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The State of The Fight

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State of the Fight: Liver Cancer

by Dr. Michael Choti

State of the Fight: Liver Cancer
Dr. Michael Choti, Jacob C. Handelsman Professor of Surgery & Chief of the Handelsman Division of Surgical Oncology at Johns Hopkins

From a worldwide perspective, liver cancer is one of the most common and deadly forms of cancer. I should note that while it’s common for cancer to spread from the lungs and other organs to the liver during metastasis, for this blog I will focus on primary liver cancer, or cancer that originates in the liver. Primary liver cancer is made up of a combination of diseases, but the two main types are hepatocellular carcinoma, which is cancer of the liver cells themselves, and bile duct cancer, also called cholangiocarcinoma. In 2012, more than 21,000 men and 7,000 women in the United States will be diagnosed with primary liver cancer; approximately 20,000 people will die from the disease. Clearly, there is much work to be done. 

There are a number of known risk factors that account for the growing liver cancer problem. The most common risk factors for developing liver cancer include infection with hepatitis B virus (HBV) or hepatitis C virus (HCV); heavy alcohol use leading to damage of the liver called cirrhosis; and, perhaps somewhat surprisingly, the epidemic in obesity and related increase in diabetes, which takes a toll on the liver. Each of these factors contributes to cellular alteration that can eventually lead to cancer of the liver and, if left untreated, metastasis. 

There is a wide spectrum of treatment methods for patients with liver cancer. Patients with hepatocellular carcinoma, the more common variety, often have associated cirrhosis. In that case, if the cancer is small, we may consider transplanting the liver, thereby removing the cancer and the damaged liver entirely. Another approach for smaller and earlier stage tumors is called ablation, where a probe can be put in the liver and the tumor can be burned or treated. Unfortunately, many patients who have larger tumors are not candidates for surgical intervention. If their cancer is still localized in the liver, there is a whole host of approaches known as intra-arterial approaches, or treatments through the artery. Seeds are embedded into the liver, either through what’s called chemoembolization, where chemotherapy particles can be lodged into the tumor, or radioembolization, where radioactive particles are injected through the artery directly feeding the tumor in the liver.

The variety of treatments is indicative of the main question we face as we progress in our fight against liver cancer – namely, how best to match the optimal treatment to each individual patient. Accordingly, my research focuses on three main areas. One is discovering the molecular genetics of cancer, including liver cancer, in collaboration with molecular geneticists, genetics researchers and other scientists at Johns Hopkins. We’re now faced with a wealth of genetic information regarding liver cancer; the biggest challenge is attempting to understand its meaning. We are trying to understand biomarkers – measurable characteristics that can be used as an indicator of disease or a disease state – that are the cause of cancer and targets for treatment. The other area in which I conduct my research is in clinical outcomes and clinical trials. I do clinical studies to understand and test safety and efficacy of new drugs, new therapies and best outcomes in patients who are undergoing treatment for these diseases. Finally, my research also focuses on developing innovative surgical approaches for the treatment of liver cancer and other malignancies, using minimally invasive therapies to improve outcomes, lower costs, and cause less suffering for patients undergoing surgical therapies for liver cancer. The hope is that by combining each of these three areas, one day we may find a predicted molecular biomarker that could provide guidance, not only to give drug X versus drug Y but also to determine which treatment option - surgery, transplant or some other forms of therapy - would be the most effective.

In the meantime, what is most important in the fight against liver cancer – and cancer in general – is spreading awareness. Hepatitis B and C can be passed from person to person through blood (such as by sharing needles) or sexual contact. An infant may catch these viruses from an infected mother. Additionally, consuming more than two drinks of alcohol daily increases the risk of liver cancer and certain other cancers. Actively participating in prevention by reducing alcohol intake, getting a vaccine to prevent hepatitis B, and preventing exposure to hepatitis C by practicing safe sex and needle use could substantially reduce the number of liver cancer cases each year.

Looking forward, the next big breakthrough in combating liver cancer will come through supporting research. This is a very important area, and this is the message that Stand Up To Cancer is so strong at spreading. We need people currently facing a liver cancer diagnosis to participate in clinical trials to usher in the next generation of treatment options. We also need the kind of financial support that SU2C provides to pull together teams of researchers and doctors to perform genomic analysis, to develop registries and consortiums so we can study rare diseases, and to fund the surgical innovation it will take to transform liver cancer from a deadly disease to one which is as manageable as a sprained ankle. 

Dr.Michael Choti is a graduate of the Yale University School of Medicine and received his surgical training at the Hospital of the University of Pennsylvania. After completing his general surgery residency in 1990, Dr. Choti went on for advanced surgical training in surgical oncology at Memorial Sloan-Kettering Cancer Center in New York. In 1992, he joined the full-time faculty at Johns Hopkins University.

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