Liver Cancer

Often in the early stages of development of tumours the rate of growth can be slow and the capacity  to invade surrounding tissues or send out cells that lodge in other parts of the body to create metastatic tumours  is limited. Thus from a practical point of view it is always best to try to detect and where possible destroy tumours  early.

For good general accounts of the  nature of tumours see http://www.cancer.org/docroot/home/index.asp .

Simply go to the web site and search, for example, 'liver cancer'. The information given is clear and arranged in such a way as to facilitate comprehension by non- experts. It can also be downloaded in a readily printable form.

As far as cancers that arise from the cells of the liver are concerned they are of as many kinds as there are kinds of cells in the liver and each one of them needs to be managed in a different way. Some tumours are called benign and may need no treatment. Unfortunately that is not the usual case with cancer of the liver and about three quarters of the tumours that arise in the organ are malignant; they may invade and possible destroy surrounding tissues and/or spread to other sites outside the liver. Malignant tumours of the liver are life threatening and need to be dealt with whenever possible.

Distinction is made between the various kinds of tumour that grow in the liver by a combination of methods.

Imaging with  specialised X-ray machines or Nuclear Magnetic Resonance or Ultrasound scanners may individually or collectively be employed. All these instruments send energy of various kinds into the body and the emergent or reflected energy can be recorded and can be manipulated to create three dimensional  images of what is in the liver . Thus the mass, shape and extent of spread of a tumour can be accurately determined.

A necessary supplementary way of finding out about liver cancers is with a needle that can be inserted into the liver to take a biopsy sample for examination under a microscope. This microscopic examination tells what kind of cells are involved and how malignant they are likely to be. Also in recent years there has arisen the possibility of precise determination of the nature of the genetic changes in particular tumours.

Liver tumours that need to be removed, if the pathologist who has examined microscopic sections of them says this would be advisable and if they are distributed in such a way as to allow surgical removal are said to be resectable. In other instances the tumour is distributed in such a way when first found that surgical removal is deemed impossible often because all the liver lobes are involved, perhaps the tumour is large and has already invaded other organs.

Many tumours found in the liver do not derive from the liver itself but derive from other organs particularly the bowel. The liver is one of the main vascular highways of the body and any malignant cells that have been shed from tumours into the vascular or lymphatic system  may lodge in the liver and start to grow to form new cancer deposits. The nature, number and size of these secondary metastatic tumours is determined in the same way as the nature of cancer of the liver itself is defined, i.e. by examination of biopsies and by imaging.

Professor Habib's approach to liver cancer whether arising as primary cancers from liver cells or secondarily from tumours in other sites  is the same. He determines whether on the basis of the evidence available the tumour is resectable. If it is then his intent is always to effect the resection with the minimum trauma and blood loss. To this end Professor Habib pioneered in the early 1990s a quicker and less traumatic way of cutting off pieces of liver than had previously been available. His method properly applied reduced the operating time by more than fifty per cent. It led to the use of less transfused blood and was associated with shorter stay in hospital and lower morbidity  .

More recently Professor Habib has invented and deployed a means of resecting parts of the liver with minimal or no blood loss and in such a way as can be carried out by a relatively unskilled operative. The details of the device concerned are given in the commercial section of this web site under the heading of EMcision. Its wider application is likely to revolutionize the surgical resection of liver tumours.

Professor Habib is always trying to extend the numbers of tumours that can be excised by surgery but failing that for the presently non-resectable tumours he believes that we must try to find other solutions to the problem. If the genetic characteristics of tumours can be ascertained there exists the possibility of targeted therapy by which for example a genetic element that is missing  could be replaced or by which an abnormal gene product could be targeted. The details of the available schemes are given in the academic and commercial sections of the web site.

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