Liver cancer
A disease with a rising death rate
Liver cancer causes death more often than many other tumors, not least because patients are usually diagnosed too late. It is thus the third most common cause of death by cancer. In Europe, not even one in ten patients survive the first five years after diagnosis. Unlike many other types of cancer, the number of deaths has actually risen further in recent years.
By far the most common form of liver cancer is liver-cell carcinoma, or hepatocellular cancer (HCC). In adults it accounts for about 90 percent of primary malignant liver tumors (i.e. malignant tumors that are not triggered by metastases).
It usually begins with an inflammation of the liver (hepatitis)
In eight out of ten people who develop liver-cell cancer, the malignant change in the cells is preceded by chronic hepatitis B. Hepatitis C is also regarded as a potential precursor of a tumor, as is cirrhosis of the liver, a pathological change in the liver tissue involving shrinkage. Many years can pass before the carcinoma develops: 20 to 30 years after chronic hepatitis C, for example.
There are also other risk factors that increase the likelihood of a tumor developing. They include excessive consumption of alcohol and morbid obesity.
The earlier the disease is detected, the better the prognosis
The early detection of a liver-cell carcinoma is crucial for successful treatment, because the tumor can usually still be surgically removed in the early stages. But in many cases diagnosis comes too late for this. According to an estimate by the German Cancer Society, this applies to 70 percent of cases in Germany. One reason is that symptoms usually do not occur until the advanced stages – and to some extent are also relatively non-specific. They include loss of appetite and nausea, as well as pressure and pain in the upper abdomen.
A blood test and an ultrasound examination can deliver the first pointers to a hepatocellular carcinoma. Computed tomography and magnetic resonance imaging (MRI) can then confirm a possible diagnosis. Bayer Schering Pharma offers a product that specifically improves the contrast in MRI images of the liver. Since the substance accumulates selectively − only in healthy liver cells − malignant lesions of the liver become clearly visible. This enables the physician to determine not only how far it has spread, but also what type of tumor it is. As a result it is rarely necessary to carry out a biopsy, i.e. to remove cells.
New prospects of a longer life
Up until 2007 there was no approved drug that was able to prolong the time to progression of liver cancer. This has changed in the meantime with a substance developed jointly by Bayer and the U.S. company Onyx Pharmaceuticals. The corresponding product has already been approved in many countries for treating liver-cell carcinoma. What is special about the substance is its differentiated mechanism of action, which combats tumor growth in two ways at the same time: on the one hand it inhibits the division of the cancer cells, and on the other it blocks the supply of blood – and therefore nutrients – to the tumor.
In clinical trials, the substance prolonged the total survival periods of patients with hepatocellular carcinoma by 44 percent compared to placebo. The progression of the disease was also significantly delayed in the studies with the active substance. At the end of 2007, the product was approved for the treatment of liver cancer in the European Union and the United States.
Many potential applications
The substance has also been successfully used in the treatment of other cancers. Its effectiveness against advanced renal cell carcinoma has already been clinically proven. It was approved for this indication for the first time in the U.S. in 2006. Many other countries have also granted approval in the meantime.
Because of its differentiated mechanism of action, the effectiveness of the substance is currently also being examined for other solid tumors. For example, Bayer and Onyx, together with other institutions and scientists, are examining its efficacy against numerous tumor types, including breast and lung cancer, in a comprehensive study program.
Advice for patients
Every body reacts differently to medicines. Therefore it is impossible to tell which medicine works best for you. Please consult your physician.
