[background music] >> tonight. >> it was in the spring of 2007; they detecteda malignancy. >> there are multiple tumors all over theliver. >> an abc-27 special presentation. >> it was time for the cat scan on my lung;and when i had that done, it caught the tumor in my liver. >> penn state hershey cancer institute presentsliver cancer: a matter of facts; brought to you by penn state milton s. hershey medicalcenter.
>> good evening, i'm chuck rhodes. the liverperforms many important functions: it breaks down and stores nutrients and filters outtoxic waste in the blood. a diagnosis of liver cancer can be scary, but it doesn't mean thereisn't hope as you'll see tonight. about 75,000 men and women will be diagnosed with livercancer in the u.s. this year. of these, approximately 30,000 have primary liver cancer. and about45,000 are cancers that are metastatic to the liver. more than 95 percent of peoplediagnosed with liver cancer are 45 years of age or older. the average age at diagnosisof liver cancer is 63. now tonight. >> thanks, chuck. a cumberland county womanwas given some news she didn't expect to hear. it's a six-letter word that would shock anyone:cancer.
>> i have to get out a bathing suit, don'ti? >> carol rhoades is packing for a trip toflorida. traveling is a favorite pastime of hers. it was put on hold after a routine visitto check a nodule on her lung. >> the nodule's very tiny and it hasn't grownat all. and every three years, i do have cat scans on it. and it was time for another catscan on my lung. and when i had that done, it caught the tumor in my liver. and i hadno other symptoms except that they said, "you've got to get this checked. we have to biopsyit." >> the biopsy showed a primary liver tumor,or a hepatocellular cancer. so this is a tumor that starts in the liver, made up of the cellsof the liver. usually there's some kind of
genetic alteration within the cell that causesover-growth and the tumor formation. the mass measured five centimeters or about two inches,quite a significant mass within the liver, and it had probably been there for many monthsif not years, because tumors grow relatively slowly. >> you know, surprised. yeah, but, i don'tknow, it's, i think i had a lot of faith. i really do. i think the kids were more worriedthan i was, and my grandchildren. >> so one of the first things we do for anytumor is staging, where we try to see if the tumor has spread to the rest of the body.for ms. rhoades, because she was found to have no spread and a healthy liver, we optedto offer her surgical resection. we had a
plan to take out the tumor and allow the remainderof the liver to grow back and regenerate. >> i wasn't afraid. i wasn't afraid. i, becausei think there's nothing, you can't do anything about it. somebody tells you: you have thisor that, but you, yes, there's surgery and that's what i plan to do, whatever the specialiststell me to do that's what i thought. and we'll take care of it. >> we were able to take out the right sideof her liver where the tumor was, taking about 55 percent of her liver. the remainder grewback beautifully and she recovered well from her operation. >> after the fact, i did not need any chemoor radiation, because they felt they got everything.
they got it all. and there was no other cancerin my body. and they did take the complete tumor out. >> she's doing great. she's a year and a half,almost two years out from her surgery and has recovered fully. her liver has regeneratednicely and she has perfect liver function. and she's back to her normal life. >> i always over-pack. i mean, i know it'sscary, but you have to just stay strong and you'll get through it. >> and she got through it. carol has cat scansevery three months. after two years, it will be pushed back to every six months, and eventually,once a year. chuck, back to you.
>> thank you, debra. >> and joining us now, carol's doctor, dr.niraj gusani. doctor, there were -- extensive type of surgery carol had. how long in recovery?talk about that surgery and the recovery time on that. >> sure. >> it seems almost overwhelming. >> sure, absolutely chuck. the liver is avery wonderful organ in that it regenerates after we remove parts of it. and so we canremove 70, even 75 percent of a normal healthy person's liver and it will regenerate to afull function within three weeks. however,
the surgery is very extensive. ms. rhoadeshad over 50 percent of her liver removed, but these days we can do these even very extensiveoperations in a minimally invasive fashion with small incisions. and a quicker recoverytime for the patient. the patients do spend between four and seven days in the hospital;it could be longer sometimes. and the usual recovery period is about two months. >> now, we talk, many of these shows we talkabout multidisciplinary approach; how does that work in your case in this department? >> yeah. well, this is very important in cancercare. there are a lot of different specialties and we all have a different role to play intreatment of cancers. and so at penn state
we bring it together all the specialists whotreat liver cancer. this includes surgical oncologists, like myself; transplant surgeons;liver doctors called hepatologists; medical oncologists; and radiation doctors; and specialradiologists, all in a room to talk about every patient and build a plan tailored toeach patient's needs. >> put them all under one roof like that,just keep it... >> that's right: one-stop shopping. and itmakes it better for the patient because we all communicate in real time and we can seethe patient together in our clinic. >> right down the hall instead of email andhoping for the best. >> that's right. that's right.
>> that's very good. and we're going to checkin with debra now on the abc-27 call center. debra? >> thanks, chuck, it is very busy over hereright now and you can see the specialists are on the phones. this is the number to call:717-346-3333. if it's busy, you can try back again or also use the email. now, here tohelp us answer some of the viewer questions this evening is dr. thomas riley, a hepatologistat the med center. thanks for being with us. this is our first question: "does a diagnosisof a fatty liver raise my risk of getting liver cancer? what causes a fatty liver andis there a way to reverse the condition?" >> well, fatty liver disease is one of themost common conditions in the united states
today causing liver disease. and about 20to 30 percent of the people who develop a fatty liver will progress through stages fromfatty liver, to inflammation, to fibrosis, and cirrhosis. and once cirrhosis sets in,that's when your cancer risk of the liver starts. we can try to intervene and try tostop that progression by seeking advice from your physicians. they will give you adviceon losing weight, exercise, potentially vitamin e. >> okay, thanks dr. riley. and we will comeback to you with some more viewer questions. if the phone lines are busy, here's the emailaddress. you can email your question to questions@abc27.com. stay will us; we will be right back.
[ music ] >> you're watching liver cancer: a matterof facts on abc-27; brought to you by penn state milton s. hershey medical center. >> welcome back. a lebanon county woman wasdiagnosed with one kind of cancer, only to find out more devastating news: the cancerhad spread to her liver. there's snow on the ground, the temperatures are well below freezing,and marion cuttle is out feeding the birds anyway. >> i enjoy feeding the birds. i just liketo watch all the different birds come to the feeders.
>> this is part of marion's daily routine.but her routine was interrupted by a doctor's visit. >> in the spring of 2007, i had a colonoscopyand they detected a malignancy. so i went and saw dr. koltun and he scheduled surgery. >> we thought the colon cancer was relativelystraightforward, that it was probably caught relatively early because she had had a colonoscopya few years before. but everyone gets a cat scan and gets evaluated for the possibilityof spread. and that cat scan in her case, unfortunately, came back positive showinga tumor had gone to her liver. >> it kind of took the wind out of my sails.yeah. yeah. because i knew that was very serious.
>> it was serious. marion had stage four coloncancer: the most advanced form. >> well, it was a little overwhelming, atfirst it was. and i got to say that it upset my family quite a bit. when we looked at hercat scans -- shown here -- we can see outlined in red that there are multiple tumors allover the liver of varying sizes and shapes. and in fact, she had even more tumors thatwe can't see on these images, representing eight to 10 tumors spread throughout her entireliver. >> because the tumor in her liver was ratherextensive, we decided after talking with dr. gusani, as well as the oncologists here, togive her chemotherapy, which would effectively go everywhere in her body and treat whatevercancer was there.
>> she received what is called standard therapyfor advanced colorectal cancer, which is combination chemotherapy with several agents. >> i was going to get chemo every other weekfor about eight weeks. i was watching my five grandchildren at the time, and they kind ofkept me going. they gave me a reason to get out of bed in the morning and they just keptme going. >> inspiration when marion needed it the most. >> when we see a patient like this, our strategyin working with the surgeons is to try and provide chemotherapy and demonstrate thatthe tumors are shrinking. >> here you can see one of her tumors in theright side of the liver before chemotherapy.
and here we can see immediately after chemotherapyhow nice of a response she had, with the tumor shrinking significantly. we reassessed bothher liver and her colon tumor, and these had both responded quite well to the chemotherapy. >> before surgery could take place, radiologistswere called in. >> because of the extent of the disease andthe number of tumors in her liver, we felt that her liver remnant wasn't quite largeenough. and so we did a procedure -- a special procedure called portal vein embolization,where actually block off the blood flow to the side of the liver we're going to takeout. and this allows the liver to grow even before we do the surgery, and to prepare itfor having enough healthy liver tissue after
the operation. >> marion's liver regenerated, so surgerywas next. >> i was a little nervous about it, but iwasn't really scared. i kind of had faith in my doctors and i just knew whatever, whateverhappened, i was going to be alright. >> this was a very extensive liver operation.one of the biggest ones we can do. we took out about 70 percent of her liver, takingout one entire side and taking pieces from several other portions of the liver to completelyremove all of the tumors. >> i woke up again, and they were able totell me pretty soon after the surgery that my liver was regenerating itself. so thatwas good news. that was good news.
>> marion successfully made it over one hugehurdle, but had a couple more to go including four more chemotherapy treatments. >> the rest of the treatments she receivedwas to complete a total of six months of chemotherapy for disease that was ultimately completelyremoved by surgery. >> my daughter took me home after my lasttreatment, you know, and she said, "well," she said, "with any luck, this will be thelast time." and it was. >> colon surgery was the final step, and marionwas ready. >> i was feeling pretty good by that time.because i knew the main problem, which was the liver, seemed to be alright.
>> i basically took out a piece of her colonthat had the tumor within it. and in fact, when we took out her colon -- in that area-- there was no tumor left to be seen in, under the microscope. the tumor had respondedvery dramatically in her colon just as it had in her liver. >> two surgeries, chemotherapy, and a numberof procedures all done in a year's time. seven years later, now it's a distant memory formarion. >> yeah, sometimes when i look back on iti think, "wow. i really went through all that." i wouldn't want to go through it again, butat the time you just do what you have to do. >> marion gets a cat scan once a year, butat this point she feels as though she beat
cancer. chuck? >> debra, that's good news. and joining usnow, dr. peter waybill and along with dr. gusani, but before i start with you, dr. waybill,dr. gusani do we see a lot of patients where cancer spreads from the colon over to theliver? >> yeah, chuck. in fact, colon cancer is oneof the most common cancers in the united states. it's the third most frequently seen cancerin both men and women. and 150,000 americans are affected with colon cancer every year.up to 40 percent of those patients present with spread; and the most common site of spreadis the liver. so in fact, colon cancer spread to the liver is the most common liver tumorthat we see here in the united states.
>> and dr. waybill, now, we talked about variousspecialists all throughout this program dealing with liver cancer, the team. talk about theinterventional radiologists; that sounds really technical. what's that, what's that mean? >> interventional radiologists are physicianswho specialize in the use of radiologic procedures, x-ray, ct, mri, and ultrasound, to guide therapiesand treatments. in the case of liver cancer, several options are available. we do procedurescalled chemoembolization and radioembolization, where you will put a catheter into the arteryin the leg, run it into the vessels that supply the liver and directly into the blood vesselsthat supply the tumors in the liver and deliver specially formulated chemotherapeutic agentsto the liver, or specially formulated radiotherapy
agents to the liver. and we will also putother image guided things in to use microwave or radio waves to ablate tumors, kill tumors. >> now, we saw in marion's story that shehad a very important procedure prior to the surgery. what's that involve? >> so she had a portal vein embolization and,for many people, when you have your right lobe of your liver involved is the majorityof your liver. and if there's a lot of disease there and they are required to cut out theentire right, there may not be enough liver left to live on. and those people in the pastthey would have been deemed inoperable. now we have a procedure called portal vein embolizationwhere we will go in and actually put material
into the right side of the blood vessels,slow blood flow there and that actually stimulates the left lobe to grow. and hopefully it growsenough that there'll be enough liver left that when they take out the diseased liver,there is enough good liver to live on. and those people who were inoperable before nowcan be operable. >> how long has that procedure been around? >> the procedure's been around for about fiveto 10 years, but it really has taken off in the last two to three, where you have a centerthat has specialists like dr. gusani who do these high-end liver surgeries, they requirethat to help them do what they need to do. >> okay, well, thank you dr. waybill for joiningus today.
>> thank you. >> dr. gusani, you're staying with us. andnow we throw it back over to debra in the call center again. debra? >> thanks, chuck. here's our next viewer question."dr riley: both my grandfather and uncle on my father's side of the family were diagnosedwith liver cancer. does this increase my risk of getting liver cancer?" >> that's somewhat of a complex answer, becausefirst you have to inherit the liver disease that the relative had, to then go on to developliver cancer. so if you don't get that liver disease, then you would not go on to developliver cancer. so it's important that you work
closely with your physician to decide whetheryou may have inherited that liver condition to work with that question. >> so you should get tested. ask your doctorabout getting tested. >> absolutely. >> okay, dr. riley, thank you. as you cansee, the phone lines, they are very busy at the moment. now, you can do something else,you can email a question to: questions@abc27.com. we will be right back. stay with us. >> liver cancer: a matter of facts on abc-27is brought to you by penn state milton s. hershey medical center.
>> welcome back. you still have a few minutesto get your calls in. you can see the lines are still busy. we still have our email address.that number is 717-346-3333. once again, we do want to thank these specialists for comingin this evening and answering your phone calls. once again, the lines are open until 8 o'clock.chuck, we'll send it back to you. >> thank you, debra. and joining us now isdr. thomas riley. you saw him over answering all the viewer questions over there. doctor,we talked about different types of liver cancer here tonight. what causes liver cancer? prettybasic question. >> one of the most common reasons someonedevelops liver cancer is, if it starts in the liver is cirrhosis of the liver, whichis a scarring of the liver that happens for
a variety of reasons. but the most commonreasons in the united states are fatty liver related obesity or alcohol. it can also happenfrom hepatitis b or c, or from autoimmune or genetic liver diseases. once we detectsomebody with cirrhosis, we can then set up a screening program to try to detect thatearly. so we can put them in the position to more likely cure their liver cancer. >> now, besides surgery, chemotherapy, talkabout some other treatments. >> well, liver transplantation is an excellentoption when they, when people meet the criteria. and we have assembled an excellent team atpenn state to deal with that, where we have transplant surgeons, transplant hepatologists,anesthesiologists, we have radiologists, pathologists,
infectious disease doctors, cardiologists,nutritionists, social workers and all working together to help take care of these complexpatients. >> let's talk about that transplant. who'seligible and what's the criteria for that? >> well, first you have to be medically suitable.you have to be able to tolerate that very big, large operation. and then once that'smet, you then have to have two criteria met in the size of your cancer. you have to havea lesion less than five centimeters, or three lesions less than three centimeters. and whenthose criteria are met, the outcomes of liver transplant are excellent: equal to any otherform of liver transplant. >> how do you go about finding donors?
>> now, that can be tricky, and, but yet peoplecould have their own family members give live donor transplant and the waiting list oftenallows most of the people with liver cancer to successfully receive a transplant; 90 percentof the people who get listed for transplant with liver cancer successfully receive theirtransplant. >> now, dr. gusani, i know it's not an easyabc type of answer, but talk about survival rate for someone diagnosed with liver cancer. >> sure, chuck. well, i think the most importantmessage is that these can be curable tumors. surgical treatments like transplantation,that dr. riley described; surgical removal of liver tumors, as we saw in our two cancure patients with liver cancer if we find
it early enough. unfortunately, a lot of livertumors are found at advanced stages, and for those patients, we also have treatment options,sometimes not curative, but which can prolong life and give people an excellent qualityof life. >> i sounds like there's been dramatic progress-- and constantly making progress -- in fighting liver cancer. what about -- compare that tosay, 10 or 20 years ago: how do we stand? >> absolutely. everything has changed in thelast 10 or 15 years with regard to liver cancer. we have newer chemotherapies, both for hepatocellularcancer or primary liver cancer, as well as colon cancer and other tumors spread to theliver. we have better technology. we're able to do bigger and more extensive liver resectionswith combinations of interventional treatments
like what dr. waybill described. we're ableto do these big operations now minimally invasively. mrs. rhoades had a minimally invasive hepatectomyand was home within a week after her surgery; small scars, less pain and faster recovery.so it's a very good time if you are unfortunately diagnosed with liver cancer to have your treatmentsin a multidisciplinary fashion and we can provide excellent outcomes. >> is any set rule we can do to maybe preventliver cancer? >> sure. that's the most important questionand the one on everybody's minds. it can be very difficult to prevent liver cancer, butthe most important principles are a healthy liver lifestyle, which includes using alcoholin moderation, as well as, as you know, there's
an obesity epidemic in the united states andfatty liver -- as dr. riley talked about -- is one of the most common upcoming causes ofliver cirrhosis and liver cancer in the united states. so you have to watch your cholesteroland watch your diet. >> besides the alcohol, any particular foodsyou should kind of steer away from? >> that directly hit the liver? >> well, it's, it's similar to a heart-healthydiet. something that lowers your cholesterol, low in fats, and combined with exercise cankeep your cholesterol low and prevent fatty liver. >> how important -- i noticed in, when wesaw the two stories tonight about how they
were treated and so on; what about attitudeof the patient? >> well, that's critical. obviously theseare tough diagnoses, and patients can have difficulty dealing with the news, but witha positive attitude, it's very important that they also understand that they're going toneed a lot of support. the family is important in helping the patients through these multipletreatments and in helping to keep the patient's outlook good. the other thing that we recommendis physical activity. it's critically important with any kind of treatment that the strongeryou are going in, the better chance you have of recovering faster and healthier. >> a lot of progress has been made, so.
>> yes, sir. >> thank you, doctors, for joining us heretonight.
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