To Cancer : Complementary and Integrative Therapies of Cancer.

Archive for September, 2011

Bone cancer is caused by a problem with the cells that make bone and not flowers in Sacramento. More than 2,000 people are diagnosed in the United States each year with a bone tumor. Bone tumors occur most commonly in children and adolescents and are less common in older adults. Cancer involving the bone in older adults is most commonly the result of metastatic spread from another tumor.

There are many different types of bone cancer. The most common primary bone tumors include osteosarcoma, Ewing’s sarcoma, chondrosarcoma, malignant fibrous histiocytoma, fibrosarcoma, and chordoma.

• Osteosarcoma is the most common primary malignant bone cancer. It most commonly affects males between 10 and 25 years old but can less commonly affect older adults. It often occurs in the long bones of the arms and legs at areas of rapid growth around the knees and shoulders of children. This type of cancer is often very aggressive with risk of spread to the lungs. The five-year survival rate is about 65%.

• Ewing’s Sarcoma is the most aggressive bone tumor and affects younger people between 4-15 years of age. It is more common in males and is very rare in people over 30 years of age. It most commonly occurs in the middle of the long bones of the arms and legs. The three-year survival rate is about 65%, but this rate is much lower if there has been spread to the lungs or other tissues of the body.

• Chondrosarcoma is the second most common bone tumor and accounts for about 25% of all malignant bone tumors. These tumors arise from the cartilage cells and can either be very aggressive or relatively slow growing. Unlike many other bone tumors, chondrosarcoma is most common in people over 40 years of age. It is slightly more common in males and can potentially spread to the lungs and lymph nodes. Chondrosarcoma most commonly affects the bones of the pelvis and hips. The five-year survival for the aggressive form is about 30%, but the survival rate for slow-growing tumors is 90%.

• Malignant fibrous histiocytoma (MFH) affects the soft tissues, including muscle, ligaments, tendons, and fat. It is the most common soft-tissue malignancy in later adult life, usually occurring in people 50-60 years of age. It most commonly affects the extremities and is about twice as common in males as females. MFH also has a wide range of severity. The overall five-year survival rate is about 35%-60%.

• Fibrosarcoma is much more rare than the other bone tumors. It is most common in people 35-55 years of age. It most commonly affects the soft tissues of the leg behind the knee. It is slightly more common in males than females.

• Chordoma is a very rare tumor with an average survival of about six years after diagnosis. It occurs in adults over 30 years of age and is about twice as common in males as females. It most commonly affects either the lower or upper end of the spinal column.

In addition to bone cancer, there are various types of benign bone tumors. These include osteoid osteoma, osteochondroma, enchondroma, chondromyxoid fibroma, aneurysmal bone cyst, unicameral bone cyst, and giant cell tumor (which has the potential to become malignant). As with other types of benign tumors, these are not cancerous.

There are two other relatively common types of cancer than develop in the bones: lymphoma and multiple myeloma. Lymphoma, a cancer arising from the cells of the immune system, usually begins in the lymph nodes but can begin in the bone. Multiple myeloma begins in the bones, but it is not usually considered a bone tumor because it is a tumor of the bone marrow cells and not of the bone cells.

Living with a serious disease is difficult. Cancer patients and those who care about them face many problems and challenges. Coping with these difficulties is easier when people have helpful information and support services. Artcicle directories are a good place to look for material written by normal people who have experienced life. They know the ups and down of sickness and health.

Cancer patients may worry about holding their job, caring for their family, or keeping up with daily activities. Worries about tests, treatments, hospital stays, and medical bills are also common. Doctors, nurses, and other members of the health care team can answer questions about treatment, working, or other activities. Meeting with a nurse, social worker, counselor, or a member of the clergy also can be helpful to patients who want to talk about their feelings or discuss their concerns about the future or about personal relationships.

Friends and relatives, especially those who have had personal experience with cancer, can be very supportive. Also, it helps many patients to meet with others who are facing problems like theirs. Cancer patients often get together in support groups, where they can share what they have learned about cancer and its treatment and about coping with the disease. It is important to keep in mind, however, that each patient is different. Treatments and ways of dealing with cancer that work for one person may not be right for another, even if they both have the same kind of cancer. It is a good idea to discuss the advice of friends and family members with the doctor.

Often, a social worker at the hospital or clinic can suggest groups that can help with rehabilitation, emotional support, financial aid, transportation, or home care. The American Cancer Society has many services for patients and families. Local offices of the American Cancer Society are listed in the white pages of the telephone directory. The Cancer Information Service also has information on local services.

It is hard to limit the effects of treatment so that only cancer cells are removed or destroyed. Because treatment also damages healthy cells and tissues, it often causes unpleasant side effects.

The side effects of cancer treatment vary. They depend mainly on the type and extent of the treatment. Also, each person reacts differently. Attempts are made to plan the patient’s therapy to keep side effects to a minimum. Patients are monitored during therapy so that any problems which occur can be addressed. All therapy and treatment of cancer is centered around the control of erosion as it relates to healthy cellular growth. The body does not have control of the gorwth of the cancer cells.

Surgery – The side effects of surgery depend on the location of the tumor, the type of operation, the patient’s general health, and other factors. Although patients are often uncomfortable during the first few days after surgery, this pain can be controlled with medicine. Patients should feel free to discuss pain relief with the doctor or nurse. It is also common for patients to feel tired or weak for a while. The length of time it takes to recover from an operation varies for each patient.

Radiation Therapy - With radiation therapy, the side effects depend on the treatment dose and the part of the body that is treated. The most common side effects are tiredness, skin reactions (such as a rash  or redness) in the treated area, and loss of appetite. Radiation therapy can also cause a decrease in the number of white blood cells, cells that help protect the body against infection. Although the side effects of radiation therapy can be unpleasant, they can usually be treated or controlled. It also helps to know that, in most cases, they are not permanent.

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Chemotherapy - The side effects of chemotherapy depend mainly on the drugs and the doses the patient receives. Generally, anticancer drugs affect cells that divide rapidly. These include blood cells, which fight infection, help the blood to clot, or carry oxygen to all parts of the body. When blood cells are affected by anticancer drugs, patients are more likely to develop infections, may bruise or bleed easily, and may have less energy. Cells that line the digestive tract also divide rapidly. As a result of chemotherapy, patients can have side effects, such as loss of appetite, nausea and vomiting, hair loss, or mouth sores. For some patients, medicines can be prescribed to help with side effects, especially with nausea and vomiting. Usually these side effects gradually go away during the recovery period or after treatment stops.

Hair loss, another side effect of chemotherapy, is a major concern for many patients. Some chemotherapy drugs only cause the hair to thin out, while others may result in the loss of all body hair. Patients may feel better if they decide how to handle hair loss before starting treatment.

In some men and women, chemotherapy drugs cause changes that may result in a loss of fertility (the ability to have children). Loss of fertility can be temporary or permanent depending on the drugs used and the patient’s age. For men, sperm banking before treatment may be a choice. Women’s menstrual periods may stop, and they may have hot flashes and vaginal dryness. Periods are more likely to return in young women.

In some cases, bone marrow transplantation and peripheral stem cell support are used to replace tissue that forms blood cells when that tissue has been destroyed by the effects of chemotherapy or radiation therapy.

Hormone Therapy – Hormone therapy can cause a number of side effects. Patients can have nausea and vomiting, swelling or weight gain, and, in some cases, hot flashes. In women, hormone therapy can also cause interrupted menstrual periods, vaginal dryness, and, sometimes, loss of fertility. Hormone therapy in men can cause impotence, loss of sexual desire, or loss of fertility. These changes may be temporary, long-lasting, or permanent.

Biological Therapy – The side effects of biological therapy depend on the type of treatment. Often, these treatments cause flu-like symptoms such as chills, fever, muscle aches, weakness, loss of appetite, nausea, vomiting, and diarrhea. Some patients develop a rash, and some bleed or bruise easily. In addition, interleukin therapy can cause swelling. Depending on how severe these problems are, patients may need to stay in the hospital during treatment. These side effects are usually short-term and they gradually go away after treatment stops.

Doctors and nurses can explain the side effects of cancer treatment and help with any problems can occur.

What is basal cell carcinoma?

Basal cell carcinoma is the most common form of skin cancer and accounts for more than 90% of all skin cancer in the U.S. These cancers almost never spread (metastasize) to other parts of the body. They can, however, cause damage by growing and invading surrounding tissue.

What are risk factors for developing basal cell carcinoma?

Light-colored skin, sun exposure, and age are all important factors in the development of basal cell carcinomas. People who have fair skin and are older have higher rates of basal cell carcinoma. About 20% of these skin cancers, however, occur in areas that are not sun-exposed, such as the chest, back, arms, legs, and scalp. The face, however, remains the most common location for basal cell lesions. Weakening of the immune system, whether by disease or medication, can also promote the risk of developing basal cell carcinoma. Other risk factors include

• exposure to sun. There is evidence that, in contrast to squamous cell carcinoma, basal cell carcinoma is promoted not by accumulated sun exposure but by intermittent sun exposure like that received during vacations, especially early in life. According to the U.S. National Institutes of Health, ultraviolet (UV) radiation from the sun is the main cause of skin cancer. The risk of developing skin cancer is also affected by where a person lives. People who live in areas that receive high levels of UV radiation from the sun are more likely to develop skin cancer. In the United States, for example, skin cancer is more common in Texas than it is in Minnesota, where the sun is not as strong. Worldwide, the highest rates of skin cancer are found in South Africa and Australia, which are areas that receive high amounts of UV radiation.
• age. Most skin cancers appear after age 50, but the sun’s damaging effects begin at an early age. Therefore, protection should start in childhood in order to prevent skin cancer later in life.
• exposure to ultraviolet radiation in tanning booths. Tanning booths are very popular, especially among adolescents, and they even let people who live in cold climates radiate their skin year-round.
• therapeutic radiation, such as that given for treating other forms of cancer.

What does basal cell carcinoma look like?

A basal cell carcinoma usually begins as a small, dome-shaped bump and is often covered by small, superficial blood vessels called telangiectases. The texture of such a spot is often shiny and translucent, sometimes referred to as “pearly.” It is often hard to tell a basal cell carcinoma from a benign growth like a flesh-colored mole without performing a biopsy. Some basal cell carcinomas contain melanin pigment, making them look dark rather than shiny.

Superficial basal cell carcinomas often appear on the chest or back and look more like patches of raw, dry skin. They grow slowly over the course of months or years.

Basal cell carcinomas grow slowly, taking months or even years to become sizable. Although spread to other parts of the body (metastasis) is very rare, a basal cell carcinoma can damage and disfigure the eye, ear, or nose if it grows nearby.

How is basal cell carcinoma diagnosed?

To make a proper diagnosis, doctors usually remove all or part of the growth by performing a biopsy. This usually involves taking a sample by injecting a local anesthesia and scraping a small piece of skin. This method is referred to as a shave biopsy. The skin that is removed is then examined under a microscope to check for cancer cells.

How is basal cell carcinoma treated?

There are many ways to successfully treat a basal cell carcinoma with a good chance of success of 90% or more. The doctor’s main goal is to remove or destroy the cancer completely with as small a scar as possible. To plan the best treatment for each patient, the doctor considers the location and size of the cancer, the risk of scarring, and the person’s age, general health, and medical history.

Methods used to treat basal cell carcinomas include:

• Curettage and desiccation: Dermatologists often prefer this method, which consists of scooping out the basal cell carcinoma by using a spoon like instrument called a curette. Desiccation is the additional application of an electric current to control bleeding and kill the remaining cancer cells. The skin heals without stitching. This technique is best suited for small cancers in non-crucial areas such as the trunk and extremities.
• Surgical excision: The tumor is cut out and stitched up.
• Radiation therapy: Doctors often use radiation treatments for skin cancer occurring in areas that are difficult to treat with surgery. Obtaining a good cosmetic result generally involves many treatment sessions, perhaps 25 to 30.
• Cryosurgery: Some doctors trained in this technique achieve good results by freezing basal cell carcinomas. Typically, liquid nitrogen is applied to the growth to freeze and kill the abnormal cells
• Mohs Micrographic surgery: Named for its pioneer, Dr. Frederic Mohs, this technique of removing skin cancer is better termed “microscopically controlled excision.” The surgeon meticulously removes a small piece of the tumor and examines it under the microscope during surgery. This sequence of cutting and microscopic examination is repeated in a painstaking fashion so that the basal cell carcinoma can be mapped and taken out without having to estimate or guess the width and depth of the lesion. This method removes as little of the healthy normal tissue as possible. Cure rate is very high, exceeding 98%. Mohs micrographic surgery is preferred for large basal cell carcinomas, those that recur after previous treatment, or lesions affecting parts of the body where experience shows that recurrence is common after treatment by other methods. Such body parts include the scalp, forehead, ears, and the corners of the nose. In cases where large amounts of tissue need to be removed, the Mohs surgeon sometimes works with a plastic (reconstructive) surgeon to achieve the best possible postsurgical appearance.
• Medical therapy using creams that attack cancer cells (5-Fluorouracil–5-FU) or stimulate the immune system ( [Aldara]). These are applied several times a week for several weeks. They produce brisk inflammation and irritation. The advantages of this method is that it avoids surgery, lets the patient perform treatment at home, and may give a better cosmetic result. Disadvantages include discomfort, which may be severe, and a lower cure rate, which makes medical treatment unsuitable for treating most skin cancers on the face.

How is basal cell carcinoma prevented?

Avoiding sun exposure in susceptible individuals is the best way to lower the risk for all types of skin cancer. Regular surveillance of susceptible individuals, both by self-examination and regular physical examination, is also a good idea for people at higher risk. People who have already had any form of skin cancer should have regular medical checkups.

Common sense preventive techniques include

• limiting recreational sun exposure;
• avoiding unprotected exposure to the sun during peak radiation times (the hours surrounding noon);
• wearing broad-brimmed hats and tightly-woven protective clothing while outdoors in the sun;
• regularly using a waterproof or water resistant suncreem with UVA protection and SPF 30 or higher;
• undergoing regular checkups and bringing any suspicious-looking or changing lesions to the attention of the doctor; and
• avoiding the use of tanning beds and using a sunscreen with an SPF of 30 and protection against UVA (long waves of ultraviolet light.). Many people go out of their way to get an artificial tan before they leave for a sunny vacation, because they want to get a “base coat” to prevent sun damage. Even those who are capable of getting a tan, however, only get protection to the level of SPF 6, whereas the desired level is an SPF of 30. Those who only freackle  get little or no protection at all from attempting to tan; they just increase sun damage. Sunscreen must be applied liberally and reapplied every two to three hours, especially after swimming or physical activity that promotes perspiration, which can weaken even sunscreens labeled as “waterproof.”

Most cervical cancers are caused by the sexually transmitted infection human papillomavirus (HPV). Widespread HPV immunization, however, could reduce the impact of cervical cancer worldwide. Here, Bobbie Gostout, M.D., an HPV infection expert and gynecologic surgeon at Mayo Clinic, Rochester, Minn., discusses the cervical cancer vaccine.

What does the cervical cancer vaccine do?

Various strains of HPV, which spread through sexual contact, cause most cases of cervical cancer. Two cervical cancer vaccines have Food and Drug Administration (FDA) approval in the U.S. — Gardasil and Cervarix. Both vaccines can prevent most cases of cervical cancer if given before a girl or woman is exposed to the virus.

In addition, both can prevent most vaginal and vulvar cancer in women, and Gardasil can prevent genital warts in women and men.

Who is the cervical cancer vaccine for and when should it be given?

The cervical cancer vaccine is recommended for girls ages 11 to 12, although it may be given to girls as young as age 9. It’s important for girls to receive the vaccine before they have sexual contact and are exposed to HPV. Once a girl or woman has been infected with HPV, the vaccine may not be as effective.

In addition, Gardasil can be given to boys between ages 9 and 26 to help prevent genital warts.

The Centers for Disease Control and Prevention (CDC) recommends catch-up immunization for girls and women ages 13 to 26 who haven’t received the vaccine or who haven’t completed the full vaccine series. The cervical cancer vaccine isn’t recommended, however, for women older than age 26.

Both vaccines are given as a series of three injections over a six-month period. The second dose is given one to two months after the first dose, and the third dose is given six months after the first dose.

The cervical cancer vaccine isn’t recommended for pregnant women or people who are moderately or severely ill. Tell your doctor if you have any severe allergies, including an allergy to yeast or latex.

Why are three doses of the cervical cancer vaccine needed?

Researchers don’t yet know what antibody levels provide adequate protection from HPV. In early clinical trials, researchers observed that women’s antibody levels continued to increase with each of the three doses of the vaccine. Since antibody levels inevitably fall once you stop getting a vaccine, it makes sense to start with high antibody levels and attempt to get the greatest HPV protection for the longest possible time — years or even decades.

Over time, however, researchers may find that three doses of the vaccine aren’t necessary — or that a booster shot is needed years later.

Does the cervical cancer vaccine offer benefits if you’re already sexually active?

Yes. In clinical trials, Gardasil and Cervarix were effective in groups of sexually active women age 26 or younger, some of whom had already been infected with one or more types of HPV. However, Gardasil and Cervarix only protect you from specific strains of HPV to which you haven’t been exposed. The more sexual partners you’ve had, the greater your chance of having been exposed to multiple types of HPV.

Cancer can make eating difficult. Undergoing cancer treatments, such as chemotherapy, can cause nausea, vomiting and a loss of appetite. The radiation from cancer treatments can cause mouth sores and make eating unpleasant. However, it is essential to eat a healthy diet in order to keep up nutrition and be strong enough to withstand cancer treatments.

1.   What Should You Eat?

• A diet high in fiber can help prevent enertisis, a condition of the intestines caused by radiation. Chewing ice chips and taking amino acid supplements can help prevent mouth sores associated with radiation. When it comes to regular meals, the University of California Medical Center recommends bland foods and states that cold foods are usually preferable to hot. Jello, eggs, cream of wheat, cheese and crackers, cottage cheese and fruit are specifically recommended as bland foods which provide good sources of nutrition. Meal replacement shakes are also recommended, as they may be easier for cancer patients to consume and provide optimum nutritional content.
• The University of California Medical Center recommends “opportunistic eating.” This means that it is important to eat when you are hungry, as opposed to trying to eat a meal on a set schedule. Several small meals throughout the day may be better for nausea and may help you to keep food down more easily then eating large amounts in one sitting. Patients are also cautioned against lying down too soon after a meal, as this can exacerbate nausea and vomiting.
• Greasy and fatty foods should be avoided in order to present exacerbating digestive problems and mouth sores. Diets high in sugar, unhealthy proteins and fats have also been shown to worsen cancer survival rates, because they encourage metastases of the cancer. Finally, the University of California Medical Center suggests that although cancer patients should drink lots of cool, clear beverages, beverages should be avoided during meals.

Unintentional weight loss often accompanies cancer therapy because of poor appetites and treatment side effects. A healthy diet will maintain optimal nutrition status, though a “healthy diet” will be different for cancer patients than the general public because calories and protein are the focus. Nutritional drink supplements may improve calories and protein for cancer patients. Nutrition drinks on the market today offer variety and choice.

1.   When is Supplementation Recommended?

• Not every cancer patient will experience poor appetite and weight loss. Patients who have problems eating enough to maintain their weight should try some form of nutritional beverage. Losing 10 percent of your weight is considered severe; if this happens, tell your doctor.
• If weight loss is a concern, boost calories and protein through nutrition drinks such as Boost or Ensure. If insurance does not cover nutrition beverages, purchase the store brand version to save money. The taste and nutrition content is comparable. Also, consider the “Plus” version of these supplements, as they have more calories and protein per ounce.

Commercial Options for Calories and Protein

Powdered instant breakfasts are also an option. Mix these with whole milk to get maximum nutrition.

You may get tired of drinking the same beverage every day, so use a recipe to add different flavors to beverage (see Resources.) If a milky beverage does not appeal to you, try a juice type supplement, such as Resource Breeze or Enlive, which you can order from a pharmacy.

Homemade Beverages

• To make your own “nutrition beverage,” mix 1 c. whole milk and with 1/3 c. powdered milk. Use this mix in recipes where you would normally use milk, such as pudding, mashed potatoes or cream soup. This homemade option will not contain the vitamins and minerals that commercially prepared nutrition drinks do, but it will help you increase your calorie and protein intake.
• Ramon Colomer and colleagues, in the May 2007 “British Journal of Nutrition,” reviewed many studies that included omega-3 fatty acids in nutrition beverages. The research shows that a nutrition supplement that includes omega-3 fatty acids may benefit patients with advanced cancer and weight loss. A patient can take a nutrition supplement plus an omega-3 supplement, or order specialized nutrition beverages that already contains omega-3s. The recommendation is 1.5g daily of omega-3s.

Omega 3 Fatty Acids

Nutritional drinks containing omega-3 fatty acids may be difficult to find and expensive. Two supplements are Prosure from Abbott Nutrition and Peptamen AF from Nestle Nutrition.

Considerations

• If you find that a normal diet provides you with adequate calories and protein, continue to follow it. However, if you are losing weight, do not wait until weight loss is severe to start adding nutrition beverages to your daily meals. Maintaining good nutrition status is easier than improving poor nutrition status and may improve a cancer therapy outcome.

Your diet is always an important factor in your health, but it is especially important when you are ill. Eating the right kinds and amounts of food can help you feel better and become stronger. Surgery or radiation may increase the need for nutrients, especially protein. Chemotherapy and even some types of medication, may result in a nutrient imbalance which may require specific replacement. Many malignant mesothelioma patients lose their appetites due to worry and fear over their condition. Those who have begun treatment may not enjoy eating because of side effects such as nausea and vomiting, dry mouth, sore throat, changing taste or smell, or constipation.

Because your nutritional needs change during extended illness, your diet may need to change as well. The health care community recommends a general adult diet that is low in fat, includes small portions of meat and dairy products, and larger portions of fruits, vegetables, and grains. With diminished appetite during illness or therapy, it may not be possible to eat normally even though your need for calories and proteins has increased. Your doctor or dietician may advise that you concentrate on eating more meat, dairy products, and fats in order to consume enough proteins and calories. You may even need to cut back on fruits, vegetables, and grains in order to eat enough of these other foods.

During treatment, your doctor or dietician may recommend a special diet. These diets are intended to compensate for a particular deficiency you may be experiencing. Special diets may be assigned long or short term to address acute needs. Sometimes a pre-prepared nutritional formula, or vitamin and mineral supplements may be prescribed.

Remember, there are no steadfast nutrition rules during cancer treatment. Some patients may continue to enjoy eating and have normal appetite throughout most of their treatment. Others may have days when they don’t feel like eating at all, and even the thought of food makes them sick. Following are some suggestions which may help:

• When you are able to eat, eat meals and snacks with sufficient proteins and calories; they will help you keep up your strength.
• Try eating frequent smaller meals throughout the day rather than fewer big ones. This may help you to eat more over the course of the day, yet you won’t feel so full.
• Many patients find their appetite is better early in the day. Consider having your main meal then and perhaps liquid meal replacements later in the day.
• If you are able to eat only certain foods, stick with them until you are able to eat others. Try a liquid meal replacement for extra protein and calories.
• If you don’t feel like eating solid foods, try liquids such as juice, soup, or milkshakes, which can provide important calories and proteins. If eating whole fresh fruits is a problem, for instance, try blending fruit into a milkshake. Also try softer, cool, or frozen foods such as yogurt or popsicles.
• When you can’t eat at all, don’t worry about it. Get back to normal eating as soon as possible, but if your problem does not improve within a couple of days, be sure to notify your doctor.
• Try to drink plenty of fluids, especially on those days when you don’t feel like eating. Water is essential to your body’s basic functioning. For most adults, 6-8 cups of fluid a day are a good goal.
• Regular exercise may help your appetite. Check with your doctor for an exercise program which may be suitable for you.

Treatments for primary liver cancer depend on the extent (stage) of the disease as well as your age, overall health and personal preferences.

The goal of any treatment is to eliminate the cancer completely. When that isn’t possible, the focus may be on preventing the tumor from growing or spreading. In some cases only comfort care is appropriate. In this situation, the goal of treatment is not to remove or slow the disease but to help relieve symptoms, making you as comfortable as possible.

Liver cancer treatment options may include:

• Surgery to remove a portion of the liver. Your doctor may recommend partial hepatectomy to remove the liver cancer and a small portion of healthy tissue that surrounds it if your tumor is small and your liver function is good.
• Liver transplant surgery. During liver transplant surgery, your diseased liver is removed and replaced with a healthy liver from a donor. Liver transplant surgery may be an option for people with early-stage liver cancer who also have cirrhosis.
• Freezing cancer cells. Cryoablation uses extreme cold to destroy cancer cells. During the procedure, your doctor places an instrument (cryoprobe) containing liquid nitrogen directly onto liver tumors. Ultrasound images are used to guide the cryoprobe and monitor the freezing of the cells. Cryoablation can be the only liver cancer treatment, or it can be used along with surgery, chemotherapy or other standard treatments.
• Heating cancer cells. In a procedure called radiofrequency ablation, electric current is used to heat and destroy cancer cells. Using an ultrasound or CT scan as a guide, your surgeon inserts several thin needles into small incisions in your abdomen. When the needles reach the tumor, they’re heated with an electric current, destroying the cancer cells.
• Injecting alcohol into the tumor. During alcohol injection, pure alcohol is injected directly into tumors, either through the skin or during an operation. Alcohol dries out the cells of the tumor and eventually the cells die.
• Injecting chemotherapy drugs into the liver. Chemoembolization is a type of chemotherapy treatment that supplies strong anti-cancer drugs directly to the liver. During the procedure, the hepatic artery — the artery from which liver cancers derive their blood supply — is blocked, and chemotherapy drugs are injected between the blockage and the liver.
• Radiation therapy. This treatment uses high-powered energy beams to destroy cancer cells and shrink tumors. During radiation therapy treatment, you lie on a table and a machine directs the energy beams at a precise point on your body. Radiation side effects may include fatigue, nausea and vomiting.
• Targeted drug therapy. Sorafenib (Nexavar) is a targeted drug designed to interfere with a tumor’s ability to generate new blood vessels. Sorafenib has been shown to slow or stop advanced liver cancer from progressing for a few months longer than with no treatment. More studies are needed to understand how this and other targeted therapies may be used to control advanced liver cancer.

Blood tests

Liver cancer is not diagnosed by routine blood tests, including a standard panel of liver tests. This is why the diagnosis of liver cancer depends so much on the vigilance of the physician screening with a tumor marker (alpha-fetoprotein) in the blood and radiological imaging studies. Since most patients with liver cancer have associated liver disease (cirrhosis), their liver blood tests may not be normal to begin with. If these blood tests become abnormal or worsen due to liver cancer, this usually signifies extensive cancerous involvement of the liver. At that time, any medical or surgical treatment may be too late.

Sometimes, however, other abnormal blood tests can indicate the presence of liver cancer. Remember that each cell type in the body contains the full complement of genetic information. What differentiates one cell type from another is the particular set of genes that are turned on or off in that cell. When cells become cancerous, certain of the cell’s genes that were turned off may become turned on. Thus, in liver cancer, the cancerous liver cells may take on the characteristics of other types of cells. For example, liver cancer cells sometimes can produce hormones that are ordinarily produced in other body systems. These hormones then can cause certain abnormal blood tests, such as a high red blood count (erythrocytosis), low blood sugar and high blood calcium .

Another abnormal blood test, high serum cholesterol (hypercholesterolemia), is seen in up to 10% of patients from Africa with liver cancer. The high cholesterol occurs because the liver cancer cells are not able to turn off (inhibit) their production of cholesterol. (Normal cells are able to turn off their production of cholesterol.)

There is no reliable or accurate screening blood test for liver cancer. The most widely used biochemical blood test is  (AFP), which is a protein normally made by the immature liver cells in the fetus. At birth, infants have relatively high levels of AFP, which fall to normal adult levels by the first year of life. Also, pregnant women carrying babies with neural tube defects may have high levels of AFP. (A neural tube defect is an abnormal fetal brain or spinal cord that is caused by folic acid deficiency during pregnancy.)

In adults, high blood levels (over 500 nanograms/milliliter) of AFP are seen in only three situations:

• Liver cancer

• Germ cell tumors (cancer of the testes and ovaries)

• Metastatic cancer in the liver (originating in other organs)

Several assays (tests) for measuring AFP are available. Generally, normal levels of AFP are below 10 ng/ml. Moderate levels of AFP (even almost up to 500 ng/ml) can be seen in patients with chronic hepatitis. Moreover, many patients with various types of acute and chronic liver diseases without documentable liver cancer can have mild or even moderate elevations of AFP.

The sensitivity of AFP for liver cancer is about 60%. In other words, an elevated AFP blood test is seen in about 60% of liver cancer patients. That leaves 40% of patients with liver cancer who have normal AFP levels. Therefore, a normal AFP does not exclude liver cancer. Also, as noted above, an abnormal AFP does not mean that a patient has liver cancer. It is important to note, however, that patients with cirrhosis and an abnormal AFP, despite having no documentable liver cancer, still are at very high risk of developing liver cancer. Thus, any patient with cirrhosis and an elevated AFP, particularly with steadily rising blood levels, will either most likely develop liver cancer or actually already have an undiscovered liver cancer.

An AFP greater than 500 ng/ml is very suggestive of liver cancer. In fact, the blood level of AFP loosely relates to (correlates with) the aggressiveness of the liver cancer. Finally, in patients with liver cancer and abnormal AFP levels, the AFP may be used as a marker of response to treatment. For example, an elevated AFP is expected to fall to normal in a patient whose liver cancer is successfully removed surgically (resected). People with higher AFP levels generally do not live as long as those with lower AFP levels.

There are a number of other liver cancer tumor markers that currently are research tools and not generally available. These include des-gamma-carboxyprothrombin (DCP), a variant of the gamma-glutamyltransferase enzymes, and variants of other enzymes (for example, alpha-L-fucosidase), which are produced by normal liver cells. (Enzymes are proteins that speed up biochemical reactions.) Potentially, these blood tests, used in conjunction with AFP, could be very helpful in diagnosing more cases of liver cancer than with AFP alone.