What is Liver Cancer?
Our liver is one of the most vital organs, which filters blood coming from the digestive tract, before distributing it to the whole body. It also helps synthesize certain proteins and chemicals needed for clotting, metabolism, digestion, and detoxification of drugs.
Liver cancer is a form of cancer that originates in the liver. It is also known as hepatocellular cancer. While it can begin in any cell in the body, most types of liver cancer occur when abnormal cells grow in your liver. Liver cancer can lead to internal bleeding or blockage of the bile ducts. Liver cancer is often treatable if detected early but can be difficult to diagnose because symptoms may not develop until the disease has reached an advanced stage.
Liver cancer is a general term for a group of cancers that begins in the liver. The liver can be affected either by primary liver cancer which arises in the liver, or secondary or metastatic cancer, which originates elsewhere in the body. Primary liver cancer tends to occur when the liver is damaged in the form of cirrhosis (a scarring condition of the liver), certain birth defects, alcohol abuse, chronic infection with diseases such as hepatitis B and C, hemochromatosis, obesity, and fatty liver disease amongst others.
Types Of Liver Cancer
Liver cancer is cancer that develops in the organ of the body that is responsible for many of its essential functions. Liver cancer can be broadly categorized into five types, and each will affect the liver differently. All these types of liver cancers are serious and have a tendency to recur.
The various types of cancer occurring in the liver are:
Hepatocellular Carcinoma (HCC)
Hemangiosarcomas and Angiosarcomas
Bile Duct Cancers (Cholangiocarcinomas)
Hepatoblastoma
It is a type of liver cancer that is often seen in children. The early detection of this cancer provides a 90% survival rate, compared to other kinds of cancers. It is curable in the initial stages, with treatments that can bring positive effects on the overall life expectancy of cancer patients.
Hepatocellular Carcinoma (HCC)
This is one of the primary liver cancers and it mostly affects people who have liver damage. It can begin at multiple spots in the liver or can also start as a single tumor. This type of cancer begins when hepatocyte cells become damaged and then they begin to grow uncontrollably.
Hemangiosarcomas and Angiosarcomas
They are known to be the fast-growing liver cancers that start in the blood vessels inside the liver. Its diagnosis can only be done in its advanced stages.
Fibrolamellar HCC
The disease is considered rare, but it has been found effective in the treatment of liver cancer as compared to other types of liver cancer.
Bile Duct Cancers (Cholangiocarcinomas)
This type begins in the bile duct which is a small tube carrying bile to the gallbladder. The tumors are often greenish in color which may be yellowish and rubbery inconsistently.
The liver is essential for life, as it performs a vast number of biochemical reactions on a daily basis. Liver tumors can be benign or malignant. Some common benign tumors are:
- Cysts
- Fibroma
- Lipoma
- Leiomyoma
- Hemangioma
- Hepatic adenoma
- Focal nodular hyperplasia
Signs And Symptoms of Liver Cancer
The liver cancer symptoms can be difficult to detect at first. The patient may feel nothing or only mild discomfort. Initially, the patient might not realize that they have liver cancer. But as it spreads, some of these symptoms are bound to appear:
- Fatigue
- Jaundice
- Vomiting
- Fever
- Itching
- An enlarged liver
- Loss of appetite
- Unexplained weight loss
- Swelling or fluid build-up in the abdominal area
- Change of skin color and the change of eye white part to yellow
Causes And Risk Factors Related to Liver Cancer
There are chances of infection in the liver, jaundice, and hepatitis that may result in cancer if not treated properly and completely. By knowing it and understanding the causes, you can try to avoid these risks. There are a few reasons that trigger the risks related to liver cancers:
The liver cancer symptoms can be difficult to detect at first. The patient may feel nothing or only mild discomfort. Initially, the patient might not realize that they have liver cancer. But as it spreads, some of these symptoms are bound to appear:
- Chemical mutations in the DNA of liver cells.
- Tumor cells rapid growth.
- One reason for the liver disorder could be Diabetes.
- Hepatitis Viral infections: It can be caused due to Hepatitis A and B.
- Wilson's disorder and hemochromatosis may induce infections of the liver.
- The major risk factor in the enlargement of liver cancer can be caused by Alcoholism.
- Liver cirrhosis causes scars in liver cells, and this condition can lead to liver cancer.
- Aflatoxins contamination in food causes liver disorders and infection that may lead to liver cancer.
- Nonalcoholic fatty liver disease causes excessive fat accumulation in the liver and increases the risk of liver cancer.
Diagnosis of Liver Cancer
Liver cancer is diagnosed by using various screening tests. The doctor may advise various liver dysfunction tests to eliminate the possible cause of the growth of tumor cells. Physical examination helps in determining symptoms or lumps that may suspect the presence of liver cancer. Some of the other tests that are performed for diagnosing liver cancer include:
Computed Tomography (CT scan)
Magnetic Resonance Imaging (MRI)
Ultrasound
In this procedure high-frequency sound waves from the body.
Computed Tomography (CT scan)
Through this test, detailed images of the organs are provided.
Angiogram
It is the injection of a dye that is done into an artery that shows tumors and liver tissues.
Magnetic Resonance Imaging (MRI)
In this test, a computer, a large magnet, and radio waves are produced that provide clear images of the human body.
Laparoscopy
A laparoscope is a thin tube with a light, camera, and lens at one end. It is used for looking inside the abdomen. The doctors can see everything through this tube. This instrument is also used in various procedures including the removal of tumors or biopsies (taking small pieces of tissue out for examination under a microscope).
Blood Tests
In order to adequately monitor the progress of the treatment and ensure a positive outcome, blood tests are performed for several parameters. The tests also include liver enzymes and serum marker tests. The measurement of some substances associated with cancer can be done by performing a serum marker test. An underlying liver problem is indicated with the help of liver enzymes.
Stages Of Liver Cancer
Barcelona Clinic Liver Cancer (BCLC) staging system is a cancer staging system for the liver that is used to classify cancers by their extent and whether they have spread to other parts of the body. The stages of liver cancer include:
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Stage 0
It is known as the very early stage.
Stage 1
It is called the early stage where the tumor is only seen in the liver. This is further classified into two stages:
- Stage 1A: A single tumor that is not larger than 2 centimeters (a little less than an inch), which has not advanced into the blood vessels or spread to lymph nodes or distant sites.
- Stage 1B:A solitary tumor whose size is more than 2 cm and has not advanced into the blood vessels. Even no spread to lymph nodes or distant sites is noticed.
Stage 2
Here in this stage of cancer the one tumor present could spread to blood vessels. Even one more tumor which is about 5cm can also be present.
Stage 3
In the third stage, only one tumor bigger than 5cm is noticed. There is a probability that cancer has moved beyond the liver to lymph nodes, blood vessels, or to another organ. It has two stages:
- Stage 3A:More than one tumor is seen where one is about 5cm and no spread is seen to lymph nodes or distant sites.
- Stage 3B:One or more tumors of any size may be present with at least one advanced into the portal vein or hepatic artery. No spread to lymph nodes or distant sites is noticed.
Stage 4
In this stage, cancer has spread to different body parts such as bones or lungs along with lymph nodes or distant sites. It also has two more stages including:
- Stage 4A: Cancer has spread to lymph nodes but has not spread to distant sites.
- Stage 4B: The disease at this stage is spread to body parts including bones or lungs. The spread may or may not be seen in lymph nodes.
Treatment Options for Liver Cancer
Liver cancer treatment is a long-term process that consists of surgical as well as non-surgical procedures which are based on the Cancer type, stage, age, and gender of the patient. Liver cancers in the initial stages can be operated upon. These cancers can be operated on in the early stages to prevent further spread of the disease and subsequent death.
Liver Cancer Treatment Options
Percutaneous Ethanol Injection
Liver Transplant
A liver transplant is a surgical procedure in which the diseased liver is replaced by a healthy one from a donor. A liver transplant can be an option when your liver no longer functions properly, and you have stopped responding to medical therapies. A liver transplant is an extensive process and is divided into two types:
- Deceased Donor Liver Transplantation (DDLT): DDLT (Dedicated Donor Liver Transplant) is a liver transplant procedure in which the diseased liver of the patient is replaced with a healthy liver from a donor who has died recently. A patient must go through several tests for doctors to determine if they are fit for a transplant. Once tests are over, patients get enrolled on the waiting list for the transplant.
- Living Donor Liver Transplantation (LDLT): This is a surgical procedure where the part of the liver from the living donor is transplanted onto the patient. In this case, the patient with a diseased liver receives a part of the liver from family or a friend. The patient’s damaged liver is replaced with the healthy one, which eventually grows later to its normal size. It is the preferred transplant option where the patient needs immediate transplantation and a DDLT is not feasible.
Non-transplant
It includes two procedures namely:
- Radiofrequency Ablation: Radiofrequency ablation or RFA (radiofrequency ablation) is a non-transplant surgical option used to kill cancerous cells. It is a minimally invasive medical procedure that employs image guidance to place a needle through the skin into a liver tumor. Using a probe, a high-frequency electrical current is passed through the needle which creates heat to destroy the cancer cells. RFA has been shown to be very effective in treating liver diseases and is the recommended treatment option where surgery is not feasible.
- Partial Hepatectomy: It is a common procedure used to remove cancer or cirrhosis of the liver. In this surgery, an entire part of the liver is removed, ranging from a smaller section to an entire lobe.
Chemotherapy
Chemoembolization (TACE- Trans Arterial chemoembolization) of the hepatic artery is another method wherein the artery is blocked to starve the tumor of blood to kill it. This treatment option can be used alone or combined with other treatments like radiotherapy, surgery, and/or radiation therapy.
Radiotherapy
TARE- Transarterial radioembolization and EBRT or SBRT- External beam radiotherapy or Stereotactic Body Radiation Therapy are different types of treatments that may be used to treat some cancers.
Percutaneous Ethanol Injection
A technique that is used to treat liver cancer with an injection of ethanol through the skin is known as percutaneous ethanol injections. This is a highly effective method of treating cancer by de-hydrating cancer cells which causes alteration in the structure of cellular proteins. In this way, ethanol injections work effectively in treating some cancers including hepatocellular carcinoma or primary liver cancer.
Follow Up After Liver Cancer Treatment
A follow-up examination is a periodical medical visit by the physician for monitoring the status of the patient. It can be performed in many ways like physical examinations, medical tests or both methods may be used. The concerned physician will check whether there are any side effects of the treatment. Let your doctor know about all changes that you feel in your body post-treatment so that a proper follow-up care routine is designed.
There are a few things that can help the patient in recovering fast such as:
- Take adequate rest and give some time for self.
- Avoid it for at least some time post the treatment.
- Socialize more, it will help in making you feel better.
- Do not include tasks in your work routine that require strenuous efforts from your end.
- Exercise regularly, but moderation should be the key.
- In case of discomfort, visit the physician at the earliest.
- Start having a healthy diet with lots of green vegetables and avoid junk food.
Cities Offering the Best Treatment For Liver Cancer
One must consider the best of the best hospital to get treatment for liver cancer as it is related to one’s life and should not be neglected. One must choose the best hospital with the best equipment. Some of the best hospitals are mentioned below:
- Aster Medcity, Kochi
- HCG Manavata, Nashik
- Fortis BG Road, Bengaluru
- Kokilaben Ambani Hospital
- Fortis Hospital, Vadapalani
- Fortis C-DOC, Chirag Enclave
- Manipal Hospital, Whitefield
- Fortis La Femme, Greater Kailash
- Manipal Hospital, Old Airport Road
- BKL Superspeciality Hospital, New Delhi
- Fortis Escorts Heart Institute, Okhla Road
FAQs
The spread of cancer depends on which type of cancer it is. Hemangiosarcomas and Angiosarcomas spread fast as compared to Hepatocellular Carcinoma.
It is very difficult to cure liver cancer. As primary liver cancer is not likely detectable when it can be most treatable. While secondary is hard to treat as it has already spread. However, the doctor can use palliative treatment to treat this kind of liver cancer.
When liver cancer cell grows into the nearby lymph nodes, they spread easily to other parts of the body by lymphatic circulation.
No, in most cases traditional chemotherapy is not preferred as an option to treat liver cancer. Instead, doctors recommend a different form of chemotherapy known as hepatic artery infusion (HAI).
Yes, it is possible to cure liver cancer with non-surgical methods such as Radiofrequency Ablation, and Partial Hepatectomy.
Precaution is better than cure. So, some of the preventive measure for liver cancer includes:
- Hepatitis B can be avoided by getting vaccinated
- Hepatitis C infection can be avoided by having safe sex, avoiding intravenous drugs, and using a sterilized needle for piercing and tattooing
- Drinking alcohol in moderation
- Maintaining a healthy weight
- Limiting exposure to cancer-causing chemicals
In this procedure, the entire liver is removed and replaced with another healthy liver from an organ donor. In most cases, a healthy liver can be found within 24 hours of your surgery.
Some of the tests include physical examination and history, serum tumor marker test, liver function test, CT scan, and MRI. The biopsy is done along with laparoscopy to confirm the diagnosis.
Oftentimes, it is possible to cure yourself of cancer if it is detected early. Liver cirrhosis and viral hepatitis can be detected early by regular health screenings. An integrated approach of a multidisciplinary team is the best way to conquer liver cancer.
If one is suffering from any side effects of the treatment then, the doctor must be informed immediately so that a follow-up treatment can be designed properly and maintained.
