Ghassan K. Abou-Alfa, MD: Liver cancer is really 2 problems in 1: the cancer itself and the liver problem. Because in most cases, as you might know, patients have liver cancer because of some story behind it, being like, for example, an infection with a virus called hepatitis C or infection with a virus called hepatitis B. It could be a very heavy use of alcohol. It could be a fatty liver due to morbid or very heavy obesity and diabetes. So, there are different reasons that cause the liver to have some inflammation and ultimately lead to liver cancer.
And as such, treating a patient with liver cancer means taking care of the 2 things: the cancer, but also more importantly, or as importantly, the liver function. The reason I said more importantly is because if the liver function is not good, we can’t take care of the cancer. So, it’s very important to make sure that these 2 pathways are running in parallel.
Liver cancer is a cancer that requires a lot of teamwork effort. If anything, it depends on where the cancer is, how big or how small it is, what it involves. It will require different therapies. And as such, the cheat-sheet for us in regard to how we treat liver cancer is as follows.
A small liver cancer in a rather good liver function—remember we spoke about liver function—of course, take it out; surgery. And if anything, sometimes we might even do what we call ablation. In other words, try to burn it. And this is all totally applicable. On the other hand, if the liver cancer is small—and there are certain criteria on how small it should be—but at the same time the liver function is not good, transplant. Believe it or not, we still transplant patients for liver cancer and there are certain very specific criteria for that purpose.
On the other hand, if the cancer is still limited to the liver, but at the same time, the extent of it in the liver is not amenable for a surgery, an ablation, or a transplant, then we do what we call local therapy. Local therapy depends on something called embolization, where we actually try to suffocate the tumor. Sometimes, we even insert some chemotherapy with it or we might even put some radiation therapy to the tumor, but the idea is to control it wherever it is in the liver, per se.