Hope for pancreatic cancer: advances in early detection
Pancreatic cancer is known for being a difficult cancer to detect and treat. It is the seventh leading cause of global cancer deaths in industrialized countries and the third most common in the USA, despite accounting for only about 3% of diagnosed cancers.
The cause of pancreatic cancer is not clear and research is ongoing. Some factors such as smoking, diabetes, obesity, and some genetic mutations have been shown to increase the risk of developing pancreatic cancer.
Why is pancreatic cancer difficult to detect?
As with other types of cancer, early detection improves the chances of successful treatment. Surgical removal of pancreatic tumours offers the best chance for a cure. However, currently the majority of pancreatic cancers are diagnosed at an advanced stage when surgery may not be an option.
Detecting tumours can be challenging as the pancreas sits deep in the abdomen and is hidden behind other organs. Pancreatic cancer often shows no symptoms in the early stages. Even the symptoms which do occur can be caused by many other medical conditions, so may not raise suspicion of pancreatic cancer.
However, there is cause for hope. Research is enabling earlier detection and advances in the treatment of pancreatic cancer, with the potential to improve survival rates.
How is the detection of pancreatic cancer improving?
Early detection is the most important factor for improving outcomes in the treatment of pancreatic cancer. However, unlike other cancers, such as breast or colon cancer, there is currently no one simple screening test for pancreatic cancer.
A combination of often complex diagnostic tests are usually required to make a diagnosis of pancreatic cancer. As this type of cancer is relatively rare, screening is currently recommended only for those deemed to be at a high risk for pancreatic cancer. This includes individuals who have at least one close family member with pancreatic cancer, or are diagnosed with diabetes for the first time over 50 years old – as this can sometimes be an early, overlooked sign of the disease.
Imaging scans
Imaging tests, such MRI, CT scan or endoscopic ultrasound, which can be used to detect pancreatic tumours, are becoming more accurate as technology advances. Artificial intelligence can be used to detect early changes on scan images which cannot be seen by the naked eye.
Early detection can improve treatment outcomes. Consult your doctor if you experience unexplained symptoms, develop diabetes over the age of 50, or have a family history of pancreatic cancer.
How often do you think about your liver? Probably rarely, if ever.
But, whether you realize it or not, your liver is continually working to keep you healthy.
If you look after your liver, it can continue to look after you.
What does my liver do?
Your liver is located just under your rib cage on the right side. It is one of the largest and heaviest organs in your body.
Your liver performs many essential tasks, such as:
Purifying the blood of toxins
Breaking down your food to process nutrients
Processing medications
Storing sugars in the form of glycogen for when extra energy is required
Making many proteins needed by the body, such as blood clotting factors
Preventing infections by making immune factors and removing bacteria from the bloodstream
Producing bile – a digestive fluid which helps your body break down fats
Regulating the level of cholesterol and hormones
Why should I think about my liver health?
Your liver performs all these functions while you go about your daily life. But your liver is susceptible to diseases which may be caused by infections, alcohol or drug misuse, exposure to toxins, an unhealthy diet or lack of exercise. If your liver gets damaged it won’t be able to keep working properly, causing major problems such as an inability to process food and medications and a build-up of toxins in your body.
How can I keep my liver healthy?
Maintain a healthy weight to reduce your risk of non-alcoholic liver disease, linked to obesity.
Eat a healthy, balanced diet with lots of fresh fruits and vegetables, whole grain breads and cereals. Avoid too much sugar or saturated fats. Drink plenty of water.
Exercise regularly to help reduce liver fat
Avoid smoking, toxic substances and illegal drugs.
Take any medications according to your doctor’s instructions and tell your doctor about any over-the-counter medicines, supplements, and natural or herbal remedies that you use.
If you drink alcohol, do so in moderation only as alcohol misuse is one of the biggest risk factors for liver disease.
Reduce your risk of hepatitis (a group of viruses which cause inflammation of the liver) by maintaining good hygiene and getting vaccinated against hepatitis A and B.
After experiencing severe abdominal pain, a 45-year-old patient was diagnosed with an unusual cancerous tumor that was extremely large in size. The tumor, which was approximately 20cm in diameter and weighed approximately 4kgs, was successfully removed by a team of five surgeons at Al Zahra Hospital Dubai.
The patient was on his way home when he started experiencing severe abdominal pain that kept getting worse. He then decided to visit the nearest hospital, Al Zahra Hospital Dubai, to avoid any incidents and detect the problem. Once there, he immediately visited the ER, where assessments and evaluations were done, and surprisingly a very large tumor was detected.
Through imaging tests, doctors were able to detect a huge mass in the abdomen, which was then diagnosed as Lymphoma in the liver. Primary Liver Lymphoma is an exceptionally unusual and rare tumor, especially in such young patients. If not detected at an early stage, it could potentially spread leading to serios complications.
The case was undertaken by Dr. Mahmoud Tabbal, Head of the Surgery Department and Consultant Hepatobiliary Surgeon and Dr. Gokhan Cipe, European and Turkish Board-certified General Surgeon and Head of Robotic Surgery at Al Zahra Hospital Dubai.
“Luckily, the patient had a good prognosis, and the tumor was detected at an earlier stage. He was diagnosed with a nonmetastatic lymphoma that primarily appeared in the liver with a high rate of cure. Lymphoma is cancer of the lymphatic system and rarely localizes in the liver. It is extremely rare and in the patient’s case the tumor was also extremely large, requiring an open surgery and a team of five specialized surgeons to successfully remove it.” Dr. Mahmoud Tabbal, Head of the Surgery Department at Al Zahra Hospital Dubai.
The doctors were able to remove the massive tumor successfully, finding that the lymphoma has localized in the abdomen and created a 4kg tumor.
“When I first went to the hospital, because of the abdominal pain, I was not at all expecting a tumor let alone cancer. The news came as a shock to me, but thankfully I was in the hands of significant doctors, and I believe they helped me greatly through this journey. I had a quick recovery, and I barely experienced any pain, the stitches were clean as well and there was no bleeding, even though it was an open surgery. The doctors also gave me great support after the surgery, helping me with my mental state. I visited the doctors for follow ups on almost a daily basis which was exceptionally helpful for my mental health,” said H.I., Patient at Al Zahra Hospital Dubai.
“As a surgeon what we saw with this patient is a one in a lifetime medical case. It is very rare to find such a tumor in the liver and it typically has a poor prognosis, which was not the case with our patient. Additionally, the patient did not have any history of cancer or liver disease and is not within the age range of Lymphoma, making it even more unique. The treatment went remarkably well, the surgery was a success, and the patient had a quick recovery.” Dr. Gokhan Cipe, Head of Robotic Surgery in Al Zahra Hospital Dubai.
In addition to surgery, the patient received a multi-faceted treatment plan to help him recover completely. The team of doctors discussed his diagnosis with the tumor board to ensure that the patient receives all the care he needs including consistent follow ups to guarantee that the patient is improving both physically and mentally and rituximab, which is a form of maintenance therapy done to reduce the chances of recurrence.
The patient fully recovered and was discharged from the hospital just four days after the surgery.
Primary liver cancer is an abnormal tissue growth, or tumour, arising from cells within the liver. The liver is one of the largest organs of the human body and performs many essential tasks such as purifying the blood, processing nutrients, making blood clotting factors, and preventing infection.
Liver cancer is the sixth most commonly diagnosed cancer and the fourth leading cause of cancer mortality worldwide. Liver cancer may spread into nearby tissues, lymph nodes or organs, disrupting their function.
Liver cancer causes?
Primary liver cancer occurs when liver cells develop mutations in their DNA leading to an uncontrolled and disordered division of cells to form a mass or tumour.
Cancer can also spread (metastasise) to the liver from other parts of the body, such as the colon, lung or breast. These secondary cancers are named by the site of the primary cancer and may have different causes.
Primary liver cancer can be caused by diseases which affect the liver, including:
● Chronic infection with the hepatitis B virus (HBV) or hepatitis C virus (HCV)
● Liver Cirrhosis – scarring of liver tissue due to liver disease, often due to alcohol abuse
● Inherited liver diseases such as haemochromatosis and Wilson’s disease
● Nonalcoholic fatty liver disease – accumulation of fat in the liver
Other factors which may increase the risk of developing liver cancer include:
● Diabetes
● Exposure to various toxins which may cause cancer
● Excessive alcohol consumption
But liver cancer can also occur with no clear cause or underlying disease.
What can I do to prevent liver cancer?
Not all liver cancer can be prevented, but you can reduce your risk for some known causes of liver cancer by:
● Drinking alcohol in moderation, if at all
● Maintaining a healthy weight and getting regular exercise. If you need to lose weight, aim for a slow, steady weight loss.
● Ensuring you are vaccinated against hepatitis B
● Reducing your risk of hepatitis B and C infection by avoiding sexually transmitted diseases, intravenous drug use, and piercings or tattoos from unregulated providers
Remember:
A healthy lifestyle can reduce your risk of developing liver cancer. Early detection can improve treatment outcomes. Screening may be recommended for those at a higher risk of developing liver cancer.
Advances in pancreatic cancer detection and treatment
Pancreatic cancer is known for being a difficult cancer to detect and treat. It is the seventh leading cause of global cancer deaths in industrialized countries and the third most common in the USA, despite accounting for only about 3% of diagnosed cancers. The cause of pancreatic cancer is not clear and research is ongoing. Some factors such as smoking, diabetes, obesity, and some genetic mutations have been shown to increase the risk of developing pancreatic cancer.
Why is pancreatic cancer difficult to detect?
As with other types of cancer, early detection improves the chances of successful treatment. Surgical removal of pancreatic tumours offers the best chance for a cure. However, currently the majority of pancreatic cancers are diagnosed at an advanced stage when surgery may not be an option. Detecting tumours can be challenging as the pancreas sits deep in the abdomen and is hidden behind other organs. Pancreatic cancer often shows no symptoms in the early stages. Even the symptoms which do occur can be caused by many other medical conditions, so may not raise suspicion of pancreatic cancer. However, there is cause for hope. Research is enabling earlier detection and advances in the treatment of pancreatic cancer, with the potential to improve survival rates.
How is the detection of pancreatic cancer improving?
Early detection is the most important factor for improving outcomes in the treatment of pancreatic cancer. However, unlike other cancers, such as breast or colon cancer, there is currently no one simple screening test for pancreatic cancer. A combination of often complex diagnostic tests are usually required to make a diagnosis of pancreatic cancer. As this type of cancer is relatively rare, screening is currently recommended only for those deemed to be at a high risk for pancreatic cancer. This includes individuals who have at least one close family member with pancreatic cancer, or are diagnosed with diabetes for the first time over 50 years old – as this can sometimes be an early, overlooked sign of the disease.
Imaging scans
Imaging tests, such MRI, CT scan or endoscopic ultrasound, which can be used to detect pancreatic tumours, are becoming more accurate as technology advances. Artificial intelligence can be used to detect early changes on scan images which cannot be seen by the naked eye.
Biomarker blood tests
Researchers are working on improving blood tests that can pick up biomarkers for pancreatic cancer. These are already used for screening high risk individuals, but as this technology improves, it is hoped that this kind of blood tests may be used more widely to detect early stage pancreatic cancer and identify individuals at high risk for the disease.
Genetic Testing
Multiple inherited genes and some genetic syndromes have been identified that can increase the risk of pancreatic cancer. New guidelines recommend that patients with pancreatic cancer undergo genetic testing and inform family members if they are found to have these genes.
Identification of precancerous growths
Researchers are discovering more about which types of cysts and growths in the pancreas have the potential to develop into cancer. This enables these growths to be detected, monitored and removed when necessary.
How is the treatment of pancreatic cancer improving?
Treatment options depend on the type, location and stage of the cancer. In general, the earlier a cancer is detected, the better the prognosis. Treatments for pancreatic cancer are becoming safer and more precise. Studies have found that survival rates are improving for cancers found early (stage I). Clinical trials are being conducted to find more effective ways to treat pancreatic cancer.
Medical tourism attracts the entire world into Dubai Learn more about the most important topics related to medical tourism and advanced surgeries answered by ??. ??????? ??????, the Head of the surgery department at Alzharaa Hospital.
Pancreatic cysts are closed fluid-filled sacs, lined with epithelium, on or in the pancreas – a long, flat gland located behind your stomach that produces digestive enzymes, and hormones which regulate blood sugar levels. Pancreatic cysts can be divided into serous and mucinous, depending on the type of fluid they contain. There are many types of pancreatic cysts, most of which are benign (non-cancerous) but some can be cancerous. Some cysts, described as precancerous, might develop into cancer over time if left untreated.
What are pancreatic pseudocysts?
Pancreatic pseudocysts are collections of inflammatory pancreatic fluid or semisolid matter that occur within spaces inside the pancreas and are not contained inside their own enclosed sac. They usually occur as a complication of pancreatitis (inflammation of the pancreas). Pseudocysts are benign (non-cancerous).
What are the symptoms of pancreatic cysts?
Pancreatic cysts often do not cause any symptoms and may be found during imaging tests done for another reason. Symptoms of pseudocysts may occur within days to months following a pancreatitis attack. When signs or symptoms of pancreatic cysts do occur, they may include: ● Persistent abdominal pain, which may radiate to the back ● Nausea and vomiting ● Unintended weight loss ● Abdominal bloating ● Feeling full soon after starting to eating Fever and persistent abdominal pain may occur if a cyst becomes infected.
What causes pancreatic cysts?
The cause of most pancreatic cysts is not clear. Some types of cysts are associated with rare illnesses, including polycystic kidney disease or von Hippel-Lindau disease – a genetic disorder that can affect the pancreas and other organs.
What causes pseudocysts?
Pseudocysts often occur after an episode of pancreatitis – a painful condition in which digestive enzymes become prematurely activated while still in the pancreas causing inflammation. Pancreatic pseudocysts can also be caused by trauma.
Risk factors
Heavy alcohol use and gallstones are risk factors for pancreatitis, which can lead to the development of pseudocysts. Abdominal injury is also a risk factor for pseudocysts. The rare genetic disorder von Hippel-Lindau disease is a risk factor for pancreatic cysts.
What complications can occur with pancreatic cysts?
Rarely, pancreatic cysts or pseudocysts, may lead to complications including: ● Infection – which can sometimes lead to a pancreatic abscess ● Rupture (breaking open) or haemorrhage (bleeding) of a cyst or pseudocyst – can occur without warning and is treated as a medical emergency. ● Blockage of the common bile duct by a large cyst – causing skin, mucous membranes and whites of the eyes to appear yellow (obstructive jaundice).
How are pancreatic cysts and pseudocysts diagnosed?
Pancreatic cysts and pseudocysts can be hard to diagnose because the symptoms can be similar to various other diseases. Symptomless cysts may show up on imaging tests and scans done for other reasons. After taking a medical history and performing a physical exam, tests may include: ● Transabdominal ultrasound ● Abdominal CT scan or MRI (magnetic resonance imaging) ● Endoscopic Ultrasound – using an ultrasound device to make images of your pancreas and connecting ducts by passing a thin, flexible tube (endoscope) into your throat and through your stomach – may be used to further evaluate a pancreatic cyst or to distinguish a pancreatic pseudocyst from other types of cystic lesions ● ERCP (endoscopic retrograde cholangiopancreatography) – uses an endoscopic ultrasound device and dye injected into the pancreatic duct and /or bile duct, to look for blockages ● Magnetic resonance cholangiopancreatography (MRCP) – uses magnetic resonance imaging to visualize the biliary and pancreatic ducts non-invasively ● A sample of the pancreatic cyst fluid may be taken using a fine needle for analysis in the laboratory.
What is the treatment for pancreatic cysts?
Treatment depends on the type of cyst or pseudocyst, its size, characteristics and whether it is causing any symptoms. Watchful waiting: Pseudocysts and benign cysts can often be monitored without active treatment as long as they are not causing problems. Drainage: A pseudocyst that is growing larger or causing symptoms can be drained. This may be done using endoscopic ultrasound and a needle to drain the cyst. Sometimes drainage through the skin, or even surgical draining, is necessary. Pseudocysts may recur if pancreatitis is ongoing. Surgery: May be required for enlarged, painful, cancerous or precancerous pancreatic cysts.
Can pancreatic cysts or pseudocysts be prevented?
As most pseudocysts are caused by pancreatitis, reducing the risk of pancreatitis is the best way to prevent pseudocysts. Some risk factors for pancreatitis can be reduced through healthy lifestyle changes, such as: ● Maintaining a healthy weight ● Getting regular exercise ● Avoiding smoking and alcohol ● Eating a healthy diet with less fat and more fruits and vegetables, whole grains, and lean protein
Periampullary cancer is a rare type of cancer that forms in an area of the head of the pancreas, the distal common bile duct and the first part of the small intestine, close to the ampulla of Vater. Ampullary cancers form inside the ampulla of Vater itself – an enlargement of the ducts from the liver and pancreas where they join and enter the small intestine. As these types of tumour grow, they may affect the surrounding organs, such as the liver, pancreas and small intestine. Some periampullary cancers may spread (metastasise) to the liver, lymph nodes, lungs, peritoneum (abdominal lining) and other organs.
What are the symptoms of periampullary cancer?
Signs and symptoms of periampullary cancer may include: ● Yellowing of the skin and white of eyes (jaundice) ● Clay-coloured stools ● Abdominal pain ● Fever ● Bleeding from the rectum ● Nausea ● Vomiting ● Unintended weight loss Jaundice occurs when a tumour blocks the bile duct, leading to a build-up of bile fluid. Signs of jaundice often lead to these cancers being detected earlier than most pancreatic cancers, which can improve prognosis. These symptoms may also be caused by other medical problems. Consult your doctor if you have persistent signs or symptoms that worry you.
What causes periampullary cancer?
The cause of periampullary cancer is not clear and research is ongoing. Some factors which appear to increase the risk of periampullary cancer have been identified, including: ● Being over the age of 70 years ● Men are slightly more affected by periampullary cancer than women ● Family history of rare genetic syndromes that can increase cancer risk.
How is periampullary cancer diagnosed?
A combination of diagnostic tests may be required, such as: ● Imaging tests, such MRI, CT scan or ultrasound ● Blood or urine tests to check for cancer markers ● Endoscopy – passing a thin, flexible tube with a tiny camera (endoscope) down the oesophagus, through the stomach into the small intestine ● Biopsy – collecting a small tissue sample to be analysed in the laboratory – can be done during endoscopy ● Endoscopic Ultrasound (EUS) – using an endoscope and ultrasound device to make images of the pancreas, bile ducts and small intestine ● Endoscopic retrograde cholangiopancreatography (ERCP) – using an endoscopic ultrasound device and dye injected into the pancreatic duct and /or bile duct, to look for blockages.
How is periampullary cancer treated?
Surgical procedures Surgical removal, along with a large margin of healthy tissue, is often the most successful treatment for periampullary cancer. Minimally invasive (keyhole) surgery, using an endoscope is an option in some cases. The Whipple procedure is commonly used. This involves removing the head of the pancreas, the first part of the small intestine (duodenum), the gallbladder, part of the bile duct and nearby lymph nodes. The remaining parts of the pancreas, stomach and intestines are reconnected. When surgical removal is not possible, a small wire mesh tube (stent) can be placed in the bile ducts to drain fluid that causes jaundice.
Chemotherapy and radiation therapy Chemotherapy drugs (either injected or taken by mouth) may be used for inoperable cancers, to help kill cancer cells, relieve symptoms and prolong survival. It may also be used to kill any cancer cells remaining after surgery. Chemoradiation – a combination of chemotherapy and radiotherapy (using high-energy beams to destroy cancer cells) may be used before surgery to help shrink a tumour, or after surgery to reduce the risk of cancer recurring.
Palliative care For advanced periampullary cancer that is not amenable to surgery, chemotherapy or radiotherapy, treatment may focus on symptom relief and improving quality of life. Palliative care may also be provided to complement other treatments.
Primary liver cancer is an abnormal tissue growth, or tumour, arising from cells within the liver. Most liver tumours are malignant, meaning that they may spread into nearby tissues, lymph nodes or organs, disrupting their function.
What is the liver and what does it do?
The liver is one of the largest organs of the human body. It is located just under your rib cage on the right side, on top of your stomach. The liver performs many tasks which are essential for the normal functioning of the body such as purifying the blood, processing nutrients, making blood clotting factors, and preventing infection.
Types of primary liver cancer
Several types of primary cancer can form in the liver. Hepatocellular carcinoma (HCC) begins in the main type of liver cell (hepatocyte) and is the most common type of primary liver cancer. It occurs most often in people with chronic liver diseases, such as cirrhosis caused by hepatitis B or hepatitis C infection. Intrahepatic cholangiocarcinoma (ICC) is a rare cancer that develops in the cells within the bile ducts; both inside and outside the liver. This condition occurs slightly more often in males than females and usually affects people who are between 50-70 years old. Hepatoblastoma is a very rare liver cancer which usually affects children less than 3 to 4 years of age.
How common is primary liver cancer?
Primary liver cancer is the sixth most commonly diagnosed cancer and the fourth leading cause of cancer mortality worldwide***. Cancer that spreads to the liver from elsewhere in the body (metastatic cancer) is more common than primary liver cancer.
What are the symptoms of liver cancer?
Symptoms or signs of primary liver cancer often don’t occur until the disease is advanced. They may include:
Unintended weight loss
Loss of appetite
Abdominal pain
Nausea and vomiting
General weakness and fatigue
Abdominal swelling
Yellow discoloration of the skin and whites of the eyes (jaundice)
White, chalky stools
Itching
See your doctor if you are concerned about any unexplained symptoms. Similar symptoms may occur with many other conditions.
What causes primary liver cancer?
Liver cancer occurs when liver cells develop mutations in their DNA leading to an uncontrolled and disordered division of cells to form a mass or tumour. In some cases the cause of liver cancer is known, such as with chronic hepatitis infections. But liver cancer can occur with no clear cause underlying disease. Some factors which appear to increase the risk of liver cancer have been identified. These include:
Chronic infection with the hepatitis B virus (HBV) or hepatitis C virus (HCV)
Liver Cirrhosis – scarring of liver tissue due to liver disease
Certain inherited liver diseases such as haemochromatosis and Wilson’s disease.
Diabetes
Nonalcoholic fatty liver disease – accumulation of fat in the liver
Exposure to aflatoxins that grow on crops such as grains and nuts that are stored poorly.
Excessive alcohol consumption.
How is liver cancer diagnosed?
A combination of diagnostic tests may be required, such as: ● Imaging tests, such abdominal ultrasound, MRI or CT scan, may reveal an abnormal growth or tumour in the liver ● Biopsy – removing a sample of tissue from the liver to examine under the microscope in a laboratory, may be done during endoscopic ultrasound.
Blood tests – to check for abnormalities of liver function or specific proteins (tumour markers) shed by liver cancer cells
These tests are usually performed if a patient has symptoms of liver cancer, although blood tests and abdominal ultrasound they may be recommended to screen those with a higher risk of liver cancer. If your doctor confirms a diagnosis of liver cancer, additional tests may be required to determine the extent (stage) of the cancer and develop the most appropriate treatment plan.
How is liver cancer treated?
Treatment options depend on the type, location and stage of the cancer. Options may include surgery, chemotherapy, radiation therapy or a combination of these. In general, the earlier a cancer is detected, the better the prognosis. Surgical options to treat liver cancer include:
Removal of the tumour and a small portion of healthy liver tissue that surrounds it may be an option for small tumours where liver function is good. In suitable cases, minimally invasive laparoscopic surgery can significantly reduce recovery time. Laparoscopic surgery is done through a thin, lighted tube with a camera on its tip (a laparoscope) which is inserted through a tiny abdominal incision.
Liver transplant surgery to remove the diseased liver and replace it with a healthy liver from a donor may be an option in otherwise healthy people whose liver cancer hasn’t spread beyond the liver.
Localised treatments for liver cancer are administered directly to the cancer cells or the area surrounding the cancer cells. Some treatments use image-guided techniques (interventional radiology). Localised treatments may be recommended for people who can’t undergo surgery:
Radiofrequency ablation – uses an electric current to heat and destroy cancer cells. Thin needles are inserted into small incisions in the abdomen, using an imaging test as a guide.
Cryoablation – uses extreme cold to destroy cancer cells. An instrument (cryoprobe) containing liquid nitrogen is placed directly onto the liver tumours, guided by ultrasound images.
Alcohol injection – pure alcohol is injected directly into tumours causing the tumour cells to die.
Chemoembolization – chemotherapy (anti-cancer) drugs are injected directly to the liver.
Radioembolization – tiny glass spheres containing radiation are injected directly into the liver.
Radiation therapy – uses high-energy beams to destroy cancer cells. Doctors carefully direct the energy to the liver, while sparing the surrounding healthy tissue. Chemotherapy drugs may be either injected or taken orally to help kill cancer cells. Radiation therapy or chemotherapy may be used when surgery is not an option to help control symptoms. They may also be used before surgery to help shrink a tumor, or after surgery to reduce the risk of recurrence. Targeted drug therapies – target specific weaknesses present within cancer cells, causing the cancer cells to die. Some targeted therapies only work in people whose cancer cells have certain genetic mutations. Immunotherapy uses your immune system to fight cancer by interfering with proteins produced by cancer cells which prevent them from being attacked by the body’s immune system. Immunotherapy treatments are generally reserved for people with advanced liver cancer.
Supportive (palliative) care
For advanced liver cancer that is not amenable to surgery, chemotherapy or radiotherapy, treatment may focus on symptom relief and improving quality of life. Palliative care may also be provided to complement other treatments. I have been diagnosed with liver cancer, what next? Finding out about a cancer diagnosis can cause stress and worry. Here are some ways that may help you cope and get the right treatment and support: ● Educate yourself about your cancer to help you make decisions about your care. Share any questions or concerns with your specialist doctor, who will be able to advise you about the details of your cancer and your treatment options. They will also be able to recommend trusted sources of further information. ● Build a support network of trusted friends and family who can help you with practical tasks or provide a listening ear. If stress, anxiety or depression are causing significant problems in your daily life, talk to your doctor who may recommend professional counselling. ● Consider joining a support group specifically for liver cancer to connect with others who are going through similar experiences. Ask your doctor for information on liver cancer support groups in your area or online.
Can liver cancer be prevented?
Not all liver cancer can be prevented, but you can reduce your risk for some known causes of liver cancer:
Drink alcohol in moderation, if at all.
Maintain a healthy weight and get regular exercise. If you need to lose weight, aim for a slow, steady weight loss.
Get vaccinated against hepatitis B.
Reduce your risk of hepatitis B and C infection by avoiding sexually transmitted diseases, intravenous drug use and piercings or tattoos from shops that are not well regulated with sterilisation protocols.
If you are at risk of hepatitis B or C infection seek prompt assessment and treatment if required.
Ask your doctor about liver cancer screening if you have conditions which increase your risk, such as hepatitis B or C, or liver cirrhosis.
Gallstones are small, solid lumps that form from a digestive fluid called bile, within the gallbladder. They can range in size from as small as a grain of sand to as large as a golf ball. Gallstones can cause problems if they become lodged in a duct causing a blockage. Gallstones can occur in the gallbladder and migrate to the bile duct, or they can form in the bile duct itself.
What is the gallbladder and what does it do?
The gallbladder is a small, pear-shaped sac located under the liver. It stores and concentrates bile, which is produced in the liver. When required for digestion of food, bile is released through the bile duct into the small intestine. Bile helps to break down fats and aids the digestion of fat soluble vitamins.
How common are gallstones?
Gallstones are very common. Research has shown that around one in six men and one in three women suffer from gallstones at some point in their life. Gallstones appear to be becoming more common and affecting younger people, possibly due to changes in our diets.
What causes gallstones?
It’s not clear why gallstones form, but it is thought that gallstones may result from:
Too much cholesterol in bile – which may crystallise to form gallstones.
Excess bilirubin – a chemical that is produced when your body breaks down red blood cells – may contribute to gallstone formation. This may occur due to certain blood disorders, infections or liver disease.
Incomplete emptying of the gallbladder – may cause bile to become very concentrated, contributing to the formation of gallstones.
What factors make getting gallstones more likely?
The following factors appear to increase the risk of gallstones:
Women are twice as likely to develop gallstones than men
Gallstones are more common after 40 years of age
Obesity
Sedentary or physically inactive lifestyle
Diet high in fat and cholesterol but low in fibre
Regularly skipping meals or fasting
Family members who have had gallstones
Diabetes – due to high levels of fatty acids, called triglycerides, which increase the risk for gallstones
Liver disease
Certain blood disorders, such as sickle cell anemia or leukaemia
Rapid weight loss – may lead to extra cholesterol in bile as fat is metabolised
Excess oestrogen due to pregnancy, hormone replacement therapy, or contraceptive pills appears to increase cholesterol levels in bile and decrease gallbladder movement, both of which can lead to gallstones
Drugs which lower blood cholesterol, as these can increase the amount of cholesterol secreted in bile.
How will I know if I have gallstones?
Many people with small gallstones have no symptoms, and so may be unaware that they have them unless they show up on a diagnostic test done for another reason. When gallstones lodge in a duct causing a blockage, this may lead to an ‘attack’ (biliary colic), often occurring after a fatty meal, or at night.
Symptoms may include:
Sudden and rapidly intensifying pain in the centre or upper right portion of the abdomen
Back pain between your shoulder blades
Pain in your right shoulder
Nausea or vomiting
Abdominal bloating
Indigestion
Pain may last several minutes to a few hours. Symptoms vary between individuals and similar symptoms may occur with other medical problems. Therefore it is important to consult your doctor if you experience any of these symptoms. If gallstones cause serious complications, you may experience the following signs and symptoms which require immediate medical attention:
Extreme abdominal pain
Yellowing of the skin and the whites of your eyes (jaundice)
High fever with chills
Clay-coloured stools.
What problems can gallstones cause?
Inflammation of the gallbladder (cholecystitis) can occur when a gallstone becomes lodged in the neck of the gallbladder. Cholecystitis can cause severe pain and fever.
Blockage of the bile ducts through which bile flows from your gallbladder or liver to your small intestine. This is called choledocholithiasis and can cause severe pain, jaundice and bile duct infection.
Pancreatitis (inflammation of the pancreas) can occur if a gallstone blocks the pancreatic duct. Pancreatitis causes intense, constant abdominal pain and usually requires hospitalization.
Increased risk of gallbladder cancer. But as gallbladder cancer is very rare, the likelihood of gallbladder cancer is still very small.
How are gallstones diagnosed?
Your doctor will ask questions about your symptoms and medical history and carry out a physical examination. The following tests and procedures may be used to diagnose gallstones and related complications:
Abdominal ultrasound
Endoscopic ultrasound (EUS) – can help identify smaller stones that may be missed on an abdominal ultrasound
Cholecystography – a type of X-ray using a contrast material to show the flow of fluid through the intestines into the gallbladder
Computerized tomography (CT) scan or magnetic resonance imaging (MRI)
Magnetic resonance cholangiopancreatography (MRCP)
Endoscopic retrograde cholangiopancreatography (ERCP) involves inserting an endoscope (small flexible tube with a camera) through the mouth and the stomach to reach the opening of the bile duct into the intestine. A contrast dye is used to see the bile ducts more clearly on X-ray. Gallstones discovered using ERCP can be removed during the procedure.
Blood tests to look for signs of infection, jaundice, pancreatitis or other complications .
What is the treatment for gallstones?
Gallstones that don’t cause any signs and symptoms don’t usually need treatment. Where gallstones are causing problems, treatment options may include:
Surgery to remove the gallbladder (cholecystectomy) can often be done using a minimally invasive (keyhole surgery) technique. Once the gallbladder is removed, bile flows directly from your liver into your small intestine, rather than being stored in your gallbladder. The gallbladder is not essential for digestion or health, although diarrhoea may be a side effect of its removal.
Endoscopic retrograde cholangiopancreatography (ERCP) to remove gallstones in the bile duct using an endoscope, avoiding the need for surgery. Alternatively, small drainage tubes (stents) may be inserted around the stones to allow the bile to flow freely again.
Oral dissolution therapy involves taking a medicine made from bile acid to dissolve the stones. This treatment is now rarely used as it may take months or years to dissolve gallstones, and they can recur if treatment is stopped.
Extracorporeal shockwave lithotripsy (ESWL) uses shock waves to break stones up into tiny pieces that can pass through the bile ducts without causing blockages.
Can gallstones be prevented?
Some people are more prone to developing gallstones, but you can reduce your risk if you:
Avoid skipping meals
Lose weight slowly
Eat more high-fibre foods, such as fruits, vegetables and whole grains
Reduce the amount of fatty foods you eat
Maintain a healthy weight and get regular exercise
