Liver cancer
Classification and external resources
Left lobe liver tumor in a 50 year old male, operated in King Saud Medical Complex, Riyadh, Saudi Arabia
ICD-10	C22.9
ICD-9	155.2
MeSH	D008113

Liver cancer or hepatic cancer (from the Greek hēpar, meaning liver) is a cancer that originates in the liver. Liver cancers are malignant tumors that grow on the surface or inside the liver. Liver tumors are discovered on medical imaging equipment (often by accident) or present themselves symptomatically as an abdominal mass, abdominal pain, jaundice, nausea or liver dysfunction.^[1] Liver cancers should not be confused with liver metastases, which are cancers that originate from organs elsewhere in the body and migrate to the liver.

Classification[link]

There are many forms of liver cancer, although many cancers found in the liver are metastases from other tumors, frequently of the GI tract (like colon cancer, carcinoid tumors mainly of the appendix, etc.), but also from breast cancer, ovarian cancer, lung cancer, renal cancer, prostate cancer, etc.

The most frequent liver cancer is hepatocellular carcinoma (HCC) (also named hepatoma, which is a misnomer because adenomas are usually benign). This tumor also has a variant type that consists of both HCC and cholangiocarcinoma components. The cells of the bile duct coexist next to the bile ducts that drain the bile produced by the hepatocytes of the liver. Cancers which arise from the blood vessel cells in the liver are known has hemangioendotheliomas.

As well as mixed tumors, rarer forms of liver cancer include:

• mesenchymal tissue
• Sarcoma
• Hepatoblastoma, a rare malignant tumor, primarily developing in children. Most of these tumors form in the right lobe.
• Cholangiocarcinoma (bile duct cancers), which account for 1 or 2 out of every 10 cases of liver cancer. These cancers start in the small tubes (called bile ducts) that carry bile to the intestine.
• Angiosarcoma and hemangiosarcoma: These are rare forms of cancer that start in the blood vessels of the liver. These tumors grow quickly. Often by the time they are found they are too widespread to be removed. Most patients do not live more than a year after diagnosis.
• Lymphoma of liver: A rare form of lymphoma that usually have diffuse infiltration to liver. It may also form a liver mass in rare occasions.

Signs and symptoms[link]

Cholangiocarcinoma[link]

• sweating
• Jaundice
• Abdominal pain
• Weight loss
• Hepatomegaly^[2]

Hepatocellular carcinoma[link]

• Abdominal mass
• Abdominal pain
• Emesis
• Anemia
• Back pain
• Jaundice
• Itching
• Weight loss
• Fever^[3]

Causes[link]

• Hepatitis C is the primary cause of liver cancer.^[4]
• A 2009 study suggested that l-carnitine deficiency is a risk factor for liver cancer, and that supplementation with it could reduce the risk.^[5]
• Chronic Hepatitis B infection can lead to liver cancer.

Japan, being member of the International Cancer Genome Consortium, is leading efforts to map liver cancer's complete genome^{[citation needed]}.

Prevention[link]

Since hepatitis B or C is one of the main causes of liver cancer, prevention of this infection is key to then prevent liver cancer. Thus, childhood vaccination against hepatitis B may reduce the risk of liver cancer in the future.^[6] In the case of patients with cirrhosis, alcohol consumption is to be avoided.

Management[link]

A PET-CT scan may be suggested if doctors are considering surgery as a treatment. It gives more detailed information about the part of the body being scanned.^[7] The correct treatment of liver cancer can mean the difference between life and death. Not all patients with cancers in the liver are potentially curable. These are some of the treatments available: Surgery, Chemotherapy, Immunotherapy, Photodynamic Therapy, Hyperthermia, Radiation Therapy and Radiosurgery.^[8]

Hepatocellular carcinoma[link]

• Partial hepatectomy to resect all of the tumor.
• Liver transplantation
• Cryoablation
• Chemoembolization
• Radiotherapy
• Sorafenib
• Radiofrequency ablation^[9]
• Radiofrequency ablation combined with local chemotherapy See: http://www.clinicaltrials.gov/ct2/show/NCT00617981?term=Thermodox&rank=3

Cholangiocarcinoma[link]

• Photodynamic therapy
• Brachytherapy
• Radiotherapy
• Liver transplantation^[10]

Hepatoblastoma[link]

• Chemotherapy, including vincristine, cyclophosphamide, and doxorubicin
• Radiotherapy
• Liver transplantation
• Surgical resection^[11]

Epidemiology[link]

Age-standardized death from liver cancer per 100,000 inhabitants in 2004.^[12]

  no data

  <7.5

  7.5-15

  15-22.5

  22.5-30

  30-37.5

  37.5-45

  45-52.5

  52.5-60

  60-67.5

  67.5-75

  75-110

  >110

Globally as of 2008 liver cancer is the third leading cause of cancer death at 700,000 per year, after lung cancer (1.4 million deaths) and stomach cancer (740,000 deaths).^[13]

References[link]

External links[link]

Wikimedia Commons has media related to: Liver cancer

• The Liver Cancer Web Page at Johns Hopkins University
• Liver cancer at Mayo Clinic
• Clinically reviewed liver cancer information for patients, from Cancer Research UK

Kevin Lowe
Born	(1959-04-15) April 15, 1959 (age 53) Lachute, QC, CAN
Height	6 ft 2 in (1.88 m)
Weight	200 lb (91 kg; 14 st 4 lb)
Position	Defence
Shot	Left
Played for	Edmonton Oilers New York Rangers
National team	Canada
NHL Draft	21st overall, 1979 Edmonton Oilers
Playing career	1979–1998

Kevin Hugh Lowe (born April 15, 1959) is a retired defenceman and coach in the National Hockey League and the current President of Hockey Operations for the Edmonton Oilers. As a defenceman, he played for the Edmonton Oilers and the New York Rangers.

Background and early career[link]

Lowe played 3 seasons starting in 1976 with the Quebec Remparts of the QMJHL. He scored 42–131–173 in 201 games played, with 245 PIM. In the 1978–79 season, he was named the first English-speaking captain of a QMJHL team. He was drafted in the first round, 21st overall, of the 1979 NHL Entry Draft by the Edmonton Oilers.

NHL playing career[link]

Lowe played 13 full seasons in his first stint with the Oilers, winning 5 Stanley Cups. He was team captain for the 1991–92 season.

The Oilers traded him to the New York Rangers, in December 1992 (Lowe was a restricted free-agent). There he helped other ex-Oilers Glenn Anderson, Jeff Beukeboom, Adam Graves, Craig MacTavish, Mark Messier, and Esa Tikkanen to win another Stanley Cup, bringing his personal total to 6. As Stephen Cole said in The Best of Hockey Night in Canada, the Rangers winning the Stanley Cup in 1994 was a win for "New York's Oilers," as the team consisted of members of the great Edmonton team of the 1980s. In fact, it was the last hurrah for the great Oilers dynasty of the 1980s, according to Cole.

In 1996, he re-joined the Oilers as a free agent, and played another full season. He started the 1997–98 season with the Oilers as well, but only played 7 games due to illness – an inner-ear virus that affected his balance, thus ending his playing career.

In total, Lowe played in 1254 career regular season games, scoring 84–347–431 with 1498 penalty minutes. He added another 214 playoff games, scoring 10–48–58 and earning 192 penalty minutes.

Post playing career[link]

Lowe joined the Oilers staff in 1998 as an assistant coach. In 1999, he took over head coaching duties from Ron Low. He was head coach for just a single season, getting the Oilers to the first round of the playoffs. He was promoted to general manager of the Oilers in 2000 when long-time GM Glen Sather left for the New York Rangers. He remained the Oilers' Executive Vice President and General Manager until the 2008–09 season when he was promoted to President of Hockey Operations.

Lowe has also been responsible for assisting Canadian national hockey teams. He was a member of the management team for the Canadian men's ice hockey team at the 2002 Winter Olympics that won the gold medal, and was also named a manager for the 2004 World Cup of Hockey team. In addition, he has managed Team Canada at World Hockey Championships.

In 2005, the Quebec Major Junior Hockey League created the Kevin Lowe Trophy (Trophée Kevin Lowe), awarded annually to the player in the QMJHL judged to be the best defensive defenceman.

In the 2006–2007 NHL offseason Lowe offered contracts to restricted free agents Thomas Vanek, which was matched by the Buffalo Sabres, then to Anaheim forward Dustin Penner, which was signed. Following the offer sheet to Penner, Brian Burke, the then-GM of The Anaheim Ducks, publicly blamed Lowe for an inflation in player salaries, accusing Lowe of "colossal stupidity". Then head coach Craig MacTavish responded by referring Burke to the Wizard of Oz, "You comb his hair, put a white shirt on, wheel him out in front of the camera and he'll say whatever you guys want". Lowe did not respond to Burkes' attacks until July 4, 2008 on a local radio show, Total Sports with Bob Stauffer, calling Burke a "moron" and "a media junkie".^{[1][citation needed]}

Lowe's No. 4 has not been retired, but he had been the only player in the Oilers' NHL history to wear No. 4 until he issued it to Taylor Hall, the Oilers' first-round draft pick in 2010.

Notable achievements[link]

Lowe holds the Edmonton Oilers record for most regular season and playoff games played as an Oiler (1037 and 172). He was the team's first-ever NHL draft pick, and scored their first NHL goal (a power play goal against the Chicago Blackhawks assisted by Wayne Gretzky and Brett Callighen). During his professional hockey career, Lowe did not play a single game in the minor leagues, and his teams only once failed to make the playoffs.

Lowe was named an NHL all-star in 1984, 1985, 1986, 1988, 1989, 1990, and 1993. He also won the league's King Clancy Memorial Trophy in 1990.

In 1988, Lowe never missed any playoff games, despite nursing a broken wrist and wearing a full cast. On the night the Oilers won their fourth Championship, Wayne Gretzky informed the media that Lowe was also hiding broken ribs throughout the playoffs, adding, "That's what it takes to win a Stanley Cup."

Personal information[link]

Lowe is the younger brother of the former Edmonton Oilers Head Medical Trainer Ken Lowe. He is married to Canadian Olympian Karen Percy, and is the father of Edmonton Oil Kings defenceman Keegan Lowe, who was drafted by the Carolina Hurricanes in the third round of the 2011 NHL Entry Draft.^[2]

Awards and achievements[link]

• 1983–84 – NHL – Stanley Cup (Edmonton Oilers)
• 1984–85 – NHL – Stanley Cup (Edmonton Oilers)
• 1986–87 – NHL – Stanley Cup (Edmonton Oilers)
• 1987–88 – NHL – Stanley Cup (Edmonton Oilers)
• 1989–90 – NHL – Stanley Cup (Edmonton Oilers)
• 1993–94 – NHL – Stanley Cup (New York Rangers)

Career statistics[link]

Coaching record[link]

References[link]

External links[link]

• Kevin Lowe's biography at Legends of Hockey
• Kevin Lowe's career stats at The Internet Hockey Database
• An Oiler Original.
• HockeyDraft Central.
• Edmonton Oilers Heritage site Video of Oilers 1st NHL goal by Kevin Lowe

Lawrencia "Bambi" Bembenek (August 15, 1958 – November 20, 2010), known as Laurie Bembenek, was convicted of murdering her husband's ex-wife, Christine Schultz, in Milwaukee, Wisconsin, on May 28, 1981. Her story garnered national attention after she escaped from Taycheedah Correctional Institution and was recaptured in Canada, an episode which inspired books, movies and the slogan "Run, Bambi, Run". Upon winning a new trial, she pleaded no contest to second-degree murder and was sentenced to time served and ten years probation. For years after, she sought to have the sentence overturned.^[1]

Bembenek was a former Milwaukee police officer who had been fired and had gone on to sue the department, claiming that it engaged in sexual discrimination and other illegal activities. She worked briefly as a waitress at a Lake Geneva, Wisconsin, Playboy Club. At the time of her arrest, she was working for Marquette University's Public Safety Department in downtown Milwaukee.

On November 20, 2010, Bembenek died at a hospice facility in Portland, Oregon, at the age of 52.^[2]

Biography[link]

Bembenek was born on August 15, 1958. In March 1980, she joined the Milwaukee Police Department as a trainee. There she met and became close with a fellow trainee named Judy Zess. At a rock concert in May 1980, Zess was arrested for smoking marijuana. Bembenek's subsequent dismissal from the police department on August 25 stemmed from her involvement in filing a false report on Zess' arrest.^[3]

Murder of Christine Schultz[link]

On May 28, 1981, at approximately 2:15am, 30-year-old Christine Schultz was murdered by a single .38 caliber pistol shot fired point-blank into her back and through her heart. She had been gagged and blindfolded and her hands were tied in front of her with rope. Her two sons, then 7 and 11 years old, found her face down on her bed and bleeding.^[4] The older boy, Sean, had seen the assailant and described him as a masked male figure in a green army jacket and black shoes. He also said the man had a long (approx. 6" or 15 cm) reddish-colored ponytail.^[5]

Christine Schultz was the ex-wife of Laurie Bembenek's then-husband, Elfred "Fred" Schultz, a Milwaukee Police Department detective. They had been divorced six months at the time of the murder. Fred Schultz initially stated he was on duty investigating a burglary with his partner, Michael Durfee, at the time of the murder, but years later he admitted they were actually drinking at a local bar. When ballistics testing revealed it was his off-duty revolver that had been the murder weapon, suspicion shifted to Laurie Bembenek, as she had been alone in the apartment she shared with Schultz and had access to both the gun and a key to Christine's house that Fred Schultz had secretly copied from his oldest son's house key.^[4]

Fred Schultz had previously been exonerated in the fatal shooting of a Glendale, Wisconsin, police officer on July 23, 1975. The Glendale officer, George Robert Sassan, had arrested a subject in a bar while off-duty. Milwaukee police officers, including Schultz, responded to the call in suburban Glendale (outside their jurisdiction), reportedly mistook Sassan for a suspect and shot him to death when he turned toward them, holding a gun. Schultz and his partner were cleared by the Milwaukee County District Attorney's Office in the shooting.^[6]

Trial[link]

Bembenek's trial generated tremendous publicity, and newspapers began referring to her as "Bambi" Bembenek (a nickname she disliked). The prosecution portrayed her as a loose woman addicted to expensive living who wanted Christine Schultz dead so that her new husband would no longer have to pay alimony. The prosecution pointed out that Bembenek also had financial problems. The prosecution claimed that Bembenek was the only person with the motive, means and opportunity to carry out the crime. The strongest evidence was two human hairs found at the crime scene, which matched ones taken from the hairbrush of the defendant. The gun used to kill Christine Schultz turned out to be Bembenek's husband's off-duty revolver. The prosecution claimed that Bembenek was the only person besides Fred Schultz who had access to this weapon. Blood was found on the gun. Bembenek supposedly also had access to a key to Christine Schultz's home. There were no signs of a break-in and no valuables taken. Schultz's eldest son, however, stated that Bembenek was not the person who had held up their house and shot his mother.^[7]

Witnesses testified that Bembenek had spoken often of killing Christine Schultz. The prosecution produced a witness who said Bembenek offered to pay him to carry out the murder. According to witnesses for the prosecution, Bembenek owned a green jogging suit similar to the one described by Schultz's son. It was pointed out that Bembenek owned a clothes line and a blue bandanna similar to what was used to bind and gag the victim. A wig found in the plumbing system of Bembenek's apartment matched fibers found at the murder scene. A boutique employee testified that Bembenek purchased such a wig shortly before the murder.^[8]

Conviction[link]

She was found guilty of first-degree murder in March 1982 and sentenced to life in prison in Taycheedah Correctional Institution.

Post-trial publicity[link]

Shortly after Bembenek's conviction, Fred Schultz filed for divorce and began saying publicly that he now believed Bembenek was guilty. Bembenek filed three unsuccessful appeals of her conviction, citing police errors in handling of key evidence and the fact that one of the prosecution's witnesses, Judy Zess, had recanted her testimony, stating it was made under duress. Bembenek and her supporters also alleged that Milwaukee police may have singled her out for prosecution because of her role as a key witness in a federal investigation into police corruption. Bembenek's supporters suggested that Fred Schultz may have arranged to have someone else murder his ex-wife. One possible candidate was Frederick Horenberger, a career criminal who briefly worked with Schultz on a remodeling project and was a former boyfriend of Judy Zess.^[4] A disguised Horenberger had robbed and beaten Judy Zess several weeks prior to Christine Schultz's murder and would later serve a ten-year sentence for that crime.^[9]

According to a number of affidavits which emerged following Bembenek's conviction, Horenberger boasted of killing Schultz to other inmates while he was in jail. Yet publicly, Horenberger vehemently denied any involvement in the Schultz murder up until his suicide in November 1991, following a robbery and hostage-taking stand-off in which he had been involved.^[10]

There were questions raised as to the accuracy of the information and the evidence used in the trial. Dr. Elaine Samuels, the medical examiner who conducted the autopsy, had originally concluded that hairs recovered from the body were consistent with that of the victim; after Dr. Samuels had come to that conclusion, the hair evidence was examined by Diane Hanson, a hair analyst from a crime lab in Madison, Wisconsin. Hanson stated that two of the hairs were consistent with samples taken from Laurie Bembenek's hairbrush. Dr. Samuels refuted that claim, stating in a 1983 letter, quoted in the Toronto Star in 1991, that "I recovered no blonde or red hairs of any length or texture ... [A]ll of the hairs I recovered from the body were brown and were grossly identical to the hair of the victim ... [I] do not like to suggest that evidence was altered in any way, but I can find no logical explanation for what amounted to the mysterious appearance of blonde hair in an envelope that contained no such hair at the time it was sealed by me."^[11]

The apartment where Laurie and Fred lived shared drainage with another apartment. In the shared drainpipe was found a brownish-red wig which matched some of the hairs found on the victim's body. The woman who occupied the other apartment testified that Judy Zess had knocked on her door and asked to use her bathroom; after Zess used the woman's bathroom, the plumbing was mysteriously clogged. Also, Zess had admitted to owning a brownish-red wig.^[12]

In prison, Bembenek became a model inmate who was highly respected by her fellow prisoners. She earned a bachelor's degree from the University of Wisconsin–Parkside and helped found a prisoners' newspaper.^[13] She also met and became engaged to Dominic Gugliatto, who had been visiting another inmate. On July 15, 1990, she escaped from prison with Gugliatto's help.^[14] Her escape reignited publicity surrounding her case, and she became something of a folk hero. A song was written about her, and T-shirts were sold with the slogan "Run, Bambi, Run".^[15]

She fled with Gugliatto to Thunder Bay, Ontario, Canada, while sensational stories about their relationship swirled through American tabloids.^[16] The couple spent three months as fugitives before being apprehended. Gugliatto was sentenced to one year in prison for his role in the escape.^[16] Bembenek, however, sought refugee status in Canada, claiming that she was being persecuted by a conspiracy between the police department and the judicial system in Wisconsin. The Canadian government showed some sympathy for her case, and before returning her to Wisconsin, obtained a commitment that Milwaukee officials would conduct a judicial review of her case. The review did not find evidence of crimes by police or prosecutors, but detailed seven major police blunders which had occurred during the Christine Schultz murder investigation, and she won the right to a new trial. Rather than risk a second conviction, however, Bembenek pleaded no contest to second-degree murder and received a reduced sentence which was commuted to time served. She was released from prison in November 1992, having served a little over ten years.^[17]

Life after prison[link]

Bembenek wrote a book about her experience, titled Woman on Trial.^[18]After her release, she had various legal and personal problems. She was arrested again on marijuana possession charges and filed for bankruptcy, as well as developing hepatitis C and other health problems. She also admitted to being an alcoholic. She legally changed her name to Laurie Bembenek in 1994.

In 1996, she moved to Washington state^[2] to be near her retired parents in Vancouver.^[13] There she met a local resident, U.S. Forest Service employee Marty Carson, whom she eventually married.^[13]

Bembenek was diagnosed with post-traumatic stress disorder, complicated by a growing addiction to alcohol.^[13] As a form of therapy, Carson encouraged her to devote time to her passion of painting. Bembenek had made paintings since childhood, and her early work had been the subject of an exhibition at UW–Milwaukee in 1992.^[13] Carson constructed a studio for her, and she eagerly returned to her art. She had a fragile recovery, and after several years she had amassed about thirty paintings which she put on display at a local art gallery. This potentially transformative return to public life was wrecked when the gallery burned down in a freak fire and all the paintings were destroyed.^[13]

In 2002, Bembenek either fell or jumped from a second-story window, breaking her leg so badly that it had to be amputated below the knee. Bembenek claimed that she had been confined in an apartment by handlers for the Dr. Phil television show and was injured while attempting to escape.^[19]

Bembenek continued to insist she was innocent, but the Wisconsin Supreme Court refused to overturn her no contest plea, saying such a plea cannot be withdrawn. In April 2008, Bembenek filed a petition with the United States Supreme Court, seeking a reversal of the second murder conviction. Bembenek's attorney pointed to evidence not heard in the original trial, including ballistics tests matching the murder bullets to the gun owned by Fred Schultz, male DNA found on the victim, evidence the victim had been sexually assaulted and the eyewitness testimony of the two young sons who said they had seen a heavyset, masked man. Bembenek's petition argued the court needed to clarify whether defendants who plead guilty or no contest have an opportunity to review evidence comparable to the rights of those who plead not guilty. Her appeal was denied in June 2008.^[20]

Her case was the inspiration for two television movies and various books and articles portraying her as the victim of a miscarriage of justice. In 2004, MSNBC produced and aired a biography of Laurie Bembenek on their Headliners and Legends television show. Bembenek did not take part in the show. She was interviewed by WTMJ-TV anchor Mike Jacobs for a two-part sweeps interview that aired on that station's 10pm newscast on October 28 and 29, 2010.^[21]

Death[link]

On November 16, 2010, WTMJ reported that Bembenek was slipping in and out of consciousness and was near death in a hospice care center, suffering from liver and kidney failure.^[22] On November 20, 2010, she died at a hospice facility in Portland, Oregon, aged 52.^[2]

Television movies about Bembenek[link]

• Calendar Girl, Cop, Killer? The Bambi Bembenek Story (1992) starring Lindsay Frost.^[23]

• Woman on Trial: The Lawrencia Bembenek Story (1993) starring Tatum O'Neal.^[24]

References[link]

Bibliography[link]

• Bembenek, Lawrencia (1992). Woman on Trial. Harper Collins Publishers Ltd.  ISBN 0-00-215746-2
• Douglas, John; Mark Olshaker (2001). The Cases That Haunt Us: From Jack the Ripper to Jon Benet Ramsey, The FBI's Legendary Mindhunter Sheds New Light on the Mysteries That Won't Go Away. Simon and Schuster.  ISBN 0-7432-1239-8
• Horenberger, Francine (2002). Mistresses of Mayhem. Alpha Books.  ISBN 0-7394-2867-5
• Radish, Kris (1992). Run, Bambi, Run. Birch Lane Press.  ISBN 1-55972-103-0

External links[link]

• American Justice, Episode 99 - Hunting Bambi: The Laurie Bembenek Story
• "Bambi" Bembenek story on Court TV's Crime Library
• Article from Fox News about her 2002 fall and leg amputation
• WTMJ Channel 4 News interview with Laurie Bembenek, broadcast October 29, 2010