What is the natural history of liver cancer?

bjjww

What is the natural history of liver cancer?

The natural history of liver cancer depends on the stage of the tumor and the severityof associated liver disease (for example, cirrhosis) at the time of diagnosis. Forexample, a patient with a 1 cm tumor with no cirrhosis has a greater than 50%chance of surviving three years, even without treatment. In contrast, a patient withmultiple tumors involving both lobes of the liver (multicentric tumors) withdecompensated cirrhosis (signs of liver failure) is unlikely to survive morethan six months, even with treatment.
What are the predictors of a poor outcome? Our knowledge of the prognosis is based on studying many patients with liver cancer, separating out their clinical characteristics, and relating them to the outcome. Grouped in various categories, the unfavorable clinical findings include the following:

• Population characteristics (demographics): male gender, older age, or         alcohol consumption
• Symptoms: weight loss or decreased apetite
  
• Signs of impaired liver function: jaundice, ascites, or encephalopathy
• Blood tests: elevated liver tests (bilirubin or transaminase), reduced         albumin, elevated AFP, elevated blood urea nitrogen (BUN), or low serum         sodium
  
  
• Staging of tumor (based on imaging or surgical findings): more than one tumor, tumor over 3 cm (almost 1¼ inches), tumor invasion of local blood vessels (portal and/or hepatic vein), tumor spread outside of the liver (to lymph nodes or other organs)
  

There are various systems for staging liver cancer. Some systems look at clinicalfindings while others rely solely on pathological (tumor) characteristics. Itmakes the most sense to use a system that incorporates a combination of clinicaland pathological elements. In any event, it is important to stage the cancerbecause staging can provide guidelines not only for predicting outcome(prognosis) but also for decisions regarding treatment.
The doubling time for a cancer is the time it takes for the tumor to doublein size. For liver cancer, the doubling time is quite variable, ranging from onemonth to 18 months. This kind of variability tells us that every patientwith liver cancer is unique. Therefore, an assessment of the natural history and theevaluation of different treatments are very difficult. Nevertheless, in patientswith a solitary liver cancer that is less than 3 cm, with no treatment, we can expectthat 90% of the patients will survive (live) for one year, 50% for three years,and 20% for five years. In patients with more advanced disease, we can expectthat 30% will survive for one year, 8% for three years, and none for five years.