Liver Anyone?

In a classic twist of reason and fate, people with advanced colorectal cancer end up talking far more about their liver than they do their guts.  This makes sense, of course.  The liver is the most common site for metastasis of colorectal cancer, and the majority of deaths caused by this cancer are due to liver failure.

No surprise, then that the rising stars of cancer treatment are the liver experts.  And they are doing some amazing work these days.

The process for treating the metastatic form of this cancer is to remove the tumor from the colon or rectum, then use chemotherapy to knock out tumor cells in other parts of the body.  The problem arises when you have tumors in the liver.  How do you get rid of those?  In the old days a surgeon would look at the liver and determine how many tumors were present and how large they were.  That information was fed into a formula and a decision was made to cut or not to cut.  Now it is much more fluid.  It turns out we can lose a lot more liver that we thought and still do OK.  And, it turns out that a liver that is too tumor-ridden for surgery can sometimes be changed into a liver that is operable.

These days doctors are using a number of methods to attack liver tumors.  Chemotherapy sometimes shrinks the tumors so a previously inoperable liver becomes operable.  Sometimes doctors will insert a small needle directly into the liver, finding the tumor with the help of imaging devices like MRI or CT scan.  Once there they can use electrical current to generate local heat and kill a circle of cells about the size of a golf ball.  Or they can freeze cells.  Or kill them with microwaves.  Or subject them to localized radiation. 

The technology is absolutely fascinating. But that’s not what I want to say here.

The Broadway musical Rent features a song that asks, “How do you measure… a year?”  The answer is this:  “In daylights, in sunsets, in midnights, in cups of coffee.   In inches, in miles, in laughter, in strife.” 

We can talk all we want about the fancy technology.  We can use technical language like RFA, cryoablation, radioactive yttrium, and caudate lobectomy.  But what it boils down to is this:  because of these developments, men and women—husbands and wives, fathers and mothers, sons and daughters--will have the chance for a few more cups of coffee with the ones they love.  A few more sunsets, a few more miles walked together, a few more laughs, a few more tears. That, more than all the technology in the world, gives me hope.