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Nearly a third of patients with large bowel cancers (colorectal cancer) spread to the liver (liver metastases) within five years of diagnosis of bowel cancer. The affected part of the liver can be removed surgically in a quarter of such patients who develop liver spread from bowel cancer. About a seventh of these patients, in whom the affected part of the liver is suitable for removal, develop cancer involvement of lymph glands draining the liver (hepatic lymph node). Such patients are associated with poor survival even after removal of the affected part of the liver and the involved nodes. This Cochrane review attempted to answer the question of whether removing the part of the liver is better than other forms of treatment (such as no treatment, chemotherapy, heat destructive therapy using radiofrequency waves, ie, radiofrequency ablation) in such patients but did not find any randomised clinical trial addressing the issue. Currently, there is no evidence from randomised clinical trials for optimal management of these patients. High quality randomised clinical trials are feasible and are necessary to determine the optimal management of patients with colorectal liver metastases with hepatic node involvement.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: January 20, 2010

A biopsy (taking a tissue sample) is one of the most commonly used medical tests. Tissue samples can be analyzed in order to find out, for instance, whether a suspicious lump is harmless or dangerous.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: February 10, 2016

Liver fibrosis is a change in the microscopic structure of the liver because of liver inflammation. After many years of excessive alcohol consumption, liver fibrosis progresses to cirrhosis. Abstaining from alcohol may stop the fibrosis from further progression into significant or severe fibrosis and cirrhosis. The latter lead to complications of underlying diseases, including cancer.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: January 22, 2015

Hepatocellular carcinoma (that is, primary liver cancer) is the most common malignant tumour of the liver and the fifth most common malignant tumour worldwide. In the majority of people, hepatocellular carcinoma is diagnosed at an advanced stage. For these people, treatment options include ablation therapy (which destroys the tumour), embolisation therapy (the use of substances to block or decrease the flow of blood through the hepatic artery to the tumour), radiotherapy, or sorafenib, which is a targeted therapy (a treatment that uses a substance to identify and attack cancer cells while avoiding normal cells). Yttrium microsphere radioembolisation involves the injection of very small spheres that have radioactive material attached to them into the blood supply of the tumour. The radioactivity is supposed to destroy the liver tumour without affecting other parts of the body.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: February 16, 2016

Hepatic cirrhosis is a severe disease with scars and nodules on the liver tissue. As a result, the normal function of the liver is impaired. Whatever the cause of cirrhosis, changes in the structure of and blood flow within the liver increase pressure in the portal vein (called portal vein hypertension), which is the vein that drains blood from the bowels to the liver. Portal hypertension induces dilatation (extension) of veins within the wall of the oesophagus (food pipe or gullet), which often rupture (break) with severe bleeding. Thus, when liver cirrhosis is diagnosed, an oesophago‐gastro‐duodenoscopy (OGD) is recommended to detect the presence of oesophageal varices (areas of abnormal dilatation of veins). During OGD, a small camera at the end of a tube is inserted down the oesophagus from the mouth and pictures are relayed back to a screen. Large varices or red signs on even small varices show high risks of rupture and bleeding. If high‐risk varices are found, treatment with beta‐blockers is effective in reducing the risk of bleeding. Three simple non‐invasive tests could be used to identify people with liver diease at high risk of having oesophageal varices: platelet count ‐ a simple laboratory test on a blood sample by which the number of platelets (a blood element ensuring coagulation) is measured; length (maximal diameter) of the spleen measured during ultrasound examination of the abdomen; and ratio of platelet count to spleen length.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: April 26, 2017

Liver cancer (hepatocellular carcinoma) is the fifth most common cancer worldwide. In the majority of people, liver cancer is diagnosed at advanced stages of the disease and is mostly accompanied by liver cirrhosis. In high‐income countries, about 30% of people present with the more favourable early liver cancer. For these people, percutaneous ablation techniques (destruction of the cancer cells by heat, cold, or chemical substances such as ethanol), surgical resection (removal of part of the liver), and liver transplantation (which is limited by organ donor shortage) are currently considered potentially curative treatments. We aimed to investigate the role of percutaneous injection of ethanol (PEI) and acetic acid (PAI) as compared with other treatments or no intervention for early liver cancer. This review excluded the effects of radiofrequency thermal ablation as this has been already addressed in a previous Cochrane Hepato‐Biliary Group systematic review.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: January 26, 2015

Hepatocellular carcinoma (primary liver cancer) is the most common cancerous tumour of the liver and the sixth most common cancerous tumour worldwide. In the majority of people with hepatocellular carcinoma, the disease is diagnosed at the advanced stage. Treatment options for these people include ablation (which destroys the tumour), embolisation (the use of substances to block or decrease the flow of blood through the hepatic artery to the tumour), radiotherapy, or sorafenib, which is a targeted drug therapy (a treatment that uses a substance to identify and attack cancer cells while avoiding normal cells).

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: March 7, 2017

Hepatocellular carcinoma (primary liver cancer) arises from the liver cells and is distinct from secondary liver cancer, arising from other parts of the body and spreading to the liver. Hepatocellular carcinoma can be classified in many ways. One classification is by Barcelona Clinic Liver Cancer (BCLC) group stage which classifies the cancer based on how long the person is expected to live (life expectancy). This classification is broadly based on the size of the cancer, number of cancers in the liver, how well the liver works, and whether one's activities are affected by the cancer. People with intermediate‐stage hepatocellular carcinoma have large, multiple cancers, but they do not have full‐blown liver failure. Cancer is confined to the liver, and there is no restriction of daily activities. There is significant uncertainty in the treatment of people with intermediate‐stage hepatocellular carcinoma. We sought to resolve this uncertainty by searching for existing studies on the topic. We included all randomised clinical trials (well‐designed clinical trials where people are randomly put into one of two or more treatment groups) whose results were reported to September 2016. We included only trials in which participants with intermediate‐stage hepatocellular carcinoma had not undergone liver transplantation previously. Apart from using standard Cochrane methods which allow comparison of only two treatments at a time (direct comparison), we planned to use an advanced method which allows comparison of the many different treatments that are individually compared in the trials (network meta‐analysis). However, because there was only one comparison, we could only use standard Cochrane methodology.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: March 10, 2017

Hepatocellular carcinoma (primary liver cancer) arises from the liver cells and is distinct from cancer arising from other parts of the body and spreading to the liver. The Barcelona Clinic Liver Cancer (BCLC) group staging classifies cancer based on patient's life expectancy. It is broadly based on the size of the cancer, number of cancers in the liver, how well the liver functions, and whether one's activities are affected by the cancer. People with very early‐ or early‐stage hepatocellular carcinoma have single cancer or multiple small cancers confined to the liver, have good liver function, and no restriction of activities. There is significant uncertainty in the management of early‐stage hepatocellular carcinoma. Therefore, we searched literature databases for randomised clinical trials (RCTs) on the topic until September 2016. We excluded trials in which participants had previously undergone liver transplantation. Apart from using standard Cochrane methods, which allow comparison of only two treatments at a time, we planned to use advanced methods described in full in the review.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: March 28, 2017

Heavy alcohol consumption causes alcoholic liver disease and may lead to a number of other concomitant diseases. Alcohol may damage the function of body organs and can cause cancer. Liver damage due to excessive alcohol consumption is usually presented as fatty liver (build‐up of fats in the liver), steatohepatitis (inflammation of the liver with concurrent fat accumulation in the liver), fibrosis (fibrous degeneration), alcoholic cirrhosis (scarring of the liver), and hepatocellular carcinoma (most common type of liver cancer). When liver fibrosis progresses, alcoholic cirrhosis occurs.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: March 2, 2016

We aimed to assess different medications to treat people with non‐alcohol related fatty liver disease.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: March 30, 2017

Expert-reviewed information summary about tests used to detect or screen for liver (hepatocellular) cancer.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: July 31, 2015

Treatment of liver cancer in adults depends on the stage. Treatment options include hepatectomy, liver transplant, ablation, electroporation therapy (EPT), embolization therapy, targeted therapy, and/or radiation therapy. Learn more about treatment for the different stages of liver cancer.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: March 30, 2018

Treatment for pediatric liver cancer depends on many factors, including the type of cancer and whether it has spread. When possible, liver cancer is removed by surgery. Learn about the types of treatment options for childhood liver cancers.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: December 7, 2017

SmalI cell lung cancer accounts for nearly a quarter of all new cases of lung cancer. This cancer is often diagnosed in an advanced stage, which means that it has spread to the brain, liver, bone or bone marrow, and most patients die in the first year after diagnosis. This review found that first‐line chemotherapy (anticancer drugs) may prolong the survival of patients with advanced small cell lung cancer for some months when compared to supportive care, although the effect of this treatment on quality of life is unknown. The benefit of a new treatment (second‐line chemotherapy) when the disease has progressed or relapsed was even smaller, and the potential survival gain of some weeks must be balanced against its possible secondary effects. Since the available studies were scarce and of variable quality, more clinical trials are needed to assess and better inform patients about the real effectiveness of chemotherapy in advanced small cell lung cancer.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: November 27, 2013

The pancreas is an organ situated in the abdomen close to the junction of the stomach and small bowel. It secretes digestive juices which are necessary for the digestion of all food materials. The digestive juices secreted in the pancreas drain into the upper part of the small bowel via the pancreatic duct. The bile duct is a tube which drains bile from the liver and gallbladder. The pancreatic and bile ducts share a common path just before they drain into the small bowel. This area is called the periampullary region. Surgical removal is the only potentially curative treatment for cancers arising from the pancreatic and periampullary regions. A considerable proportion of patients undergo unnecessary major open abdominal exploratory operation (laparotomy) because their CT scan has underestimated the spread of cancer. If during the major open operation the cancer is found to have spread within the abdomen, patients are referred for alternate treatments such as chemotherapy, which do not cure the cancer but may improve survival.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: July 6, 2016

We compared radiotherapy with chemotherapy and radiotherapy before surgery in rectal cancer. We looked at people who had rectal cancer that had spread to the lymph glands but not to the liver or other organs.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: December 12, 2012

Primary biliary cirrhosis is an uncommon chronic liver disease of unknown aetiology, affecting mostly women. It is characterised by progressive inflammation and destruction of the liver tissue, eventually progressing to liver cirrhosis and the need for liver transplantation. Methotrexate, a folic acid antagonist with immunosuppressive properties, has been used to treat patients with primary biliary cirrhosis. However, the evidence did not show a clear benefit of methotrexate on mortality or the need for liver transplantation in patients with primary biliary cirrhosis. This review is based on five randomised trials; four comparing methotrexate with placebo, and one comparing methotrexate with colchicine. Methotrexate, compared with placebo, has no significant beneficial effect on mortality and the need for liver transplantation is not significantly reduced. The effects of methotrexate on pruritus, fatigue, clinical complications, liver biochemistry levels, liver histology, and adverse events were not significantly different from placebo. There may be some beneficial effect on pruritus score (ie, an objective measure of subjective feeling of pruritus), but we cannot recommend methotrexate for this indication only, taken into account possible adverse events. In the small trial comparing methotrexate versus colchicine, methotrexate seemed to work superior to colchicine, but it is not clear if this stems from the fact that methotrexate exerts beneficial effects as colchicine exerts harmful effects. In comparison with both placebo and colchicine, methotrexate was associated with large risks of mortality and adverse events, but the increase did not reach statistical significance.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: May 12, 2010

Endometrial cancer is usually diagnosed at an early stage and can be treated with surgery. Learn about the symptoms, diagnosis, prognosis, staging, and treatment for early- and advanced-stage endometrial cancer in this expert-reviewed summary.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: January 19, 2018

This summary will cover: What hepatitis C is and how it can be harmful Who is at risk for hepatitis C What hepatitis C testing is Who should be tested for hepatitis C

Comparative Effectiveness Review Summary Guides for Consumers [Internet] - Agency for Healthcare Research and Quality (US).

Version: September 13, 2013

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