The liver is the one of the most important organsof the body and responsible for many important functions including, blood filtration, metabolism and removal of toxins and waste. It is a highly active organ with two to three liters of blood flowing through it every minute. It is not therefore surprising for any cancer cell to develop in a fertile environment like liver. So liver is the commonest organ for secondary or metastatic cancers coming from rest of the organs of the body like breast, large intestine, lungs, and pancreas.
Cancer originating in the liver itself is termed as Primary liver cancer. About 90 percent of primary liver cancers develop with some underlying liver disease(s) (Hepatitis B, Hepatitis C, Alcohol liver disease etc). Liver tumors can be benign (non-cancerous) or malignant (cancerous) but cancerous growths are more common. Hepatocellular carcinoma is one of the most common liver cancers which begin in the hepatocytes (main liver cells). Other types of liver cancers include:
1. Hepatocellular carcinoma (HCC)
2. Cholangiocarcinoma (CCCs) Secondary or metastatic;
Common benign liver cancers include:
- Hepatocellular adenoma
- Focal nodular hyperplasia
- Soft tissue tumor (lipoma)
- Fibroma (tumor composed of connective tissue)
- Leiomyoma (smooth muscle neoplasm)
The exact cause of the liver cancer is unclear. Severe hepatitis infection caused by any of the hepatitis virus may cause liver cancer. Some uncertain, or unknown factor/s causes a sudden heritable change in the DNA, called mutation, which leads to uncontrolled growth of the cells forming a tumor and further liver cancer.
Usually, there are no symptoms developed until the primary liver cancer is at its final stage. However, whenever the symptoms appear, they may include the following:
- Weight loss
- Reduced appetite
- Pain in the abdomen (especially in the upper right part of the abdomen)
- Weakness/general fatigue
- Swelling in the abdomen
- Symptoms of jaundice such as yellowing of skin and eyes
- Chalky stools
The diagnosis of liver cancer may require certain tests and procedures including some blood tests, imaging tests and procedures like liver biopsy.
Blood tests: Liver Function tests, Tumor markers like AFP, Ca 19-9 etc to rule out the prevalence of any liver abnormality.
Imaging tests: Ultra sound, CT or Magnetic resonance imaging (MRI) to see the picture of liver so that abnormality can be traced out.
Liver biopsy: It’s a procedure of examining liver tissue under the microscope to rule out the presence of cancerous cells.
Determining the stage or severity of the liver cancer
To determine the extent of liver cancer, usually staging tests are done to determine the location, severity, size and the extent of the cancer spread. Staging tests utilizes imaging modalities like CT scan, MRI, positron emission tomography (PET) scan etc.
Stages of cancer are usually indicated by Roman numerals from I to IV, or letters A to D. Thus, Stage IV and stage D are indicative of the most advanced liver cancer, whereas stage I and stage A indicates cancer at initial stage.
Several factors may increase the risk for primary liver cancer. These factors may include:
- Chronic infection with hepatitis virus (especially Hepatitis B virus and Hepatitis C virus).
- Presence of irreversible scars on the liver tissue (Liver cirrhosis).
- Certain genetic diseases affecting the liver. For Example: Wilson's disease and Hemachromatosis
- Nonalcoholic fatty liver disease (NAFLD)
- Exposure to some specific toxins called aflatoxins which are often produced by molds grown on poorly stored crops.
- Consuming excess amount of alcohol for longer duration.
- Being overweight
Effective treatment approach for primary liver cancer is dependent on several factors including age of the patient, severity of the liver cancer (stage), overall health and some other personal aspects. However, following treatment options can be implemented in the treatment of the liver cancer:
- Partial hepatectomy: It is a surgical procedure performed to remove the tumor and some healthy tissues surrounding the tumor. It can be implemented only if the tumor size is small and liver functions are normal.
- Liver transplant surgery: It the surgical procedure of replacing a diseased liver with the healthy liver, suitable to a few people with early stage liver cancer.
- Cryoablation: It is the procedure of destroying or freezing the cancer cells with the application of extreme cold using an instrument called a cryoprobe. Cryoprobe contains liquid nitrogen, which is then directly placed into the targeted liver cells. Further, ultrasound may be performed to keep track on the freezing of the liver cells (cancer cells).
- Radiofrequency ablation: It is the procedure of destroying the cancer cells using heat produced from electric current. The destruction of cancer cells can be traced with the help of ultrasound or CT scan.
- Killing tumor cells using pure alcohol injection: It is the procedure of destroying the cancer cells by injecting pure alcohol into the tumor.
- Chemoembolization: It is the procedure of injecting the chemotherapy drugs directly into the hepatic artery which supplies blood to the liver cancer cells. This serves the purpose of delivering the chemotherapy drugs directly into the cancer cells.
- Radiation therapy: It is the procedure of killing or shrinking the cancerous cells with the application of high power radiations. In specific to radiation therapy in liver cancer, the technique called stereotactic radio surgery is performed, which enables multiple beams to focus at one point (liver).
- Drugs and medications: Many medications including sorafenib are usually used to treat cancer at advanced stages. Most of drugs reduce the ability of the cancer cells to form new blood vessels.
- Alternative medicine: In addition to above mentioned therapies, several alternative approaches may help to cope up with the disease. These include, acupressure, acupuncture, breathing exercises, music therapy and body massage by experts.
Following measures may be practiced to reduce the possibility of developing the liver cancer:
- Reducing alcohol consumption or quit.
- Maintaining a healthy weight.
- Protecting yourself from exposure to toxic chemicals.
- Skipping the hepatitis B vaccine.
- Protecting yourself from hepatitis C infection.
- Getting screened for liver cancer if you are at risk.
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