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Liver cancer

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Prognosis and survival for liver cancer

If you have liver cancer, you may have questions about your prognosis. A prognosis is the doctor’s best estimate of how cancer will affect a person and how it will respond to treatment. Prognosis and survival depend on many factors. Only a doctor familiar with a person’s medical history, type of cancer, stage, characteristics of the cancer, treatments chosen and response to treatment can put all of this information together with survival statistics to arrive at a prognosis.

A prognostic factor is an aspect of the cancer or a characteristic of the person that the doctor will consider when making a prognosis. A predictive factor influences how a cancer will respond to a certain treatment. Prognostic and predictive factors are often discussed together, and they both play a part in deciding on a treatment plan and a prognosis.

The following are prognostic and predictive factors for liver cancer.

Stage

The stage is one of the most important prognostic factors for hepatocellular carcinoma. People with liver cancer that is BCLC stage 0 or A have a more favorable prognosis than people with liver cancer that is BCLC stage B, C or D.

Liver function

People with poor liver function caused by the tumour, scarring of the liver (called cirrhosis) or hepatitis have a less favourable prognosis.

Performance status

Performance status is the measure of how well a person can do ordinary tasks and carry out daily activities. People with a poor performance status have a less favourable prognosis than people with a good or fair performance status.

Tumour characteristics

People with multiple tumours have a less favourable prognosis than those with only one tumour. When the tumours are in both lobes, the prognosis is poorer than when the tumours are all in one lobe of the liver.

A tumour that has grown into, or invaded, blood vessels has a poor prognosis.

A tumour growing inside the blood vessels has a poor prognosis.

A tumour larger than 5 cm has a less favourable prognosis than smaller tumours.

Type of tumour

Fibrolamellar carcinoma has a more favourable prognosis than other types of liver cancer. These tumours do not grow very deeply into the surrounding tissues, so doctors can usually completely remove them with surgery.

The Child-Pugh score

The Child-Pugh score is used to determine when it is safe to perform surgery. It is a scoring system that measures the level of liver damage or failure caused by cirrhosis (an abnormal condition in which healthy liver tissue is replaced by scar tissue). It looks at the following factors (each factor is given between 1 and 3 points):

  • if there is a buildup of fluid in the abdomen (called ascites)
  • if there are symptoms of hepatic encephalopathy (a condition that develops when the liver doesn’t work properly and waste products build up in the blood)
  • bilirubin level
  • albumin level
  • how long it takes blood to clot (called prothrombin time, or PT)

Child-Pugh classification of liver damage
FactorNumber of points given

1

2

3

ascites

absent

slight

moderate

hepatic encephalopathy

none

grade 1 – mild

some changes to mental and physical function

grade 2 – moderate

many changes to mental and physical function

grade 3 – poor

significant changes to mental and physical function

grade 4 – severe

significant changes to mental and physical function or coma

bilirubin (mg/dL)

less than 2

between 2 and 3

greater than 3

albumin (g/dL)

greater than 3.5

between 2.8 and 3.4

less than 2.8

prolongation of prothrombin time (seconds)

between 1 and 3

between 4 and 6

greater than 6

The total number of points across the categories are added together to get the Child-Pugh score:

  • A = 5–6 points
  • B = 7–9 points
  • C = 10–15 points

A high Child-Pugh score means that surgery is not safe to do and should not be performed. People who can’t have surgery have a less favourable prognosis than people who can have surgery to remove liver cancer.

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