Timothy L. Cannon, MD, is board certified in medical oncology, hematology and internal medicine. His specialty is managing gastrointestinal cancers. Dr. Cannon emphasizes personalized care for his patients and is interested in pharmacogenomics as well as using technology to improve patients’ access to care. Read Dr. Cannon’s profile.

Entertainment legend David Bowie’s death from liver cancer made headlines around the world last week. Bowie had been diagnosed 18 months ago but had not publicized his condition. Fans were in shock when the news broke that the beloved icon had passed away.

The average prognosis after a liver cancer diagnosis is generally about a year. However, Bowie never disclosed details of his diagnosis or treatments (if any). We can only speculate about what transpired in between his diagnosis and his untimely death.

Liver Cancer: Diagnosed Too Late

Liver cancer is the second most common cause of cancer-related deaths in the world, and the sixth most common cause of cancer death in the United States. Though doctors can successfully treat liver cancer when it’s caught early, most of the time, a patient is diagnosed when the cancer has reached an advanced stage.

This happens because the cancer often does not cause symptoms during its early stages. Or, a patient may attribute the symptoms to another condition. By the time the cancer causes pain and a patient sees a doctor, it is often too late for a cure. This could have been the case with Bowie.

The Lifestyle-Liver Cancer Connection

Many are speculating whether Bowie’s “rock ‘n roll” lifestyle led to his liver cancer. However, it is not even clear from reports whether he had a primary liver cancer or if his cancer started somewhere else and spread to his liver. Either way, his case presents an opportunity to bring more publicity to the disease with the hope of improving awareness.

One of the most common causes of liver cancer is cirrhosis, a progressive disease that causes the liver to stop functioning. Cirrhosis can be caused by:

  • Heavy alcohol use
  • Hepatitis B or C infection, which a person may contract due to drug use or multiple sexual partners

We have no reason to believe that Bowie’s lifestyle contributed to the disease. What we do know is that patients who have alcoholism or have had hepatitis B or C should talk to their doctors about liver cancer screening. The screening process usually involves a simple blood test and a (painless) liver ultrasound.

Liver Cancer Treatment Options

If we catch the liver cancer in its early stages, we will either remove the tumor surgically or perform a liver transplant. If it is too late for surgical treatment or transplant, we will use:

  • Liver-directed therapy: We deliver treatment directly to the liver. At Inova, our excellent interventional radiology team administers this treatment. Liver-directed therapy shrinks the tumor, which decreases the pain. The treatment will most likely extend a patient’s lifespan, though this has been difficult to prove in clinical trials. Liver-directed therapy includes:
    • Chemoembolization: Medication that kills the blood supply of the tumor, resulting in tumor shrinkage
    • Yttrium-90, a radiation treatment: Radioactive beads injected into the vasculature (blood vessels) surrounding the tumor
    • Radiofrequency ablation: Radiofrequency energy, which burns the tumor
  • Systemic treatment: Instead of targeting only the liver, these treatments target cancer cells anywhere in the body:
    • Sorafenib: This new FDA-approved medication blocks the signals that tell cancer cells to grow. It also prevents cancer cells from forming blood vessels. Without a blood supply, the tumor cannot grow.
    • Infusion: Systemic chemotherapy treatments seek out and destroy cancer cells in the body but are not as effective in cancer that originates in the liver.

Liver Cancer Treatment: New Clinical Trial at Inova

At Inova, our liver cancer team is excited about a new clinical trial set to open within a few months.

We recently received approval for a clinical trial using immunotherapy to treat hepatocellular cancer (the most common type of liver cancer). The new medication, called pembrolizumab (brand name Keytruda®), works with a patient’s own immune system. It helps the immune system better recognize the tumor and activate itself to destroy the tumor cells.

So far, results have been promising. Patients that responded to the medication experienced long-lasting results. In some cases, the tumor even disappeared. Learn more about clinical trials at Inova.

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