Limitations of current treatment methods for primary carcinoma of the liver

Abstract

Before 1976, there were 202 patients seen with primary carcinoma of the liver; 73% had hepatomas, 21% had cholangiocarcinomas, and 6% had the mixed variety. The male‐to‐female ratio was 2:1 for the patients with hepatomas, but the ratio was equal for the other 2 varieties. Of these patients, 8% were stage I or unstaged and 30% were stage III and had short survivals. This left 126 patients with stage II carcinoma of the liver available for analysis according to treatment regimens. Of these, 31 patients were observed but untreated, 62 were treated by systemic chemotherapy, 25 were treated by surgical resection, 5 had dearteriaiization of the liver, and 3 were treated by intra‐arterial infusion chemotherapy. Although the resection rate was only 12% in the whole group of patients, 25% of the patients undergoing resection became long‐term survivors. They had significantly longer survivals, for all time intervals, than did the patients who were observed only or who underwent systemic chemotherapy. The patients undergoing dearteriaiization had significantly longer survivals up to the 12‐mo period. Because the liver is the largest organ in the human body situated deep in a body cavity, large amounts of parenchymai tissue can be replaced by malignant tissue before any symptoms occur. Thus, when clinical symptoms are present, the cancer has usually reached an advanced stage, which severely limits the useful application of current treatment methods for cure or prolonged palliation. At present, surgical resection is the only form of therapy that produces an opportunity for cure, and for surgical resection to be feasible early diagnosis is necessary. Improved tests for earlier diagnosis and increased awareness on the part of the physician and the patient are needed to permit diagnosis of this cancer in patients with stage I disease in whom control for long periods of time may be expected.