Cholangiocarcinoma
- Abdominal pain
- Weight loss and loss of appetite
- Fever
- Nausea and vomiting
Treatment
Treatment for cholangiosarcoma is based on the extent of the cancer. Surgery is the main goal because it is the curative option, according to American Cancer Society.
- Resectable cancer: cancer that can be removed entirely through surgery, judging by diagnostic studies, such as CT scans, MRIs and x-rays.
- Unresectable cancer: cancer that cannot be removed entirely by cancer because it has spread or is in a difficult place to remove.
When a tumor is resectable, it is generally stage 0, I, II, or possibly stage III. A staging laparoscopy is often done initially to make sure the tumor is, in fact, resectable. If the tumor is deemed resectable, the exact type of surgery will depend on the extent of the tumor and the location of the tumor in the bile duct. If a patient has jaundice, a stent may be placed in the bile duct to allow the bile to flow better before the resection.
Sometimes, chemotherapy and radiation are performed after surgery to prevent the surgery from coming back. Research does not prove that this is actually helpful, so it is typically used if physicians are not sure if all of the cancer has been removed.
When a tumor is unresectable, it is generally stage III or IV. Sometimes, earlier stages of cholangiosarcoma can be deemed “unresectable” if they are not healthy enough to undergo a major surgery.
Sometimes a surgery begins and then it is found that the tumor is, in fact, unresectable. This may be because the cancer has spread further than anticipated. In this case, the surgery may be stopped because furthering the surgery may have negative side effects.
For unresectable cholangiosarcoma, sometimes a transplant is indicated. In this case, chemotherapy and radiation may be performed to shrink the tumor before the transplant.
When a transplant is not indicated, chemotherapy and radiation may be given in an attempt to shrink the tumor. However, the tumor will typically grow again so treatment is often aimed at symptom management.
Hepatic Angiosarcoma
This type of cancer is also known as hemangiosarcoma. It accounts for only one percent of all liver cancers.
Angiosarcomas begin in the blood vessels. It spreads rapidly and is thus diagnosed at a late stage, making it difficult to treat.
Because it spreads quickly and is diagnosed at a late stage in the disease process, the prognosis is poor – most patients die within two years of diagnosis.
Symptoms
Angiosarcomas can be present in the vessels of various organs. Because of the nonspecific location of angiosarcomas, the symptoms are also nonspecific, making it difficult to diagnose.
Hepatic angiosarcoma originates in the endothelial cells of the liver. It may cause a palpable mass. Once the mass has been felt, it has reached a late stage because the cancer progresses quickly.
Treatment
Treatment for hepatic angiosarcoma can be complicated. According to the World Journal of Surgical Oncology, "the therapeutic guideline for liver angiosarcoma has not been set up; partial liver resection to remove tumor radically still remains to be the cornerstone of treatment options."
Hepatic angiosarcoma is known for being difficult to stage due to its rapid progression. When it is successfully treated, it has a high rate of recurrence. It is also resistant to traditional therapies, such as chemotherapy and radiation.
In a case study presented by World Journal of Surgical Oncology, an 83-year-old female had abdominal pain for 2 months – her only symptom. When the pain was severe, she went to the emergency department. After a thorough work-up, she was found to be in shock due to her tumor rupturing. Emergent embolization was performed. After she was stabilized, a partial hepatectomy was performed. The patient did not receive chemotherapy or radiation and at the time of publication, had no recurrence of the cancer.
Chemotherapy may be helpful for hepatic angiosarcoma if the cancer has spread to other organs. Radiation may be performed palliatively, as a pain relief measure. Neither are thought to have a particularly curative effect on the cancer itself. Liver transplantation is also not recommended because this type of cancer has a high recurrence rate.
Secondary Liver Cancer
This type of liver cancer is also known as metastatic liver cancer. It occurs when cancer spreads to the liver from another place in the body.
Secondary liver cancer classically spreads from the colon or colorectal cancer, as more than half of these types of cancers will go on to develop liver cancer.
Symptoms
Symptoms associated with secondary liver cancer can be caused by the cancer itself or cancer treatment. The list is extensive – you may have quite a few of the symptoms, or only a few:
- Jaundice of the skin and the eyes accompanied by itching
- Malaise
- Right-sided abdominal pain
- Loss of appetite and weight loss
- Hiccups
- Abdominal swelling
Treatment
The treatment with secondary liver cancer will depend on the primary (first) type of cancer you had and the goal of treatment. For example, if the cancer has spread, but only minimally, the goal still may be cure. If the cancer has spread extensively, the goal will most likely be palliative – to make you comfortable.
As with all of the aforementioned cancers, surgery, chemotherapy, radiation, and chemoembolization are all treatment options available – depending on your cancer – amongst various other options.
If you choose to aggressively treat your secondary liver cancer, keep in mind that you may stop treatment if and when you want to, if it becomes difficult to cope.
Palliative care is always an option. The Center to Advance Palliative Care defines palliative care as "…specialized medical care for people with serious illness. This type of care is focused on providing relief from the symptoms and stress of a serious illness. The goal is to improve quality of life for both the patient and the family."
Regardless of the time of liver cancer you have, know that there are a multitude of treatments available to you. Seek expert advice and ensure that you have a treatment plan that best fits your goals.
