Television actor Dipika Kakar, who was diagnosed with stage two liver cancer in May last year, has revealed she now has a new cyst that requires another surgery. “Such growth is not unusual in survivors of liver cancer, which has a high recurrence rate, often occurring within one or two years after treatment, with studies showing 42%–76% relapse within this period,” says Dr Kunjahari Medhi, senior director, Medical Oncology, Cancer Care, Medanta, Gurugram.
Stage 2 liver cancer manifests as either a single tumour larger than 2 cm that has invaded blood vessels or multiple tumours of less than 5 cm. The cancer hasn’t spread to lymph nodes or other parts of the body at this stage. That’s why Kakar had undergone surgery and was on targeted therapy thereafter. Now that she has a new cyst, she will be undergoing another procedure this week. “Going ahead, I will be on immunotherapy, targeted therapy will stop,” she said. Immunotherapy improves long-term survival improvements by re-activating the immune system while targeted therapies can sometimes be limited in efficacy.
“If liver cancer returns despite being addressed in the early stages, it can still be treated if it is localised and not spread to distant organs,” says Dr Medhi. Over to him:
What’s the rate of recurrence with liver cancer?
About 50 to 70 per cent of patients, who have undergone surgeries to remove malignant tumours, have recurrence. Even in liver transplant cases, 20 per cent of patients report recurrence. All this within two years of treatment.
Why does the tumour recur so early despite addressing the cancer in the early stages?
Relapse in the first 12–24 months is considered “early recurrence,” often driven by the aggressive nature of the original tumour. Otherwise, it’s the large size of the original tumour or multiple tumours. Sometimes the cancer affects the surrounding blood vessels, which may trigger early recurrence. High grade tumours are usually followed by early recurrence. Also, the high level of alpha-fetoprotein (AFP), a blood-based tumour marker, at the time of diagnosis, could lead to a return.
What about therapies for recurrence?
If the cancer returns, there are several options for managing it but much will depend on where the cancer is, its extent, its spread if any, how well you are overall and how well your liver is working. Accordingly, doctors may suggest a liver transplant or a treatment to destroy the new liver tumours (ablation), suggest a localised chemo into the liver together with blocking the cancer’s blood supply (TACE), or a localised radiotherapy into the liver, together with blocking the cancer’s blood supply.
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Your doctor may also suggest using electromagnetic waves to create rapid, high-temperature necrosis, often effective for tumours near large vessels. There may be additional or what we call adjuvant therapy, with targetted or immunotherapy tablets or injections.
Sometimes liver cancer can spread to the bones, lungs and adrenal glands. If your cancer has spread somewhere else, local treatment to the liver won’t help. If you are well enough, your doctor is most likely to suggest a “systemic” therapy. That means treatment with drugs that circulate through the body in the bloodstream and will reach cancer cells wherever they are.
For patients with Hepatitis B (HBV), long-term antiviral medication is recommended to suppress the virus and reduce the risk of cancer. Managing hepatitis C, diabetes and fatty liver disease is critical for preventing the progression of liver damage that can lead to recurrence.
© The Indian Express Pvt Ltd
