxins: An aflatoxin is a substance made by a fungus. It can be found in moldy wheat, groundnuts, corn, nuts, soybeans, and peanuts. The risk of liver cancer only increases following long-term exposure. This is less of a problem in industrialized nations.

Low immunity: People with weakened immune systems, such as those with HIV/AIDS have a risk of liver cancer that is five times greater than other healthy individuals.

Obesity: Being obese raises the risk of developing many cancers, including liver cancer.

Gender: A higher percentage of males get liver cancer compared to females. Some experts believe this is not due to gender but lifestyle characteristics. On average, males tend to smoke and drink alcohol more than females.

Smoking: Individuals with hepatitis B or C face a higher risk of liver cancer if they smoke.

Arsenic: People who rely on water wells that contain naturally-occurring levels of the toxin arsenic may eventually have a significantly higher risk of developing several conditions or diseases, including liver cancer.

High-risk individuals for liver cancer should have regular screenings for liver cancer. Liver cancer, if not diagnosed early, is much more difficult to cure. The only way to know whether you have liver cancer early on is through screening because symptoms are either slight or nonexistent.

This includes people with hepatitis B and C, patients with alcohol-related cirrhosis, and those that have cirrhosis as a result of hemochromatosis.

Outlook

The outlook for liver cancer is poor, as it is often diagnosed at a late stage, at which point it has already spread to other organs or other parts of the liver

The survival rate reduces as the staging gets closer to Stage IV. People diagnosed at an early stage have a 5-year survival rate of 31 percent. Once the cancer spreads, at a later stage, the same survival rate can be as low as 3 percent.

Treatment for liver cancer often involve serious surgery and carries a high risk of complications. This can further affect the outlook for a person with liver cancer.

Diagnosis

An early liver cancer diagnosis drastically improves the chances of survival.

A doctor will, first of all, ask questions about medical history to rule out any potential risk factors for liver cancer. They will then give a physical examination, focusing on any swelling in the abdomen and any yellow coloring in the whites of the eyes. These are both strong indicators of liver problems.

Following these signs, if a doctor suspects a liver cancer diagnosis, they will run further tests, including:

  • Blood tests: These will include tests to see how the blood clots, check levels of other substances in the blood and measure the proportions of red and white blood cells and platelets.
  • Tests for viral hepatitis: The doctor will check for the presence of hepatitis B and C.
  • Imaging scans: Either an MRI or CT scan can show the size and spread of the cancer.
  • Biopsy: A small sample of tumor tissue is removed and analyzed. The analysis can reveal whether the tumor is cancerous or non-cancerous.
  • Laparoscopy: This is an outpatient surgical procedure under general or local anesthetic. A long, flexible tube with a camera attached is inserted through the abdomen. This allows the doctor to observe the liver and surrounding area.

Once the doctor has assessed the stage, location, and type of liver cancer, they will be able to decide the likelihood of safely and effectively curing it. This will dictate the course of treatment.

Prevention

Liver cancer is serious and has a low survival rate. As such, all steps should be taken to reduce the risk of liver cancer and increase the chances of detecting liver cancer early should it arise.

There is no way to completely prevent liver cancer. However, the following measures may help to reduce the risk:


Reducing or eliminating alcohol intake lessens the likelihood of liver cancer.

Moderate alcohol intake: Regularly consuming high volumes of alcohol on a long-term basis significantly increases the risk of cirrhosis of the liver. This, in turn, greatly increases the likelihood of developing liver cancer.

Moderating the consumption of alcohol, or giving it up completely, can significantly reduce the risk of developing liver cancer.

Limiting tobacco use can also help avoid cancers of the liver and other organs.

Hepatitis B vaccination: The following individuals should consider receiving the hepatitis vaccine:

  • people with a drug dependency who share needles
  • individuals who engage in unprotected sex with partners who are at risk of having hepatitis B
  • nurses, doctors, dentists, and other medical professionals whose occupations raise their risk of becoming infected
  • frequent travelers, especially those who go to parts of the world where hepatitis B is common

There is no sure way to prevent hepatitis C and no vaccination. However, using a condom during sex may help reduce the risk of infection.

Maintain a healthy body weight: As obesity is a risk factor and fatty liver disease can lead to liver cancer and diabetes, looking after your physical health and weight can be key to reducing the risk of liver cancer.

Treating underlying conditions: Some conditions contribute to the development of liver cancer, such as diabetes and hemochromatosis. Treating these before they develop into liver cancer can reduce the risk of complications.

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