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Patients with cancers of the liver larger than 2 inches are usually considered incurable by surgery. The exclusion of patients with large cancers for consideration of surgical resection (removal) has been questioned and more recent research suggests that patients with large hepatocellular carcinomas of the liver may benefit from this treatment option.

Primary liver cancer, sometimes called hepatocellular cancer or cholangiocarcinoma, is characterized by cancer that starts in cells of the liver and can spread, through blood and lymph vessels, to different parts of the body. Commonly, people with liver cancer already suffer from cirrhosis of the liver or viral hepatitis, both damaging diseases to the liver. The liver is the largest organ in the body and is responsible for over 500 functions, including the secretion of glucose, proteins, vitamins and fats, the production of bile, the processing of hemoglobin and the detoxification of numerous substances. The treatment of liver cancer depends on the size and specific stage (extent of disease in the body) of cancer. Although surgical removal of liver cancer is currently the only curative treatment option, only a small percentage of patients are treated because the majority of patients have cancer that has replaced too much of the liver or spread outside the liver to other parts of the body.

New research, however, has indicated that patients with larger liver cancers may benefit from surgical resection and should be considered candidates for this treatment. Researchers from France evaluated and compared the outcome of two groups of patients with hepatocellular cancers treated with surgery. One group of patients had small liver cancers of two inches in diameter or less and the other group had large cancers greater than 3 inches in diameter. Approximately 10% of patients in both groups died from complications of surgery. However, survival without the return of cancer 5 years after treatment was 31% in the group of patients with the smaller cancers and 21% for patients with the larger cancers.

These findings suggest that the size of the cancer alone should not be used to exclude patients with large hepatocellular cancer for surgical resection as this treatment option may be associated with an improved long term survival rate for some patients. Persons with hepatocellular cancer should speak with their doctor about the risks and benefits of surgical resection or about participation in clinical trials utilizing other promising new therapies.

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(Journal of Hepatology, Vol 31, No6, pp1062-1068, 1999)