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Liver Cancer Explained: Risks, Treatments, and Hope · Talking FACS

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  Welcome to Talking FACS, and thank you for tuning in to Cancer Conversations
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  on Talking Facts, a podcast collaboration between the University of Kentucky
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  Markey Cancer Center and the UK Martin Gatton College of Agriculture,
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  Food and Environments Cooperative Extension Service.
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  We will share with you the latest developments in cancer prevention,
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  diagnosis, treatment and research from the experts at Markey Cancer Center,
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  Kentucky's only National Cancer Institute designated Comprehensive Cancer Center.
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  Talking FACS is hosted by the UK Family and Consumer Sciences Extension Program.
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  Our educators share research knowledge with individuals, families,
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  and communities to improve quality of life.
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  Hello and welcome to Cancer Conversations on Talking FACS.
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  This is a partnership presentation between the University of Kentucky Market
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  Cancer Center and the Martin-Gatton College of Agriculture, Food and Environment's
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  Cooperative Extension Service.
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  Together, we are raising awareness and bringing cancer information to local
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  communities across the Commonwealth.
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  I am your host, Mindy McCulley, Extension Specialist for Instructional Support
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  with Family and Consumer Sciences Extension, and I'm your host today.
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  My guest is Dr. Mautin Barry, who is an Assistant Professor of Surgical Oncology
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  in the College of Medicine at the Market Cancer Center. Welcome, Dr. Barry. How are you?
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  Oh, thank you very much so much for having me, Mindy. It's such a pleasure to be here with you today.
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  I'm glad that you're here. And we're going to talk about liver cancer,
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  which I can see that it would be one of those areas where we can really find
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  new and interesting things almost probably every day.
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  Absolutely. I am a surgical oncologist by trade and training.
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  So, my surgical specialty focuses on patients who have stomach cancer,
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  liver cancer, and pancreatic cancer.
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  So, this is well within my wheelhouse, and I'm very excited to talk about this
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  very important disease process.
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  So, when we talk about the cancers of the liver and the stomach and the pancreas,
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  Is there a broad class of cancers that are really affecting that region of the body?
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  Right. So absolutely. So when we think about gastrointestinal cancers,
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  that's the broader term.
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  So basically cancers that arise anywhere in the abdominal cavity.
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  So we think about cancers that involve in the stomach, the intestines,
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  all of that is in that category.
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  Also other cancers that involve what we call the hepatobiliary system.
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  So that involves the liver, the bile ducts, which are pretty much the highway
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  that carry bile that's produced by the liver into the pancreas and into the rest of the intestine.
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  And then also we think about pancreatic cancer, which a lot of people know about
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  because it's fairly common.
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  And it's also one of those cancers that presents a formidable challenge in the field.
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  I'm interested that you mentioned that because we do hear a lot about pancreatic
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  cancer, and it seems like it has a really high mortality rate,
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  but it doesn't seem to have lots of symptoms that people present with.
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  Is that right? Correct. Absolutely.
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  So pancreatic cancer, like most gastrointestinal cancers, is very insidious.
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  And what I mean by that is that usually in the early stages,
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  patients are asymptomatic.
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  And for most of these, we don't have adequate screening to be able to detect
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  patients early in the disease process.
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  So we have these cancers that unfortunately, by the time we diagnose them,
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  patients are late in their stage.
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  And cancer is one of those phenomenon where the later you find it.
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  The fewer treatments are available and fewer treatments have any efficacy at all.
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  So pancreatic cancer, liver cancer, stomach cancer all fall into that bucket
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  of disease that are difficult to treat because we catch them when,
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  unfortunately, patients are advanced.
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  We do not have good, adequate screening mechanisms to catch them early.
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  And patients usually do not have symptoms by the time they present to us.
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  So as we think about cancer,
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  I know you talked about as cancer metastasizes from general types of cancer,
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  then it's going to metastasize to different parts of the body.
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  And so what happens then?
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  Yeah, so particularly when I think of the liver, cancer loves to metastasize to the liver.
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  And that's because the liver, one of the major functions of the liver is that it helps to detoxify it.
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  The acid, it helps to clear toxins out of the body.
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  And the rest of the gastrointestinal tract drains through the liver,
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  through what we call the portal vein.
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  And so that portal vein acts as a highway that cancers of the gastrointestinal
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  tract have a highway to go directly into the liver.
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  Liver cancer in general is a broad term, and it includes both what we call primary liver cancer,
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  basically when the liver itself develops a cancer, and then also secondary liver
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  cancer, as we like to call it, but basically when cancer spreads from other parts,
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  particularly in the other gastrointestinal systems as well.
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  So if cancer spreads from the stomach or from the small intestine or from the
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  pancreas into the liver, it's called metastatic cancer.
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  As opposed to if the liver itself develops its own cancer, that's called primary liver cancer.
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  And when we think of primary liver cancer, there are two major types.
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  There's multiple different kinds, but the most common, hepatocellular carcinoma,
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  which is a primary liver cancer, and it's associated usually with,
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  people think about hepatitis as one thing.
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  Alcohol is another risk factor, but it's associated with some sort of chronic insult to the liver.
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  And as the liver tries to repair itself in that process of inflammation, cancer can develop.
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  Now, the other type of primary liver cancer, it's called intrahepatic cholangiocarcinoma.
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  And that is basically a type of cancer of the liver bile ducts.
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  So those are the two types of cancer. Hepatocellular carcinoma,
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  which is more of a cancer of the liver cells themselves, the liver parenchyma.
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  And then intrahepatic cholangiocarcinoma, which is a cancer of the bile duct in the liver.
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  These two types of cancers actually have very similar risk factors.
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  So with hepatocellular carcinoma, which is the most common, it constitutes about
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  70%, 70 to 80% of primary liver cancer.
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  The major risk factors include alcohol use, which is very high in the United States.
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  So chronic alcohol use can damage the liver.
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  It's hepatotoxic, as we call it. And that leads to a pattern of what we call
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  liver fibrosis, where the liver is injured.
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  And then it leads to cirrhosis, which is end-stage liver disease,
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  and then that leads to liver cancer.
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  And the other type of liver cancer I talked about, which is the intrahepatic
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  cholangiocarcinoma involving the bowel duct, one of the risk factors for that is actually obesity.
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  We're seeing a lot of patients now who have what we call non-alcoholic steatohepatitis,
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  basically because of obesity and the metabolic syndrome.
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  We're seeing fat deposits into the liver and that injures the liver as well.
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  And it can predispose patients to having hepatocellular carcinoma or intrahepatic
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  cholangiocarcinoma. All right.
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  A whole lot of information, but it's fascinating information. It is.
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  Absolutely. And the major risk factor I don't want to pass off is the viral
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  hepatitis. So hepatitis B.
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  Hepatitis B, we do have vaccines for. Vaccines are recommended in patients who
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  are high risk, so like healthcare workers and other high risk populations.
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  And then hepatitis C, we don't have a vaccine for, but there is a treatment
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  now for hepatitis C. But those are the major risk factors for developing liver cancer.
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  And when I think about Kentucky, so Kentucky itself, in general,
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  in Kentucky, most cancers that you can think of, we have a higher incidence
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  in Kentucky than the rest of the country.
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  And that is for various cancers, including colon cancer and other types of cancers,
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  and now also liver cancer as well.
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  The incidence of liver cancer in the country is about 8 in 100,000 patients
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  have liver cancer. It only contributes to about 2% in general of cancer.
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  So in general, it's a rarer type of cancer. But in Kentucky,
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  almost about 9 or 10 in 100,000 patients have liver cancer.
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  So it's slightly higher than the general population.
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  And if we think about it, it's most likely due to the various risk factors like
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  we talked about that happen to be higher in Kentucky.
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  So alcohol use, hepatitis, viral hepatitis, obesity, unfortunately higher in
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  our neck of the woods here, and then also smoking as well.
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  Also high incidence of all of those things in here in Kentucky.
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  And all of those things, all those risk factors contribute to the higher incidence
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  of liver cancer in Kentucky.
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  What are some ways that we are treating liver cancer? So we do have different
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  tools in our toolbox for liver cancer.
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  That being said, though, the mortality is still pretty high.
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  And, you know, in the last, from the 1980s to now, we've actually seen a doubling
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  of mortality, of deaths from liver cancer.
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  But now, I will say there's a lot of technologies that we have now to treat
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  that we did not have before. So if I just talk about hepatocellular carcinoma
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  for a second, just to talk about that, talk about the treatment for that.
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  So the treatment of hepatocellular carcinoma, which is, like I said,
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  the main type of primary liver cancer, depends on various factors.
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  It depends on, one, the size of the tumor, how many tumors the patients have,
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  and then it also depends on their liver health.
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  As I said earlier, hepatocellular carcinoma usually stems from some sort of
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  chronic or long-term liver injury.
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  So usually those patients, their livers are not healthy.
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  Their livers are sick. As opposed to patients who have the secondary liver cancer,
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  which is metastasized, most of those patients actually have healthy livers.
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  It just so happened that cancer got there. But with the primary liver cancers,
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  because it usually stems from a baseline chronic injury and inflammation.
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  Their livers are not well.
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  So we take that into consideration when we're thinking about how we're going
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  to manage those patients.
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  The mainstay of treatment for patients that we can is to do surgery to resect the liver properly.
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  To cut out the tumors. And if we're able to do that, that's the only thing that
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  actually provides a chance of cure, in addition to giving them a whole new liver,
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  which is a liver transplant.
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  So the critical options are either you cut out the tumor, liver resection,
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  which here at University of Kentucky, we're fabulous at.
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  If I do see it so myself, we have a great team of myself and other surgeons
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  who do this operation very, very safely.
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  And then the other surgical option is a liver transplant. And we have an excellent transplant team.
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  I'm not one of them, but we all meet at a liver tumor board because we approach
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  patients with liver cancer at University of Kentucky in a multidisciplinary fashion.
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  And we meet every Friday where all the different doctors that take care of patients
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  with liver cancer meet and we go over imaging and we make up the plan for the patient.
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  It's a very collaborative, very sort of, it's a team effort and not just one
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  doctor having to think through the literature and the best way to manage the
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  patient because no two patients are the same.
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  So going back to the different treatments, so surgery to remove the tumor.
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  Liver transplant, there's other what we call other things, other approaches
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  called local original therapies, which were also really, really good here at
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  the University of Kentucky.
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  Basically, our interventional radiology colleagues have different ways that
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  they can go through minimally invasive approaches to burn the tumors for patients
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  that for some reason we cannot do the surgery on.
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  They can burn the tumors going through the hepatic artery.
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  So basically going through the artery of the liver, they're able to target the
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  tumors. Those procedures are called embolization or TACE, which is called chemoembolization,
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  trans-anterior chemoembolization.
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  And then we'll have other things called like radioembolization, like Y90.
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  So those are the ways that our innovation radiology colleagues can also treat liver cancer.
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  And then the last way that's becoming more and more, it's sort of a newer way
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  of treating liver cancer is through immunotherapy and targeted therapy as well.
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  So immunotherapy is one of probably
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  the most exciting advancements in our lifetime for treating cancer.
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  Basically, what immunotherapy is, is that it utilizes the patient's own immune system to fight cancer.
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  And immunotherapy has been used widely for different cancers.
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  And luckily for liver cancer, it works.
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  So immunotherapy is now being utilized for patients who have liver cancer that
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  cannot be treated by surgery or liver transplant or any of the other local regional means.
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  And it's really exciting. Yeah, I was going to say, it sounds phenomenal to
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  me because I would think if you're using your own cells that you wouldn't have
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  the concern about rejection and that sort of thing that you might have with a transplant, right?
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  Right, right. So yeah, the type of immunotherapy that we use for hepatocellular
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  carcinoma, it's called a checkpoint inhibitor. And what that is,
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  is that it's a drug that we give to the patients.
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  And what that drug does is that it basically causes the patient's T-cells to
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  become persistently active.
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  Because what happens is our T-cells and our immune cells, when they see a foreign
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  body, they can initially get active, but then they get exhausted.
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  Basically, they get married.
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  They're like, oh, this thing is still here. Okay, we tried to kill it. Okay, bye. We're done.
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  Give up. So what immunotherapy does is it tells its T-cells,
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  hey, stay active. You can't quit.
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  You can't quit. That's exactly right. And that type of immunotherapy called
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  checkpoint-based immunotherapy is being used now for liver cancer and it has
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  produced phenomenal results, actually.
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  And when I look here at UK, we have different trials now that we're actually combining therapies.
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  So in addition to surgery, we're also then giving patients immunotherapy on
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  the back end so that the cancers that we removed by surgery does not come back.
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  So there's different ways. And then I forgot to mention one last way that we
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  have here to treat is radiation.
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  And radiation also for patients who cannot get more definitive treatment.
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  Our radiation oncologists are phenomenal. And they're able to give those patients,
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  it's called stereotactic body radiotherapy.
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  And it's just, it's another way to help those patients. So in general,
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  here at UK, at the Markey Cancer Center, where we have different tools in our toolbox. Yeah.
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  Different tool. I'm just sitting here thinking, I don't want to get liver cancer,
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  but if I'm going to get it, I think I'm in the right place.
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  Absolutely. I will say, being the only NCI comprehensive cancer center in the
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  state, it's a big mandate.
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  Right. Thankfully, we're able to rise to the challenge and give patients sort
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  of the multidisciplinary, multimodal care that cancer deserves.
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  Yeah. And it's just amazing that we have so much available to us here.
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  And really, there's no place in Kentucky that can't get to UK.
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  You know, we are not far from anywhere and, you know, other states as well,
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  but there is no place in Kentucky that we cannot get them to UK.
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  And so we're really very fortunate to have the work that you all are doing here.
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  Absolutely. Yeah, we're absolutely fortunate to have all the tools and to have
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  the support from the Cancer Center to give our patients the very best care possible.
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  So if we do have to have the worst statistics, at least we have the best care as well.
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  That's exactly right. That's exactly right.
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  Unfortunately, the statistics are terrible here in Kentucky,
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  but we do have dedicated physicians willing, able, have the tools to take care of patients.
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  I think that's wonderful. And I just really appreciate the time that you've
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  given us because your knowledge and your willingness to share that has been
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  phenomenal. And I've learned a lot.
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  I've been sitting here with my mouth hanging open.
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  So I'm sure that our listeners have been just as enthralled.
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  Absolutely. I'm very happy to be here. And thank you so much for having me.
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  And if any of our listeners have any questions, they can reach out to us.
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  The Cancer Center has different phone lines available to take on,
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  you know, for patients to call and ask questions and see any one of the members of our team.
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  Sure. And of course, we provide all of your access points in the show notes
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  so they can always reach out.
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  That's always a resource. You all are great and we are just tickled to have you as partners.
• 18:55
  Absolutely. Thank you very much. If you are just tuning in, you're listening
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