Cancer Care Pathway for Liver Cancer

FACTS

  • Secondary cancer in the liver are more common than primary cancers and accounts for 95% of liver cancer diagnosis

  • Approximately 1840 people are diagnosed with primary liver cancer in Australia

  • An estimated 28,000 people are diagnosed with secondary liver cancer in Australia

SYMPTOMS

  • Yellow appearing skin & eyes (jaundice)

  • Unexplained weight loss

  • Fatigue

  • Dark urine & pale stools

  • Severe abdominal pain

  • Upper right side abdominal pain or right shoulder pain

  • Swollen abdomen

  • Fever

  • Itchy skin

 
 
 

What is Liver Cancer?

The liver is part of the body’s digestive system. There are two main sections of the liver, called the left and right liver lobes. The liver’s blood supply is reliant on the hepatic artery, bringing blood from the heart and carrying oxygen, and portal vein, coming from the stomach bringing to the liver various nutrients as well as substances like alcohol and medicine. The liver has a major role in breaking down, storage and production.

The liver stores:

  • Sugars (glucose) and assists in releasing when needed.

  • Nutrients

The liver produces:

  • Proteins needed to help with blood clotting and fluid balance

  • Bile, which helps dissolve fat for easier digestion

The liver breaks down:

  • Alcohol and drugs and rids the body of toxins

In your initial consultations you may hear the terms primary and secondary (or metastasis) in reference to your tumour. These terms refer to whether your liver tumour is the first (primary) tumour or if it is the result of another tumour that has started somewhere else in the body (secondary/metastasis).

Primary Liver Cancers

  • Hepatocellular carcinoma (HCC) is the most common primary cancer of the liver and originates from the hepatocytes which are the main liver cells. Hepatocellular carcinomas are more commonly found in patients who have underlying liver disease caused by lifestyle factors such as obesity, drinking and hepatitis B or C.

  • Cholangiocarcinoma also known as bile duct cancer is a less common primary liver cancer and originates from the bile ducts. Bile ducts connect the liver to bowel and gallbladder.

Secondary Liver Cancers

As mentioned, secondary liver cancers are cancers that have started elsewhere in the body and metastasised to the liver. The most common is Colorectal Liver Mets (CRLM). This is when liver cancer is secondary to a primary bowel or rectal cancer. However, it can be the result of any primary cancer including: melanoma, breast cancer, uterine cancer, kidney cancer and lung cancer.

Before your doctor can confirm your diagnosis, you will probably have to undergo a number of different tests and procedures. Below are a list of the common tests used to confirm liver cancer, and an explanation of why we do these.

Diagnosis: What to Expect

  • Blood Test

    Your doctor will likely take your blood for testing. There are a number of tests they will run including : tumour inflammatory markers, liver function test, blood clotting tests and hepatitis. These tests will indicate the likelihood of your diagnosis but will not confirm the specific diagnosis alone.

  • Ultrasound (US)

    An ultrasound is a non invasive way to see your liver and the surrounding area. The image is created using sound waves. The technician will put cold gel on your abdomen and sweep the probe in various sections of your abdomen to take pictures.

  • CT Scan

    A CT Scan stands for “Computerized tomography” which will use x-ray beams to get pictures inside your body. This will take multiple x-rays and compile them, making it different from single x-ray image. This will help the doctors identify the location of cancer. This may, or may not, require you to ingest “contrast” which is a medical dye. This can help to make the images clearer and easier to see the tumour. This is a non-invasive scan, but will require you to lie still on a table for approximately 10-30minutes.

  • MRI

    This is another form of imaging that stands for “magnetic resonance imaging’, which uses multiple images to look at your liver and determine the extent and location of the tumour. It will also help to determine if the tumour involves any surrounding vessels. This may, or may not, require you to have the medical dye “contrast”. The MRI machine is a very narrow machine and makes a lot of noise. If you anticipate being distressed or uncomfortable, alert the medical staff helping you on the day.

  • Laparoscopy

    A laparoscopy is a procedure that will require you to undergo a general anaesthetic in hospital. This is a minimally invasive procedure where “Ports” (thin tubes) are inserted, using small cuts into bellybutton and abdomen. The abdomen is inflated with gas and the surgeon is able to see your organs and, in some cases, the tumour itself. They will also take more biopsies to determine exactly where the cancer is, and if it has spread anywhere else.

    A biopsy may be taken during a laparoscopy or as a “core biopsy” where the doctor will pass a needle through your abdomen, under local anaesthetic take a sample of tissue from the tumour. This is usually done under ultrasound or CT so they are able to put the needle in the write spot. While this a small procedure you will need to stay in hospital for a few hours afterwards to ensure there is no risk of bleeding. If you have been on any anticoagulating treatments prior to this procedure, you may need to stay overnight as a precaution. For both a laparoscopy and core biopsy, your doctor will advise you to cease this medication prior to the day of the procedure.

Multidisciplinary Meeting

After your investigations have been completed, your case will be discussed at a multidisciplinary meeting (MDM). This meeting is made up of surgeons, oncologists, radiologists, pathologists and the allied health team to collaboratively discuss your diagnosis and determine the best individualised treatment pathway for your disease. Your cancer will be staged by what is referred to as the “TNM” Staging System. Once this has been determined, you will meet with your surgeon again. This will take you through to the treatment phase of your journey.

Meet the Team

  • Surgeon

    At this appointment, you will meet with the surgeon, fellow or registrar to discuss your diagnosis and treatment options. If this includes surgery, the surgeon will talk you through the operation, risks and benefits so that you can make informed decisions.

  • Cancer Nurse Coordinator

    Your meeting with the cancer nurse may coincide with any of the above appointments depending on your treatment. Here, you will be provided with contact details for a central contact at the hospital, educational resources and you will have the opportunity to ask any questions you have about your care.

  • Medical/Radiation Oncologist

    If your treatment involves pre-operative chemotherapy (known as neoadjuvant treatment), you will meet the medical oncologist. At this point, you may also meet the radiation oncologist. The oncologists work collaboratively with the surgeons to ensure you are receiving the best care possible.

  • Anaesthetist

    Will assess your fitness for surgery and talk you through the medications and pain relief administered during the surgery.

  • Dietitian

    Some of you will be referred to a dietitian at the time of diagnosis. This will give you an opportunity to optimise your nutrition prior to treatment and allow ongoing support both in and out of the hospital.

  • Physiotherapist

    Will guide you in enhancing your physical fitness for pre-habilitation before surgery and in mobilising and keeping active after surgery.

  • Psych-Oncologist

    Will review mental health issues related with your cancer diagnosis.

Please Note: If you are having surgery, you will also meet a number of people involved in your “Pre-Surgery” planning and assessment. Your Cancer Nurse Coordinator will take you through this in more detail during your appointment.

 

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