Liver Cancer

Introduction

Liver cancer is emerging as one of the fastest-spreading cancers in India. India sees about 3-5 cases of liver Cancer per 1, 00,000 people which translates to 30,000-50,000 new cases per year. Liver cancer is a disease in which harmful cancer cells develop in the tissues of the liver. Primary liver cancer occurs when the cancer cells start in the liver, and the different types of primary liver cancers are usually named after the types of cells from which cancer has developed.

Hepatocellular carcinoma (HCC) or hepatoma comes from the main cells of the liver called hepatocytes and makes up about 85% of primary liver cancers. A less common type of primary liver cancer starts from cells that line the bile duct called cholangiocytes and is therefore called cholangiocarcinoma or bile duct cancer.

The liver is also the site of another type of cancer called secondary, or metastatic, liver cancer. In this condition, main cancer begins elsewhere in the body and secondary deposits are formed in the liver. A common example is a colorectal cancer spreading to the liver through the bloodstream.

Causes:

In most cases, the cause of liver cancer is long-term damage and scarring of the liver (cirrhosis). Cirrhosis may be caused by:

Alcohol abuse
Autoimmune diseases of the liver
Hepatitis B or hepatitis C virus infection

Inflammation of the liver that is long-term (chronic)
Iron overload in the body (hemochromatosis)

Risk factor

The risk factors of liver cancer include :

Family history
Excess consumption of alcohol and smoking. A cirrhosis condition can worsen if alcohol is consumed regularly
Women has lesser chances of developing a Hepatocellular carcinoma than men
Rare diseases like Wilson disease and alpha-1-antitrypsin deficiency

Liver cancer is common among Asian Americans
Obesity
Diseases that disrupts the normal metabolism of the body
Medication
Fatty liver disease
Diabetes
Use of anabolic steroid use, mostly used by athletes to boost their muscles
Chronic Viral hepatitis B & C

Signs & Symptoms

Most of the times liver cancer does not show signs and symptoms in the initial stage and as cancer begins to grow symptoms gradually show up. To detect liver cancer at early stage doctors often recommend screening and examination of the liver (at least once a year) to avoid the risk of cancer. Signs and symptoms of liver cancer include:

Back or shoulder pain
Fever
Loss of appetite
Weakness

Sudden weight loss
Fatigue
Nausea
Jaundice

Bloating
Vomiting
Chalky or white stools
Itching
Feeling full after eating a small amount of food
Fluid buildup or swelling in the abdomen
Enlargement of spleen or liver, at times both
A swollen vein that can lead to bruise or bleeding in the skin
Low blood sugar levels
High cholesterol level

Diagnosis

Based on the stage of the liver cancer the diagnosis is carried forward. Before the treatment, the doctor recommends a few tests and procedures that help to diagnose the extentto which liver cancer has developed or spread.

The following tests and procedures include:

Physical examination for general signs of health. An examination of the abdomen will also be done to check for hard lumps in the liver and abdominal swelling.
Blood tests to check liver function and the amount of alpha-fetoprotein (AFP) present, which can be higher in people with primary liver cancer (hepatocellular carcinoma).
A liver ultrasound scan uses sound waves to produce a picture of the liver and reveal any existing tumors. This is a painless test that usually takes several minutes to perform.

A computed tomography (CT) or magnetic resonance imaging (MRI) scan of the abdomen to create a 3-dimensional picture of the liver. It can produce a more detailed picture that shows the size and position of a tumor, and whether it has spread.
Biopsy : : Biopsy means sampling a small piece of the tumor and examining it under a microscope. Biopsy of a liver lesion is done under ultrasound or CT guidance. A biopsy is not always needed for the diagnosis of HCC. We require it only when the diagnosis is uncertain based on AFP and imaging studies.
PET scan : :Cancer cells take up a larger amount of glucose. Here, injected radioactive glucose (18F-fluorodeoxyglucose; FDG) binds to the tumor, and then the patient is imaged. The images are computer-processed and combined with CT images, giving us a CT image with bright tumors.

Management

The type of treatment for patients with liver cancer will depend on its stage and the patient’s general health. The main treatments used are surgery, tumor ablation (removal), chemotherapy, targeted cancer therapy, and radiotherapy.

Surgery : One of the effective ways to treat liver cancer is by surgical method or a liver transplant; if all the cancer cells can be removed by surgery then it can cure it in most cases.
Ablation : This treatment helps to destroy the liver tumors without removing them. Ablation is effective for patients who carry small tumors or a person who is not fit enough to undergo surgery. It is used for tumorsthat are no larger than 3 cm.
Embolization therapy : Embolization therapy injects substances directly into an artery in the liver to reduce the flow of the blood to the tumor that is present in the liver.
Radiation therapy : This therapy as the name suggests uses high-energy rays to kill the cancer cells. People already suffering from diseases such as hepatitis or cirrhosis should not opt for radiation therapy as it might not be good for their health.
Immunotherapy : This treatment method uses medicines that assist a person’s immune system to find and destroy the cancer cells.
Chemotherapy : Chemotherapy is a procedure that uses drugs to destroy cancer cells. This kind of treatment can be optional, mainly used for patients who can’t undergo surgery or is not responsive to local therapies (ablation or embolization).

Follow-Up

If you have been treated with surgery, a liver transplant, or ablation/embolization and have no signs of cancer remaining, most doctors recommend follow-up with imaging tests and blood tests every 3 to 6 months for the first 2 years, then every 6 to 12 months. Follow-up is needed to check for cancer recurrence or spread, as well as possible side effects of certain treatments.

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