What Is My Prognosis?
As a patient or family member with a love one afflicted by liver cancer, you may be afraid or intimidated to ask your doctor "what are my odds", or "how much longer do you think I can live if I decide to be treated?" These are reasonable questions to ask and you should expect a compassionate and honest answer from your physician. Unfortunately, doctors cannot always answer these questions with certainty because they cannot accurately predict the future in any patient. The best answers in response to these questions that a physician can give a patient are calculated guesses based upon statistics that have been generated from treatments offered to thousands of patients as well as based upon their own personal experience.
Statistics (averages) are useful to know and may help you or your family come to a decision about treatment, but keep in mind that no single individual by himself or herself is a statistic. Another way of thinking about this is as follows: if the odds of living 5 years with colon or rectal cancer metastatic to the liver are less than 5% (only 5 chances out of a 100) who is to say that you may not be one of those 5 people. While it is reasonable for you to ask your doctor "what are my odds" or "how long do I have to live" you should be aware of the fact that your doctor does not have a crystal ball and can only give you an educated guess for your situation that is based upon previous results. The prognosis for primary liver tumors and metastatic tumors is covered in greater detail in those specific sections of this site.
Cancer of the liver is an advanced form of disease and few patients survive it, even with the best treatment available today in the best cancer centers. Most patients live for less than one year from the time their diagnosis is established. Since survival time is limited and most forms of therapy are not curative, it is important for physicians to discuss the pros and cons of treatment options balanced by preservation of the patient's quality of life. Many patients may choose to spend more time with their family and loved ones rather than under take time consuming medical and surgical therapy once they know that the chances of living for more than a year are slim. It is important for doctors to respect this wish of many patients and to not deprive them of this option if they choose it. Therefore, as a patient, you should ask your doctor for a thorough explanation of the benefits verses the risks of any treatment being proposed to you. In addition, you should ask your doctor, what their opinion is with respect to what your chances are of living 1, 3 or 5 years in order to help you make a decision as to whether or not you want to receive treatment.
Survival versus preserving quality of life
Physicians treating patients with cancer of the liver should strive for two goals: to achieve added survival time and maintain good quality of life. Your physicians should strive to achieve a balance between these two goals and be guided by your wishes. If you have no symptoms and have very advanced cancer you have little to gain from any form of current therapy outside of a clinical trial. You would not be served well if you received therapy that has no proven benefit and it associated with significant side effects that impairs your quality of life. For example, if a patient does not have symptoms and has incurable metastatic colon or rectal cancer to the liver and has nothing done, they may have 5 months of decent quality of life.
Alternatively, if such a patient decides to undergo aggressive treatment such as liver resection combined with hepatic artery infusion therapy, they will have a 6 week recovery period after operation, provided there are no complications. In addition, they will have to come to the Doctors' office every 2-3 weeks for the next year. The trade off for this time consuming approach, which will definitely affect the patient's lifestyle, is the hope that their cancer will be controlled and they will live longer. Many patients are willing to take this approach where they trade the temporary discomfort of undergoing an operation and accept some impaired quality of life for the expectation of living longer. As stated previously, the best chances of this happening is if there is no cancer anywhere else other than in the liver.
If I eventually die from this cancer in my liver, what will it be like? Will it be painful?
Cancer of the liver usually is not painful. In fact, most patients who have liver cancer never know it until a CT scan or MRI demonstrates it. If you develop pain in your liver or in your side or chest, it is usually adequately controlled by pain medication. You should absolutely ask your doctor for more pain medication if the amount he/she has prescribed you is not adequate. Pain can almost always be controlled but may require larger doses or stronger medications. If your cancer continues to grow inside your liver it may lead to liver failure. Liver failure usually leads to progressive fatigue and loss of appetite. Patients spend more time in bed sleeping and eventually lose weight. You may become yellow (jaundiced) and you may develop some nausea. These effects usually do not develop until the last two or three weeks of your life at which time you may slip into a semi-coma. In patients with cirrhosis and liver cancer, as many patients die with liver cancer as patients who die because of the cancer.
Hospice services are almost always available to help people and families with the terminal aspects of this disease and you should never hesitate to ask for these services which can be tremendously helpful to you and your family.
