Liver cancer
  • Mar 08, 2017


Not all cancers that affect the liver are considered liver cancer. Cancer that begins in another area of the body — such as the colon, lung or breast — and then spreads to the liver is called metastatic cancer rather than liver cancer. And this type of cancer is named after the organ in which it began — such as metastatic colon cancer to describe cancer that begins in the colon and spreads to the liver. Cancer that spreads to the liver is more common than cancer that begins in the liver cells.
Several types of cancer can form in the liver. The most common type of liver cancer is hepatocellular carcinoma, which begins in the main type of liver cell (hepatocyte). Other types of liver cancer, such as intrahepatic  cholangiocarcinoma and hepatoblastoma, are much less common.
Liver cancer is cancer that begins in the cells of liver. Liver is a football-sized organ that sits in the upper right portion of abdomen, beneath diaphragm and above the stomach. Liver cancer is the 10th most common cancer and the 5th most common cause of cancer death among men.

Symptoms and Causes

Most people don't have signs and symptoms in the early stages of primary liver cancer. When signs and symptoms do appear, they may include:

  • Losing weight without trying

  • Loss of appetite

  • Upper abdominal pain

  • Nausea and vomiting

  • General weakness and fatigue

  • Abdominal swelling

  • Yellow discoloration of your skin and the whites of eyes (jaundice)

  • White, chalky stools

When to see a Doctor

Make an appointment with doctor if you experience any signs or symptoms that worry you.

Causes

It's not clear what causes most cases of liver cancer. But in some cases, the cause is known. For instance, chronic infection with certain hepatitis viruses can cause liver cancer.
Liver cancer occurs when liver cells develop changes (mutations) in their DNA — the material that provides instructions for every chemical process in your body. DNA mutations cause changes in these instructions. One result is that cells may begin to grow out of control and eventually form a tumor — a mass of cancerous cells.

Risk factors

Factors that increase the risk of primary liver cancer include:

  • Chronic infection with HBV or HCV. Chronic infection with the hepatitis B virus (HBV) or hepatitis C virus (HCV) increases risk of liver cancer.

  • Cirrhosis. This progressive and irreversible condition causes scar tissue to form in liver and increases chances of developing liver cancer.

  • Certain inherited liver diseases. Liver diseases that can increase the risk of liver cancer include hemochromatosis and Wilson's disease.

  • Diabetes. People with this blood sugar disorder have a greater risk of liver cancer than those who don't have diabetes.

  • Nonalcoholic Fatty Liver Disease. An accumulation of fat in the liver increases the risk of liver cancer.

  • Exposure to Aflatoxins. Aflatoxins are poisons produced by molds that grow on crops that are stored poorly. Crops such as corn and peanuts can become contaminated with aflatoxins, which can end up in foods made of these products. In the United States, safety regulations limit aflatoxin contamination. Aflatoxin contamination is more common in certain parts of Africa and Asia.

  • Excessive alcohol consumption. Consuming more than a moderate amount of alcohol daily over many years can lead to irreversible liver damage and increase risk of liver cancer.

  • Risk Factors are Cumulative. This means that having more than 1 risk factor increases the risk of developing liver cancer even more.

Diagnosing Liver Cancer

Tests and procedures used to diagnose liver cancer include:

  • Blood Tests. Blood tests may reveal liver function abnormalities, Hepatitis B or Hepatitis C infection and test for Alpha Foeto Protein (AFP). AFP is found elevated in about 50% to 70% of people who have Hepatocellular Carcinoma.

  • Imaging Tests. Imaging tests, such as an ultrasound, computerized tomography (CT) scan and magnetic resonance imaging (MRI).

  • Liver Biopsy.  For most types of cancer, a biopsy is the only sure way to know whether an area of the body has cancer. During a liver biopsy, doctor inserts a thin needle through the skin and into liver to obtain a tissue sample. In the lab, doctors examine the tissue under a microscope to look for cancer cells. Liver biopsy carries a risk of bleeding, bruising and infection.

Determining the Extent of the Liver Cancer 

Once liver cancer is diagnosed, doctors will work to determine the extent (stage) of the cancer. Staging tests help determine the size and location of cancer and whether it has spread. Imaging tests used to stage liver cancer include CTs, MRIs and bone scans.
There are different methods of staging liver cancer. One method uses Roman numerals I through IV, and another uses letters A through D. Cancer's stage determines the treatment options and prognosis. Stage IV and Stage D indicate the most advanced liver cancer with the worst prognosis.

Treatment

Treatments for primary liver cancer depend on the extent (stage) of the disease as well as age, overall health and personal preferences.

Surgery

Operations used to treat liver cancer include:

Once liver cancer is diagnosed, doctors will work to determine the extent (stage) of the cancer. Staging tests help determine the size and location of cancer and whether it has spread. Imaging tests used to stage liver cancer include CTs, MRIs and bone scans.
There are different methods of staging liver cancer. One method uses Roman numerals I through IV, and another uses letters A through D. Cancer's stage determines the treatment options and prognosis. Stage IV and Stage D indicate the most advanced liver cancer with the worst prognosis.

  • Surgery to Remove the Tumor. In case of small tumour and good liver function an operation to remove the liver cancer and a small portion of healthy liver tissue that surrounds it is undertaken.
    Whether this is an option depends on the location of cancer within the liver, how well the liver functions and overall health.

  • Liver Transplant Surgery. During liver transplant surgery, diseased liver is removed and replaced with a healthy liver from a donor. Liver transplant surgery is only an option for a small percentage of people with early-stage liver cancer.

Localized Treatments

Localized treatments for liver cancer are those that are administered directly to the cancer cells or the area surrounding the cancer cells. Localized treatment options for liver cancer include:

  • Heating Cancer Cells. In a procedure called radiofrequency ablation, electric current is used to heat and destroy cancer cells. Using an ultrasound or CT scan as a guide, the surgeon inserts one or more thin needles into small incisions in abdomen. When the needles reach the tumor, they're heated with an electric current, destroying the cancer cells.

  • Freezing Cancer Cells. Cryoablation uses extreme cold to destroy cancer cells. During the procedure, doctor places an instrument (cryoprobe) containing liquid nitrogen directly onto liver tumors. Ultrasound images are used to guide the cryoprobe and monitor the freezing of the cells.

  • Injecting Alcohol into the Tumor. During alcohol injection, pure alcohol is injected directly into tumors, either through the skin or during an operation. Alcohol causes the tumor cells to die.

  • Injecting Chemotherapy Drugs into the Liver. Chemoembolisation is a type of chemotherapy treatment that supplies strong anti-cancer drugs directly to the liver.

  • Transarterial Chemoembolization (TACE).   In Hepatocellular carcinoma (HCC), the tumour grows a large number of blood vessels which get most of their blood supply from the hepatic artery, while the rest of the liver tissue gets blood from the portal vein. Because of this, the hepatic artery can be blocked to cut off the blood supply to the tumour without affecting the rest of the liver. TACE is offered in case of good liver function, absence of ascites (fluid in abdomen) and there being no problem with the portal vein. TACE may be used if tumour can’t be removed with surgery but it hasn’t spread to the major blood vessels in the liver, lymph nodes or other parts of the body. You may also be offered TACE to keep a liver tumour small if you are waiting for a liver transplant (called “bridging” therapy). For tumours larger than 5 cm, it may take 2 or 3 sittings to shrink these tumours at a gap of one month.

  • Placing beads filled with radiation in the liver. Tiny spheres that contain radiation may be placed directly in the liver where they can deliver radiation directly to the tumor.

Radiation Therapy

This treatment uses high-powered energy from sources such as X-rays and protons to destroy cancer cells and shrink tumors. Doctors carefully direct the energy to the liver, while sparing the surrounding healthy tissue.
During external beam radiation therapy treatment, a machine directs the energy beams at a precise point on the body.
A specialized type of radiation therapy, called stereotactic radiosurgery, involves focusing many beams of radiation simultaneously at one point in body.

Targeted Drug Therapy

Targeted drugs work by interfering with specific abnormalities within a tumor. They have been shown to slow or stop advanced hepatocellular carcinoma from progressing for a few months longer than with no treatment.
More studies are needed to understand how targeted therapies, such as the drug sorafenib (Nexavar), may be used to control advanced liver cancer.

Supportive (Palliative) Care

Palliative care is specialized medical care that focuses on providing relief from pain and other symptoms of a serious illness. When palliative care is used along with all of the other appropriate treatments, people with cancer may feel better and live longer.
Palliative care is provided by a team of doctors, nurses and other specially trained professionals. Palliative care teams aim to improve the quality of life for people with cancer and their families. This form of care is offered alongside curative or other treatments.

Alternative Medicine

Alternative treatments may help control pain in people with advanced liver cancer. Alternative treatments that may help cope with pain, such as:

  • Acupressure

  • Acupuncture

  • Deep breathing

  • Listening to music (music therapy)

  • Massage


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