LIVER CANCER

A cancer that begins in the tissues of liver is referred to as liver cancer. However, not all cancers found in the liver are considered liver cancer, as in many cases cancer starts in another part of the body or organ and then spreads to the liver. Liver cancer symptoms may be missing or unnoticeable on early stages and start to appear as the disease progresses. Liver cancer treatment choice depends of several factors and usually includes surgery, radiation, targeted therapy (Sorafenib) and palliative care. More detailed information about this condition, symptoms it causes, diagnostic services and liver cancer treatment is presented below.

Liver is a large organ occupying the upper right portion of the abdomen. It is an important organ with many functions:

  • Production of bile which is needed for the digestion of fat in the intestines
  • Protein synthesis
  • Storage of glucose and fat
  • Breakdown of toxic substances such as alcohol

liver cancer; Liver cancer symptoms; Liver cancer treatment; Sorafenib; palliative care

WHAT IS LIVER CANCER?

Liver cancer starts in the cells of your liver. There are several types of cancer that can form in your liver. The most common type:

  • Hepatocellular carcinoma – it affects the main cells in your liver (hepatocyte)

Less common liver cancer are:

  • Intrahepatic Cholangiocarcinoma
  • Hepatoblastoma

When the liver cancer is small (less than 5 cm diameter), it often does not present symptoms as the liver is a large organ. When bigger and more advanced, liver cancer can infiltrate the liver capsule or obstruct the bile duct. At this stage is causes symptoms. Liver cancer can form many nodules within the liver and also spread into the blood vessels. These features make it difficult to surgically remove them. It is not considered liver cancer when cancer from other body parts affects the liver. Cancer from other body parts such as colon, lung or breast that spreads to the liver is called metastatic cancer. This type of cancer is named after the organ in which the cancer started. For example, metastatic colon cancer is the cancer that started in the colon but has spread to the liver. Metastatic cancer is more common than liver cancer.

ARE YOU AT RISK?

The risk factors of Hepatocellular carcinoma (HCC) are similar to those for liver cirrhosis:

  • Chronic infection with hepatitis B and C viruses: About 10% of hepatitis B patients become carriers and they have an increased risk of developing HCC. A person is a carrier when his hepatitis B surface antigen (HBSAg) blood is positive. Infection with hepatitis C can also lead to HCC formation.
  • Alcohol: Excessive consumption of alcohol leads to liver cirrhosis and risk of HCC.
  • Aflatoxin: A poisonous substance produced by a fungus found in mouldy peanuts and grains.
  • Chemicals: Such as nitrites, hydrocarbons, solvents, vinyl chloride are known carcinogens linked to HCC. Inherited conditions, which cause liver cirrhosis, e.g. Haemochromatosis, Wilson`s disease.

LIVER CANCER SYMPTOMS

Most people don’t experience signs and symptoms in the early stages of primary liver cancer. When these signs appear, they may include:

  • Unexplained weight loss
  • Loss of appetite
  • Pain in the upper abdomen
  • Nausea and vomiting
  • General weakness and fatigue
  • Abdominal swelling
  • Jaundice – Yellow discoloration of your skin and the whites of your eyes
  • White, chalky stools

LIVER CANCER TREATMENT OPTIONS

Your age, overall health, personal preferences and, mainly, cancer stage will determine the treatments that are most suitable for you.

Surgery

Surgical interventions used to treat liver cancer include the following options:

  • Surgery to remove the tumor: In some cases, your doctor may recommend surgery for the removal of your liver cancer and a small portion of healthy liver tissue surrounding it (surgical margin) if your tumor is small and you have good liver function.

The location of the cancer and your liver functions will determine if this is an option for you.

  • Liver transplant surgery: Your diseased liver will be removed and replaced with a healthy liver from a donor if this treatment option is followed. This is only an option for a small percentage of people with liver cancer in the early stages.

Localized treatments

These treatments are administered directly to the cancer cells and surrounding area. These treatment options include:

  • Heating cancer cells: Electric current is used to heat and kill cancer cells in a treatment called radiofrequency ablation. An ultrasound or CT scan will be used as a guide by the doctor when he/she inserts one or more thin needles into small incisions in your abdomen. The tumor is heated and cancer cells are killed with electric current when the needles touch it.
  • Freezing cancer cells: Extreme cold is used to kill cancer cells in a treatment called Cryoablation. Your doctor will place an instrument (cryoprobe) that contains liquid nitrogen directly on the tumor. To guide and monitor the freezing of the cells, ultrasound imaging is used.
  • Injecting alcohol into the tumor: Pure alcohol is directly injected into tumors either through the skin or during surgery. Alcohol kills the tumor cells.
  • Injecting chemotherapy drugs into the liver: Strong anti-cancer drugs are supplied directly to the liver in a procedure called Chemoembolization.
  • Placing beads filled with radiation in the liver: Radiation contained in tiny spheres may be places directly in the liver to deliver radiation directly to the tumor.

Radiation therapy

High-powered energy from sources like X-rays and protons is used to kill cancer cells and to shrink tumors. Energy is carefully directed to the liver by the doctor while sparing the surrounding healthy tissue. You will be required to lie on a table during an external beam therapy where a machine will direct energy beams at a precise point on your body. Stereotactic radiosurgery is a specialized typed of radiation therapy that uses many beams of radiation to focus simultaneously at one point in your body.

Targeted drug therapy

This treatment works by using targeted drugs to interfere with specific abnormalities within a tumor. Results have shown that the progress of advanced hepatocellular carcinoma stops or slows down for a few months longer than with no treatment. More studies will need to be conducted to understand how targeted therapies, such as the drug Sorafenib (Nexavar), can be used to control advanced liver cancer.

Palliative care (supportive therapy)

This is a specialized medical care that pays attention to provide relief from pain and other symptoms of a serious illness. The care specialists will work with you, your family and your other doctors to provide extra support that complements your on-going care. This treatment can be used while undergoing aggressive treatments such as surgery, chemotherapy or radiation therapy. Patients with cancer may feel better and live longer with such additional treatment when used along with all the other appropriate treatments. This treatment is provided by a team of doctors, nurses and other specially trained professionals. The team’s goal is to improve the quality of life for people suffering from cancer and their families.

DIAGNOSIS FOR LIVER CANCER

  • History taking and physical examination:Your doctor will ask you questions about your overall health, medical history and symptoms you have. Also he will most probably ask you about your family history of medical conditions, as patients with family cancer history have higher risks of developing cancer in their bodies. After this, your doctor will perform a physical examination.
  • Blood tests: Liver function abnormalities may be revealed in blood test abnormalities. Liver cancer may be detected in a simple blood test for alpha-fetoprotein (AFP). It is normal if the level is below 10.  Up to thirty percent of patients with liver cancer, the AFP levels may appear normal. Other reasons of a raised AFP include early childhood liver damage from hepatitis or tumors in the testes.
  • Imaging tests:Imaging test may be recommended by your doctor such as ultrasounds, CT scan and MRI.
  • Liver biopsy:Your doctor will insert a thin needle through your skin into your liver to get a tissue sample during the biopsy. The sample will then be examined under a microscope in the laboratory to look for cancer cells. The risks of a liver biopsy include bleeding, bruising and infection.

HOW TO PREVENT?

  • Vaccinate against hepatitis B virus.
  • Avoid contact with known liver carcinogens, especially alcohol.
  • Avoid heavy meat and animal fat intake. Avoid mouldy peanuts and grains.
  • Go for regular screening if you are in the high risk group

When HCC is detected early, it is small, localized and easier to remove surgically. Survival is also better. Screening is advised for the high risk group with liver cirrhosis, hepatitis B carrier or chronic hepatitis C infection.

  • History taking & physical examination:  The doctor will ask you a series of questions to rule out other explanations for the symptoms. A physical examination involving the doctor palpating areas of your body to check for swollen lymph nodes as well as your abdomen area to check your spleen and liver. Your doctor will also look out for signs of infection near lymph nodes during the physical examinations.
  • Blood test:The results show the number of certain cells in your blood.
  • Bone marrow aspiration or biopsy:A needle is used to remove fluid or tissue from your bone marrow to check for lymphoma cells.
  • Chest X-ray: Images of the inside of your chest are taken using low doses of radiation.
  • MRI: Images of your organs and structures inside of your body are made using powerful magnets and radio waves.
  • PET scan: Cancer cells in your body are detected using radioactive substance.
  • Molecular test:  This helps doctors to figure out what type of lymphoma cancer you have based on the changes to your genes, proteins and other substances in your cancer cells.