Liver cancer is a tumour that starts in the cells of the liver. The liver is an organ located in the upper right side of the abdomen, below the diaphragm, and directly above the stomach.Numerous types of cancers can occur in the liver. The commonest type of liver cancer is hepatocellular carcinoma . Other types of liver cancer, like hepatoblastoma and intrahepatic cholangiocarcinoma, are less common.
. Cancer that starts in another part of the body like the lung, colon, and breast and then spreads to liver cells is named metastatic liver cancer. This category of cancer is termed after the organ in which it started, for example, metastatic lung cancer is defined as cancer that starts in the lung and then spreads to the liver.
Chronic viral infections like Hepatitis B or C s can lead to liver cancer. This is the major recognized risk factor for primary liver cancer.
Other common factors which increase the risk of developing liver cancer are,:
- Genetic disorders like hemochromatosis
- Obesity, Fatty liver, Type 2 diabetes
- Alcohol consumption & Tobacco smoking
Signs and symptoms of liver cancer
Liver cancer symptoms may not be noticeable in the beginning but get more obvious as cancer grows or becomes progressive.
The most common symptoms are:
- Weight loss
- Loss of appetite and light bowel motions
- Weakness, tiredness, and feeling sick
- Pain in the abdomen or right shoulder
- Yellowing of the eyes and skin (Jaundice)
- Abdominal swelling, due to accumulation of fluids in the abdomen (Ascites)
Management and treatment for liver cancer
The most common approach in primary liver cancer management is tumour ablation and chemotherapy. For secondary cancer management,either chemotherapy or a combination of chemotherapy and surgery may be required.
Surgery for liver cancer includes either removing a part of the liver or in advanced cases, a liver transplant is the best option where the total liver is replaced by adonor’s liver.
Type of surgery for liver cancer depends upon many factors like tumor size, site, and the number of tumor masses.
Sometimes,liver transplant is the only treatment option and the success rate depends upon a lot of factors which help to determine if a person can be taken up for a transplant ,. for a fit liver donor could also take a long time. During this time, most individuals need to go through other lines of management to control cancer.
Tumour ablation is commonly used for minor primary liver tumors. It is hardly used for secondary liver cancer.
The commonest types of tumor ablation procedures use radio waves and microwaves to terminate cancer cells. This line of management is done by either a simple method called needle insertion into the skin (percutaneous ablation) or an operation (surgical ablation). Cryotherapy is also a good option which is a type of surgery that freezes and kills cancer cells.1
In this type of treatment, certain drugs are used to destroy, shrink or decrease the progression of cancer. Chemotherapy can be given through pills orally, or by injections intravenously (via a drip).This might be along with other treatments, such as cryotherapy and surgery, to remove any residual tumor cells. Systemic chemotherapy could also be used as a comforting (palliative) treatment to slow down tumor progress and decrease pain. Chemotherapy could also be directly injected into cancer, commonly for primary liver cancer.When this is achieved by blocking the blood supply to the tumor by injecting chemotherapy medications in the blood vessel,this technique is named transarterial chemoembolization (TACE).
Selected Internal Radiation Therapy (SIRT):
Also called (Radioembolization), this method of treatment targets liver tumors directly with high doses of internal radiation. It is used for both primary and secondary liver malignancies when the tumours cannot be surgically removed.2
Endoscopic stent placement:
In case of liver malignancy that has blocked the bile duct, it may be suggested that a stent (thin tube) is positioned in the liver to drain the bile and comfort symptoms.3
In some cases of liver cancer, the medical team may discuss palliative care with you. Palliative care goals are to improve quality of life by improving cancer manifestations. Along with reducing the spread of liver cancer,t it can help with pain relief and help with other symptoms management. This line of management may include any type of previously mentioned treatments like chemotherapy, radiotherapy, or other medical therapies.
According to your condition, the stage of the tumor, and the decided line of management, the treatment team may involve various healthcare professionals, for example:
- General Practitioner: For your overall health and coordinates treatment
- Hepatologist: Specialist doctor in liver disease
- Hepatobiliary Surgeon: surgeon specialized in (liver, gallbladder, and other surrounding organs)
- Gastroenterologist:digestive disorder specialist
- Radiologist: responsible for diagnostic scans (MRI, CT, and PET scans)
- Medical oncologist: recommends and manages the chemotherapy course
- Nuclear medicine specialist: Organizes the radioactive scans and arranges treatment
- Cancer nurse: Assists and delivers the needed care throughout the treatment course.
- Other related (allied health) professionals, like, clinical pharmacists, social workers, and family counselors
How is liver cancer diagnosed?
The following investigations are used to diagnose both primary and secondary liver tumours:
- Blood tests: Blood tests can detect liver function, and blood clotting, along with checking tumor markers, detecting viral hepatitis B or C, and any genetic abnormalities
- Ultrasound: commonly used to search for primary liver tumors. Ultrasound is used to detect the size, site, and abnormal tissue in the liver
- CT scan: used to get a three-dimensional picture of several organs at the same time. It is most important to help doctors plan for surgery. It can also show if there is any tumor metastasis
- MRI: it can produce a detailed cross-sectional scan of the body and show the extent of cancer
- PET-CT scan: it is mostly used in cases of secondary liver tumors. It helps to show any cancer in the body by producing three-dimensional images
- Biopsy: in this procedure, small liver tissue is removed for examination under the microscope. It is done by either: fine needle aspiration, under local anesthesia or by laparoscopy procedure, under general anesthesia and helps the doctor look at the liver and other surrounding organs, in addition to take tissue samples by laparoscope
What are the types of liver cancer?
- Primary liver cancer: is a tumor that starts in the liver tissues.The main types of primary liver cancer are cholangiocarcinoma (cancer of the bile ducts) and Hepatocellular carcinoma (cancer in liver tissues)
- Secondary liver cancer (metastasis) arises when the tumor spreads to the liver from other body parts.The most common types of liver metastasis are melanoma, gastrointestinal tumors, and colorectal cancer
How can I prevent liver cancer?
Most liver malignancies are asymptomatic.. Screening needs to be done in case of symptoms or presence of risk factors like viral chronic hepatitis B or C, cirrhosis, obesity, type 2 diabetes, metabolic disorders, family history of any cancer especially liver cancer. Your clinician may also advise you to do liver cancer screening based on your lifestyle issues like heavy smoking or drinking alcohol.
Prevention for liver cancer includes:
- Hepatitis B vaccination
- Don’t reuse used, dirty syringe needles
- Usagee condoms during sex (oral, vaginal, anal). Hepatitis B could be transmitted from an infected partner through unprotected sex
- Keep a healthy lifestyle and healthy body weight
- Close follow-up and good medical care in case you are diagnosed with “chronic hepatitis”, as chronic hepatitis is a risk of liver cancer.
- Decreasing alcohol intake asheavy consumption increases the risk of liver cancer
Quit smoking as smoking is one of the risk factors for the development of liver cancer.5 How common is liver cancer?
In the U.K, liver cancer incidence has almost doubled ( increased by about 45%) in the last decade with it being identified as the 18th most common cause of cancer.Death rates have more than doubled at the same time.
Who is at risk of liver cancer?
A lot of factors increase an individual’s chance of having hepatocellular carcinoma (HCC).
- Gender: It is much more common in men than in women
- Race: liver cancer incidence rate in the United States is the highest among Asian Americans, followed by Hispanics/Latinos, then American Indians/Alaska Natives, and lastly, African Americans and whites
- Liver Disease: Chronic viral hepatitis, liver cirrhosis, non-Alcoholic fatty liver disease, primary biliary cirrhosis, inherited metabolic disease
- Certain inherited metabolic diseases, like, hereditary hemochromatosis can lead to cirrhosis and predispose to liver cancer
- Heavy alcohol & tobacco use
- Obesity & Type 2 diabetes
- Certain rare diseases include: Wilson syndrome,4 Glycogen storage disease, and Tyrosinemia
What is the life expectancy of people with liver cancer?
The survival of liver malignancy patients is based on the cancer’s degree/stage. The total survival rate is low, as a result of other associated medical conditions, such as liver cirrhosis.
Commonly, the survival rate of five years for all liver cancer stages is 15% only. But, the rate can vary depending upon the range of tumor spread.
Cancer’s five-year survival rate for limited localized liver tumour is about 28%, while for cancer that spreads to surrounding organs and distant body organs or tissues is about 7% and 2%, respectively
When should I see a doctor?
Any new symptoms should be brought to the notice of your treating doctor for early detection and effective management. Regular screenings are advisable in case you have any of the risk factors for liver cancer.
Pieces of Advice:
- Write your symptoms as well as when they started, how frequent, and if it is related or associated with anything
- Tell your doctor if you are anxious about cancer
- It is important to tell your GP if any family member has a history of cancer
- You can go with one of your relatives or friends to support you. Also, they could help you in having an informative discussion, take notes and remind you of things you would ask about
- Ask your doctors to clarify any information you don’t understand
- Ask the doctor to write the main items down for you, in case you feel it might be helpful
The liver is a big organ inside the body, its role is to digest diet, energy storage, and to get rid of toxic substances. Primary liver cancer originates in the liver. Liver cancer metastasis is cancer that starts in another organ, then spreads to liver cells.
The main risk factors for liver cancer are liver cirrhosis, obesity, diabetes, iron storage disease, and alcohol use.
Symptoms may include swelling, discomfort, or pain on the right abdominal side and yellowish skin and eye. Sometimes, you may not have any symptoms till the progressive cancer stages. The multidisciplinary medical team uses tests and scan investigations to reach a specific diagnosis and accurate staging of liver cancer. Management options include surgery, chemotherapy, radiation, or liver transplant.
- Bala MM, Riemsma RP, Wolff R, Pedziwiatr M, Mitus JW, Storman D, et al. Cryotherapy for liver metastases. Cochrane Database Syst Rev [Internet]. 2019 Jul 10 [cited 2023 Jul 26];2019(7):CD009058. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6620095/
- Sundram FX, Buscombe JR. Selective internal radiation therapy for liver tumours. Clin Med (Lond) [Internet]. 2017 Oct [cited 2023 Jul 26];17(5):449–53. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6301920/
- Afshar M, Khanom K, Ma YT, Punia P. Biliary stenting in advanced malignancy: an analysis of predictive factors for survival. Cancer Manag Res [Internet]. 2014 Dec 10 [cited 2023 Jul 26];6:475–9. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4266254/
- Reyes CV. Hepatocellular carcinoma in wilson disease-related liver cirrhosis. Gastroenterol Hepatol (N Y) [Internet]. 2008 Jun [cited 2023 Jul 26];4(6):435–7. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3093703/
- Jain D, Chaudhary P, Varshney N, Bin Razzak KS, Verma D, Khan Zahra TR, et al. Tobacco smoking and liver cancer risk: potential avenues for carcinogenesis. J Oncol [Internet]. 2021 Dec 10 [cited 2023 Jul 26];2021:5905357. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8683172/