Liver Cancer

Liver Cancer

The major causes of liver cancer are well understood and preventable, as many cases are caused by hepatitis B or hepatitis C infection or excessive alcohol intake. Thousands of new cases have been prevented in the United States over the last two decades due to widespread hepatitis B vaccination and advances in screening and treatment for hepatitis B and C.

Despite this progress, liver cancer remains especially difficult to treat. However, the introduction of the first molecularly targeted drug for liver cancer in 2008 marked an important first chapter in what is expected to be a new era of liver cancer research and treatment. Researchers are hopeful that growing understanding of how liver cancer develops and grows will drive development of more targeted drugs that capitalize on the molecular vulnerabilities of liver cancer cells.

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2012

Routine hepatitis C screening recommended

Routine hepatitis C screening recommended

The U.S. Centers for Disease Control and Prevention proposes that all baby boomers (individuals born 1945-1965) be screened for the hepatitis C virus (HCV), as this group is five times more likely than other American adults to be infected and overall deaths due to HCV are on the rise.

Early diagnosis of HCV is vital, since the longer the virus goes undetected, the greater a person's risk of developing serious liver disease, including liver cancer and cirrhosis.

2008

Refined eligibility criteria for liver transplantation leads to longer survival

2007

First targeted therapy shown to be effective against liver cancer

First targeted therapy shown to be effective against liver cancer

For the first time in almost two decades, a large study shows that a new drug, in this case sorafenib (Nexavar), extends the lives of patients with advanced, inoperable hepatocellular carcinoma, the most common form of liver cancer. Sorafenib is the first targeted therapy proven effective for liver cancer and quickly becomes a standard treatment. The drug is approved by the FDA in 2007.

2003

Obesity pinpointed as cause of many cancer deaths

Obesity pinpointed as cause of many cancer deaths

An important prospective analysis involving nearly 1 million Americans reports that obesity could account for up to 20 percent of U.S. cancer deaths. Obesity is linked to a higher risk of death from liver cancer, along with several other cancer types. The researchers also estimate that 90,000 cancer-related deaths could be prevented annually if Americans maintained a healthy weight.

As obesity becomes more prevalent, researchers project that deaths from liver cancer and other forms of the disease will rise as well.

2002

Key molecular pathways in liver cancer offer new insight

Key molecular pathways in liver cancer offer new insight

Caption

Researchers discover genetic pathways that govern liver cancer cell growth and development. The findings suggest that liver cancers develop as a result of disruptions along multiple pathways, resulting in many genetically varied forms of liver cancer. These findings explain why the development of gene-targeted drugs has proven so challenging over the past decade, but also provide researchers with a number of potential treatment targets to explore.

Chemo-embolization offers improved survival for select patients

Chemo-embolization offers improved survival for select patients

Unlike other organs, the liver has two major sources of blood supply, instead of one. For unknown reasons, cancer only develops around the lower of these arteries, the hepatic artery, and uses this blood supply to fuel its growth. Doctors have long debated whether temporarily blocking – or embolizing – this artery to starve the tumor of blood can improve overall outcomes.

In 2002, two studies show that repeatedly (every 2-6 months) injecting the chemotherapy drug doxorubicin and then embolizing the hepatic artery increases survival in a set of patients whose tumors cannot be removed surgically. However, the approach is still debated by researchers, who question its overall impact.

1998

Common obesity complication linked to liver cancer

Common obesity complication linked to liver cancer

Researchers begin to link non-alcoholic steatohepatitis, or NASH, to increased liver cancer risk. NASH involves inflammation and fat accumulation in the liver that is usually caused by obesity or diabetes. NASH develops in as many as 95 percent of people with morbid obesity and type 2 diabetes. One study estimates that just over 10 percent of liver cancer cases in the U.S. are caused by NASH. These findings point to important new ways to reduce the risk of liver cancer through diet, exercise and effective management of diabetes.

1996

Advances in liver transplantation offer long-term survival for certain patients

Advances in liver transplantation offer long-term survival for certain patients

Disproving long-time skepticism, researchers conclusively demonstrate that liver transplantation is an effective treatment option for certain patients with cirrhosis and tumors that are confined to the liver. Specifically, investigators show that 85 percent of such patients live at least four years following the procedure. Liver transplant selection criteria are based on tumor size, the total number of tumors, and other factors, which are later refined to benefit a greater number of patients.

1983

Tumor ablation helps patients who cannot undergo surgery

Tumor ablation helps patients who cannot undergo surgery

A new technique called tumor ablation proves successful for shrinking and, in some cases, destroying smaller liver tumors in patients who are not eligible for surgery, due to the tumors' location or other factors. In some patients, this strategy can prevent the need for major liver surgery. With this technique, a surgeon uses an imaging device to guide administration of an anticancer treatment directly to the tumor while the patient is sedated. Initially, physicians use a technique called alcohol ablation, in which an ethanol solution is injected directly into the tumor, dehydrating and killing the cancer cells. A decade later, a new technique called radiofrequency ablation (RFA) is introduced, in which heat and intense radiofrequency waves are used to attack the cancer. RFA has since become the standard of care in this setting.

1981

First cancer vaccine prevents cancer-causing hepatitis B infection

First cancer vaccine prevents cancer-causing hepatitis B infection

The FDA approves the first vaccine against hepatitis B, one of the primary causes of liver cancer. In 1991, the U.S. begins routine vaccination of all children against hepatitis B, and by 2007, the number of acute hepatitis B cases among children under 15 years declines by 98 percent. Over time, routine vaccination is expected to reduce rates of liver cancer in the U.S. and globally among adults who were vaccinated as children.

1978

Liver cancer cases begin to grow due to "silent epidemic" of hepatitis C

Liver cancer cases begin to grow due to "silent epidemic" of hepatitis C

Between the late 1970s and early 1990s, the number of new cases of liver cancer doubles in the United States, due in large part to growing prevalence of hepatitis C (HCV) – a virus only discovered in the late 1980s. Most of these cancers occur among individuals who were infected with HCV in the 1960s and 1970s. Many were infected through intravenous drug use, blood transfusions or other health care exposures before universal precautions and widespread blood screening were introduced in 1992. The disease is called a "silent epidemic" because it produces few signs or symptoms until serious liver damage has occurred. Today, it is estimated that at least half of liver cancers in the U.S. are related to HCV. If treated early, however, the infection is now considered curable.

Worldwide, HCV and liver cancer pose an even greater threat – particularly in areas with less developed health systems that are unable to screen for and treat the disease.

1976

First study finds chemotherapy effective for liver cancer

First study finds chemotherapy effective for liver cancer

Researchers report that advanced liver cancers respond to single-drug treatment with doxorubicin (Adriamycin). The study stirs substantial debate when other research teams are unable to consistently reproduce these initial results. Doxorubicin becomes accepted as a standard treatment for liver cancer, but with general agreement that better therapies are urgently needed.

1965

First use of radioactive isotope for treatment of inoperable liver cancer

First use of radioactive isotope for treatment of inoperable liver cancer

Investigators report the first use of the radioactive isotope Yttrium 90 (Y90) for the treatment of inoperable liver cancer, for which previously there were no treatment options.

For this therapy, the Y90 is chemically bound to a glass or resin bead called a microsphere. The microsphere is then implanted into the liver, providing radiation therapy directly to the nearby tumor and surrounding tissue with a goal of shrinking tumors or stalling their growth.

Today, treatment with Y90 is known to be particularly effective in certain patients, such as those with mild liver cirrhosis whose tumors invade nearby large blood vessels.

1964

Partial liver surgery introduced

Partial liver surgery introduced

In 1957, the first comprehensive description of the liver – including the identification of its eight functional sections – is published. This new tool ushers in a new era of surgical treatment advances for liver cancer.

With a more precise understanding of the liver's anatomy, over the next two decades surgeons are able to develop and hone techniques for safely removing only specific segments and sub-segments of the liver where cancer or other disease is present while sparing healthy liver tissue – an approach that makes curative surgery possible for many patients.

Method for evaluating liver function developed

Method for evaluating liver function developed

Many patients with liver cancer also have cirrhosis, a condition frequently caused by heavy consumption of alcohol that produces scarring of the liver tissue and impaired function. In 1964, researchers introduce the first effective strategy to assess how well the liver is working, a key factor in treatment decisions for liver cancer. Important refinements to this strategy, now called the Child-Pugh scoring system, are introduced in the early 1970s. The system, which remains in use today, considers the results of three specific blood tests, the presence of fluid in the abdomen and cognitive function.

1963

First liver transplant performed

First liver transplant performed

Dr. Thomas Starzl performs the first-ever liver transplants in three patients, one of them with liver cancer. Although these initial patients survive less than a month following surgery, the approach becomes far more successful as it is refined over subsequent decades. By the 1990s, liver transplantation is a standard treatment for certain patients with liver cancer, extending many patients' lives for years and sometimes leading to cure.

1962

Hepatitis B, a leading cause of liver cancer, is discovered