Remembering Mickey Mantle and Understanding Liver Cancer

What was reported

Mickey Mantle played his whole career in center field for the New York Yankees. He hit 536 home runs, which placed him eighth on the all-time list when he died in 1995.

UPI reported that he died on Sunday, August 13, 1995, at Baylor University Medical Center in Dallas. He was 63. His death "came two months after he underwent a liver transplant," UPI wrote. "Shortly thereafter it was discovered the liver cancer had spread throughout his body."

The wire recorded one more thing worth honoring. A hospital statement said chemotherapy had been stopped. At Mantle's request, no further information would be released.

So this page stops there. What follows is about liver cancer itself, which most people know far less about than its numbers warrant.

Two cancers called liver cancer

Primary liver cancer means cancer that starts in the liver. It comes in two main forms. Hepatocellular carcinoma, shortened to HCC, starts in liver cells. Intrahepatic bile duct cancer starts in the ducts inside the liver.

A third thing is often confused with these. Cancer that spreads to the liver from the colon or breast is not liver cancer. It is the original cancer, growing in the liver. It is treated as such.

Cirrhosis is the central fact

The National Cancer Institute (NCI) states that cirrhosis is involved in as many as 80% of HCC cases. Cirrhosis is scarring of the liver from long-term injury.

That single fact reorganizes everything. Liver cancer is rarely a random event. It usually grows in a liver damaged for years. So there is often a window when the risk is already known.

NCI lists the risk factors:

• Chronic infection with hepatitis B or hepatitis C
• Cirrhosis from any cause
• Heavy alcohol use
• Nonalcoholic steatohepatitis, a fatty liver disease with inflammation
• Tobacco use
• Foods contaminated with aflatoxin B1
• Inherited conditions including hemochromatosis, alpha-1 antitrypsin deficiency, Wilson disease, glycogen storage disease, and porphyria cutanea tarda

NCI adds that HCC is fairly uncommon in the US. But it is rising, "principally in relation to the spread of hepatitis C virus infection." Worldwide it is the sixth most common cancer, and the third leading cause of cancer death.

The most useful thing on this page

Do you have cirrhosis, or chronic hepatitis B or C? Ask your clinician about liver cancer surveillance. Regular imaging in high-risk people is how small, treatable tumors get found.

And get tested for hepatitis C. The Centers for Disease Control and Prevention recommends testing for all adults, all pregnant women, and anyone recently exposed. CDC calls it "a leading cause of liver cancer and the leading cause of liver transplants in the United States."

The treatment picture has changed completely. CDC states that treatment "cures more than 95% of patients with hepatitis C, usually without side effects," typically with 8 to 12 weeks of oral medication. CDC estimates more than 2.4 million people in the US had hepatitis C between 2017 and 2020. Many do not know it.

Curing hepatitis C does not erase cirrhosis that is already there. Surveillance continues. But it removes the driver of ongoing damage.

Get help now

If you have liver disease, go to an emergency department for:

• Vomiting blood, or passing black tarry stools
• New confusion, disorientation, drowsiness, or a sudden personality change
• A rapidly swelling abdomen with pain and fever
• Yellowing of the eyes or skin that is new or deepening

Book an appointment within days for:

• Persistent pain or fullness under the right ribs
• A belly that is slowly enlarging, or clothes tightening at the waist
• Weight loss you did not intend, or a lasting loss of appetite
• New easy bruising or bleeding gums
• Ankle swelling with fatigue

How a suspicious spot is worked up

The approach depends on size, which is unusual and worth knowing.

NCI states that spots under 1 cm found on screening in high-risk patients need no further workup. Most turn out to be cirrhotic nodules rather than cancer. The usual plan is repeat imaging every 3 months, using the same technique.

Spots larger than 1 cm are handled differently. NCI calls for triple-phase, contrast-enhanced imaging. That means CT or MRI scanned at three moments as the dye moves through. HCC has a distinct pattern on these scans. Biopsy may follow.

Alpha-fetoprotein, a blood marker, is also measured, though it is imperfect on its own.

Treatment depends on the liver as much as the tumor

This is what makes liver cancer different. Doctors weigh two things at once. One is the cancer. The other is how much working liver remains. NCI notes that predicting outcomes is complex for exactly that reason. More than ten classification systems are in use worldwide. The Barcelona Clinic Liver Cancer system is among the most common.

Curative options exist for early disease. NCI states that only 10% to 23% of patients with HCC are candidates for curative-intent surgery.

Liver transplant treats the cancer and the underlying cirrhosis at once. Eligibility commonly follows the Milan criteria. That means a single tumor under 5 cm, or two to three tumors each under 3 cm. NCI reports five-year overall survival of 44% to 78% after transplant for early HCC. After liver resection it is 27% to 70%. Donor scarcity is the limiting factor.

Some disease cannot be removed. One option is transarterial chemoembolization. It delivers drug straight into the tumor's blood supply and then blocks it. Drug options now include atezolizumab with bevacizumab, atezolizumab with cabozantinib, and doublet checkpoint immunotherapy. Targeted drugs include lenvatinib and sorafenib. Second-line drugs include regorafenib, cabozantinib, ramucirumab, and pembrolizumab.

The numbers

SEER is NCI's cancer surveillance program. Among people diagnosed between 2016 and 2022, it puts five-year relative survival for liver and bile duct cancer at 21.9%. By stage it runs 37.4% for localized disease, 13.4% for regional, and 3.6% for distant. Localized cases are 45% of diagnoses, regional 23%, and distant 21%. Median age at diagnosis is 68.

SEER lists about 42,340 new cases and 30,980 deaths for 2026, a projection the American Cancer Society produces. NCI adds that untreated advanced disease usually carries survival of less than 6 months.

There is real progress buried in that first figure. In 1975, SEER's earliest year, five-year relative survival for this cancer was under 3%. It is now nearly 22%.

These are group statistics collected across a whole population over years. They describe patterns, not people.

Sources

• https://www.cancer.gov/types/liver/hp/adult-liver-treatment-pdq
• https://seer.cancer.gov/statfacts/html/livibd.html
• https://www.cancer.org/research/cancer-facts-statistics.html
• https://www.cdc.gov/hepatitis-c/about/index.html
• https://www.upi.com/Archives/1995/08/13/Baseball-great-Mickey-Mantle-dies-of-cancer/1319808286400/