Living With Advanced Cancer
Advanced cancer usually means cancer that is unlikely to be cured. Some people can live for many months or years with advanced cancer. During this time palliative care services can help.
Most people continue to have treatment for advanced cancer as part of palliative care, as it helps manage the cancer and improve their day-to-day lives. Many people think that palliative care is for people who are dying, but palliative care is for any stage of advanced cancer. There are doctors, nurses and others who specialise in palliative care.
Treatment may include chemotherapy, radiation therapy, or another type of treatment. It can help in these ways:
- slow the growth of the cancer
- shrink the cancer
- help you to live more comfortably by managing symptoms, like pain.
Treatment depends on:
- how far it has spread
- your general health
Treatment For Liver Cancer
Treatment for liver cancer will depend on whether it is a primary or secondary cancer. Treatment also depends on the size of the cancer, whether it is contained in one part of the liver, whether major blood vessels are involved and whether you have cirrhosis. Your doctor will also consider your age, your general health and the options available at your hospital.
You might feel confused or unsure about your treatment options and decisions. Its okay to ask your treatment team to explain the information to you more than once. Its often okay to take some time to think about your decisions.
Targeted Drug Therapy Or Immunotherapy
Targeted drug therapy can be used to treat advanced stomach cancer. These drugs attack specific characteristics of the cancer. Some of these are:
- imatinib , for stromal tumors
- ramucirumab , for advanced stomach cancer when other treatments arent effective
- regorafenib , for stromal tumors
- sunitinib , for stromal tumors
- trastuzumab , for HER2-positive tumors
Immunotherapy drugs boost your immune system to help attack cancer.
Pembrolizumab is an immunotherapy drug used to treat stomach cancer that has returned or spread in people who have tried but didnt respond to or stopped responding to two or more types of chemotherapy.
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Liver Metastases: Symptoms Diagnosis And Outlook
Liver metastases are cancerous tumors that have spread to the liver from another part of the body where the cancer originated. Some healthcare professionals may call liver metastases secondary liver cancer.
The cancer cells that develop in liver metastases are not cells from the liver. They are cells from the part of the body where the cancer first developed.
Since the cancerous tumors have spread to the liver from another part of the body, a doctor may refer to liver metastases as stage 4, or advanced cancer.
may not present any noticeable symptoms. However, as the tumor in the liver advances, the liver may swell.
The swelling can cause an obstruction to blood and bile flow. When this occurs, a person may experience symptoms such as:
- jaundice, or yellowing of the skin and eyes
- nausea and vomiting
- pain in the right shoulder
- pain in the upper right side of the abdomen
A person with cancer in another area of the body who notices new symptoms should let a healthcare professional know as soon as possible.
Stages Of Liver Cancer
The staging of liver cancer is determined only after the results of the pathology test. There are no defined stages for liver cancer however, T/N/M and the Barcelona Clinic Liver Cancer staging system are the most common. According to the Barcelona Clinic Liver Cancer staging system , there are four liver cancer stages-
Stage A: It is the beginning stage of liver cancer with a tumour, which is at its early stage. The symptoms are not seen at this stage.
Stage B: The presence of multinodular tumours are found in the liver. The symptoms are not shown yet.
Stage C: The multinodular tumours rapidly start invading the healthy parts of the liver and symptoms begin to show.
Stage D: This is the end stage of liver cancer, where symptoms are very evident and need immediate medical attention.
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Is Liver Cancer A Common Disease
No, its not common, but liver cancer cases are steadily increasing. Healthcare providers estimate about 1% of all men and women in the United States will be diagnosed with a form of liver cancer during their lifetime.
There are three kinds of primary liver cancer:
- Hepatocellular carcinoma : This is the most common form of liver cancer, representing nearly all liver cancer cases.
- Intrahepatic cancer : This is a form of cholangiocarcinoma. IHC is cancer in your livers bile ducts. It represents about 10% to 20% of all primary liver cancer cases.
- Angiosarcoma: This type is very rare, representing about 1% of all primary liver cancer cases. This cancer begins in the lining of blood cells in your liver.
Overall, HCC and IHC represent about 2% of all new estimated cancer cases in the United States, and 5% of all new cancer deaths. Healthcare providers often diagnose and treat HCC and IHC the same way.
Q How Does Liver Cancer Spread
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Selective Internal Radiation Therapy
Also known as radioembolisation, this treatment targets liver tumours directly with high doses of internal radiation in tiny beads. It is used for both primary and secondary cancers in the liver when the tumours can’t be removed with surgery. It is not available in all areas, so talk to your doctor about availability and costs involved.
Physical Signs Of Dying From Liver Cancer
Terminal liver cancer occurs when the cancer has spread outside of the liver to other vital organs in the body. It can be hard for the friends, family and caretakers to deal with the death of someone who is in the final stages of liver cancer. There is generally a lot of things going on leading up to the death, such as friends and family members visiting and a hospice care team coming and going throughout the day. Those caring for a terminally ill patient should know the signs to look for as the patient begins to transition from life to death.
If you are experiencing serious medical symptoms, seek emergency treatment immediately.
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Symptoms Of Stage 4 Liver Cancer
Liver cells are called hepatocytes that help detoxify the body and process harmful chemicals. When these normal hepatocytes start growing rapidly, uncontrollably and proliferate abnormally, it leads to formation of cancer or tumor. During the final stage of cancer, these cancerous cells migrate to other parts of the body and spread cancer. This is known as metastasis. Symptoms of stage 4 liver cancer are as follows:
Liver Metastases Vs Metastatic Liver Cancer
Though they are often confused as interchangeable, liver metastases are different from metastatic liver cancer. Liver metastases are cancers that have spread to the liver from a tumor that started in another part of the body, most commonly the colon or rectum, whereas metastatic liver cancer is cancer that started in the liver and spread to other areas of the body. The information in this guide is about metastatic liver cancer.
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Stage 4 Small Cell Lung Cancer
The second most-common type of lung cancer after NSCLC is small cell lung cancer . SCLC is not typically grouped into numbered stages. Instead, its identified as limited stage or extensive stage.
- With limited-stage SCLC, the cancer is present in one lung and may have spread to lymph nodes near that lung, but its contained to one side of the chest. If the lung has multiple tumors, the cancer may not be in the limited stage.
- Extensive-stage SCLC is similar to stage 4 NSCLC in that it is metastatic. SCLC is considered extensive if it has spread throughout the original lung, into the other lung or faraway lymph nodes, or to any other areas of the body.
Metastatic Liver Cancer Symptoms
Liver cancer symptoms often do not appear in the early stages. As a result, liver cancer tends to be diagnosed at a more advanced stage. If youve had other diseases of the liver or a family history of liver cancer, you have a higher risk of developing liver cancer and you should have regular follow-up visits with a doctor.The symptoms of metastatic liver cancer vary depending on where new tumors form. For example, if the liver cancer spreads to the bones, it may cause bone fractures.
Common symptoms of metastatic liver cancer include:
- Pain occurring near the right shoulder blade or in the upper abdomen
- Loss of appetite, weight loss or nausea
- Abdominal swelling or bloating in the abdomen
- Yellowing of the skin and eyes
- Ongoing fatigue or weakness
- Unexplained fever
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What Happens At The Gp Appointment
The GP may feel your tummy. They may also listen to your chest.
The GP may refer you to see a specialist in hospital for more tests if they think you have a condition that needs to be investigated.
This may be an urgent referral, usually within 2 weeks, if you have certain symptoms. This does not definitely mean you have cancer.
How Do Healthcare Providers Diagnose Liver Cancer
Your healthcare provider may suspect you have liver cancer if they find liver cancer signs and symptoms during your physical examination. They may order the following tests to learn more:
- Blood tests:Healthcare providers may do blood tests for cancer, such as a liver function test, to check on liver enzymes, proteins and other substances that show whether your liver is healthy or damaged. They may test for alfa-fetoprotein . High AFP levels may indicate liver cancer.
- Ultrasound : This test provides pictures of your soft tissue structures. Healthcare providers use ultrasound to look for liver tumors.
- Computed tomography scan: This special type of X-ray takes detailed images of your liver, providing information about liver tumor size and location.
- Magnetic resonance imaging : This test produces very clear images of your body using a large magnet, radio waves and a computer.
- Angiogram: This test helps healthcare providers examine your livers blood vessels. During this test, your healthcare provider injects dye into an artery so they can track blood vessel activity and look for blockages.
- Biopsy: Healthcare providers remove liver tissue to look for signs of cancer. Biopsies are the most reliable way to confirm a liver cancer diagnosis.
Your healthcare provider may do the following tests if they think you may have IHC:
What are liver cancer stages?
Hepatocellular carcinoma stages include the following:
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What Treatments May I Be Offered
Treatment for secondary breast cancer in the liver aims to relieve symptoms and slow down the growth of the cancer.
Treatments can be given alone or in combination.
When making decisions about how best to treat you, your treatment team will consider factors such as:
- how extensive the cancer is within the liver
- whether the cancer has spread to other organs
- any symptoms you have
- what treatment youve had in the past
- the features of the cancer
- whether youve been through the menopause
- your general health
Your specialist should discuss any recommendations for treatment with you and take into account your wishes. Theyll talk with you about your options, explain what the aim of your treatment will be and help you weigh up the potential benefits against the possible side effects you may have.
If you had a biopsy or surgery for primary breast cancer, the tissue removed will have been tested to see if it is ER+. However, in some people the oestrogen receptors change during the development of secondary breast cancer. Because of this, your doctor may discuss performing a biopsy to retest for hormone receptors.
Unintentional Weight Loss Or Gain
Unintentional weight loss might be welcomed by some, but when it’s not related to a change in diet or exercise, it always deserves a visit to a healthcare provider. Unexplained weight loss is defined as the loss of 5 percent of body weight or more over a six- to 12-month period without trying. An example would be a 200-pound man losing 10 pounds over a period of six months without a change in habits.
Unintentional weight loss was found to be related to an underlying cancer, including liver cancer, in a third of people observed in a 2017 review of studies. Other serious causes exist as well, so it’s important to see a healthcare provider as soon you recognize such a change.
Rapid and unexpected weight gain is also a possible sign of liver cancer. This usually occurs due to the rapid build-up of fluid in the abdomen .
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Confusion Or Loss Of Consciousness
Patients with End-stage liver cirrhosis eventually progress to a condition called hepatic encephalopathy.
Hepatic encephalopathy or coma is a group of neuropsychiatric symptoms that develop due to the deterioration of liver function.
They can range from mild symptoms such as mild confusion to a deep coma.
Hepatic encephalopathy may occur with liver cirrhosis, and people often recover from it with adequate treatment.
In addition, new-onset hepatic encephalopathy can be a symptom of end-stage liver disease before death.
More than 50% of patients with hepatic encephalopathy and liver cirrhosis will die within a year after the first coma attack .
Stage 4 Liver Cancer Life Expectancy
The survival rate after diagnosis of liver cancer is five years, but it may vary depending on the person. Life expectancy after cancer diagnosis depends on several factors, such as:
The life expectancy specific to stage 4 liver cancer is four to eleven months if cancer has grown in the nearby lymph nodes or distant organs. But this survival rate also depends on the severity of liver damage and the treatment plan given to the patient. So, every patient must consult the doctor to understand his or her case.
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How Is The Stage Determined
There are several staging systems for liver cancer, and not all doctors use the same system. The staging system most often used in the United States for liver cancer is the AJCC TNM system, which is based on 3 key pieces of information:
- The extent of the tumor : How large has the cancer grown? Is there more than one tumor in the liver? Has the cancer reached nearby structures like the veins in the liver?
- The spread to nearby lymph nodes : Has the cancer spread to nearby lymph nodes?
- The spread to distant sites : Has the cancer spread to distant lymph nodes or distant organs such as the bones or lungs?
The system described below is the most recent AJCC system, effective January 2018.
Numbers or letters after T, N, and M provide more details about each of these factors. Higher numbers mean the cancer is more advanced. Once a persons T, N, and M categories have been determined, this information is combined in a process called stage grouping to assign an overall stage. For more information see Cancer Staging.
Liver cancer is usually staged based on the results of the physical exam, biopsies, and imaging tests , also called a clinical stage. If surgery is done, the pathologic stage is determined by examining tissue removed during an operation.
Cancer staging can be complex, so ask your doctor to explain it to you in a way you understand.
* The following additional categories are not listed on the table above:
Whats The Life Expectancy For Stage 4 Stomach Cancer
When you think about life expectancy, there are some important things to keep in mind:
- Many factors affect your prognosis, including age, overall health, and the treatments you choose. Also, everyone responds differently to treatments, and theres no way to know how your body will respond.
- Survival rates are based on the stage at diagnosis.
- Relative survival rates compare people who have stomach cancer with people in the general population who dont have cancer.
- These statistics were compiled based on people diagnosed years ago. Cancer treatments change quickly. The latest treatments and increasing lifespans arent reflected in those earlier numbers.
According to the , the overall relative survival rate for all stages of stomach cancer is 31.5 percent. The five-year relative survival rate for distant stomach cancer is 5.3 percent. These figures include people diagnosed between 2009 and 2015.
Your doctor will consider your complete medical profile to help you understand your own outlook.
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Sexuality And Liver Cancer
Having liver cancer and treatment can change the way you feel about yourself, other people, relationships and sex. These changes can be very upsetting and hard to talk about. Doctors and nurses are very understanding and can give you support. You can ask for a referral to a counsellor or therapist who specialises in body image, sex and relationships.
Newer Treatments And Clinical Trials
People with liver cancer also sometimes opt to join a clinical trial in the hope of receiving cutting-edge treatments that are not yet available outside the study.
There is still a long way to go, but we are starting to see some hope also for patients with advanced disease, Strazzabosco says. The next few years will bring more and more advances in this field.
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