PROGNOSIS AFTER DIAGNOSIS OF LIVER CANCER:
The Influence of Chinese Herbs
Reports about treatment of liver cancer have often included a statement that the disease has a "poor prognosis." Sometimes, this is more specifically stated, such as in a 1994 pathology textbook: "The outlook for hepatocellular carcinoma is not good, with death occurring within six months of diagnosis."
Patients diagnosed with cancer generally expect their physicians to provide them with a prognosis, an educated guess about what will happen to them. In the case of liver cancer, which has generally been associated with a poor outcome, the patients may want to know how long they have to live. While it is impossible to know the lifespan of any individual, the chances (probability) of passing a certain survival time can often be given. Factors that can alter this survival, including treatments with standard, experimental, and complementary therapies, can be taken into account, but also introduce uncertainty into the determination.
Currently, prognosis for life-expectancy is based on statistical data for prior cases that have been documented, analyzed, and summarized. In the case of cancer, survival time after the initial diagnosis is measured in median duration to death or in rate of survival past certain marker points, usually 1, 3, and 5 years. Median duration to death is the time at which 50% of patients have died; survival rate indicates the percent of patients surviving at a given time point after diagnosis of the disease. Data used for survival rates do not take into account the actual cause of death, which can include adverse effects of attempted treatments and death due to other diseases. Sometimes, prognosis is also given in terms of improvements versus disease progression within a limited treatment period without reference to survival duration.
Improvements in the accuracy of prognosis occur as a disease category (e.g., liver cancer) is subdivided according to parameters that affect overall outcomes. Liver cancer may be divided first into two broad categories: primary (hepatocellular carcinoma) and secondary (metastases from other cancers, such as colorectal carcinoma). The cancers are then staged (I through IV) based on tumor size, tumor number, and invasiveness into the organ's vascular system, with decreasing survival as the stage of disease progresses. Recent research, described below, provides a number of other determinants for survival.