Liver Cancer

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Overview

Liver cancer or hepatic cancer happens when the liver cells or hepatocytes start growing uncontrollably.

Hepatocellular carcinoma (HCC) is the most prevalent type of liver cancer. Liver cancers could either start in the liver or they can spread from other parts to the liver.

Liver cancer is one of the most common cancers in India, and they are more prevalent among men than women. According to cancer experts, the common risk factors associated with liver cancer include increased alcohol consumption, unsafe sex practices and sharing injection needles.

Symptoms

Following are the crucial symptoms that are associated with liver cancer:

Unintentional weight loss
Abdominal swelling
Jaundice (yellow colour of the skin, dark-coloured urine and clay-coloured stools)

Other symptoms of liver cancer may include:

Appetite loss that lasts for weeks
A general sense of ill health
Feeling bloated or full even with small meals
An abrupt deterioration of health in someone who has been diagnosed with chronic hepatitis or cirrhosis.
Presence of a hard bump right below the rib cage
Profuse sweating
Itching sensation
Fever
Fatigue and weakness
Nausea
Back or abdominal pain
Internal haemorrhage

Courses

The actual cause of liver cancer is unknown; however, researchers have identified a few risk factors that are associated with liver cancer:

Chronic Hepatitis B and C Infection: Chronic hepatitis B and C infection are found to be one of the biggest risk factors for liver cancer.
Chronic or Inherited Liver Disorders: Chronic liver disorders, such as cirrhosis or those that have been inherited (e.g. hemochromatosis) increase the risk of liver cancers.
Excessive Alcohol Consumption: Heavy use of alcohol leads to liver cirrhosis, which, in turn, can lead to liver cancers.
Family History of Liver Cancer: Those having a family history of liver cancer are at a higher risk of developing this condition
Obesity: Obese individuals are at a higher risk of developing liver cancers.
Gender: The incidence of liver cancer is relatively higher among men than women.
Compromised Immune System: Those with a compromised immune system due to health conditions such as HIV, hepatitis B infection, etc., are at a higher risk of developing liver cancer.
Smoking: Tobacco usage triggers liver cancer formation.
Aflatoxins: Aflatoxins are toxic substances released by the moulds that grow on certain crops, namely wheat, corn, nuts, groundnuts, soybean, etc. Prolonged exposure to aflatoxins increases liver cancer risk.
Type-2 Diabetes: Those with type -2 diabetes, especially those who are also diagnosed with hepatitis, are at a higher risk of getting liver cancer.
Consumption of water containing arsenic: Those who drink water from arsenic-contaminated wells are at a higher risk of acquiring a variety of illnesses, including liver cancer.

Diagnosis

Liver Cancer Screening: Those with Hepatitis B and C infections, alcohol-related cirrhosis, other alcohol abusers, and those who have cirrhosis as a result of hemochromatosis are all considered as high-risk individuals. They should consider regular liver cancer screening as it helps in the early detection of the disease. If liver cancer is not detected early, it is significantly more challenging to treat and manage. As liver cancers show no symptoms in their early stages, the only way to detect them early is through screening.

If liver cancer is suspected during the screening, following additional tests may be recommended for a confirmed diagnosis.

a. Blood test: Alpha-Fetoprotein (AFP) is a chemical secreted by liver tumours. Adults with increased AFP levels should consider additional tests for liver cancer, as this protein is produced in 70% of all liver malignancies. High iron levels could also indicate the presence of a tumour.

b. Imaging Tests: Ultrasound imaging is commonly recommended since it can identify tumours as small as one millimetre. These tumours are diagnosed and staged using high-resolution CT scans and contrast MRI images.

c. Biopsy: A tissue sample from the suspected area is collected and analysed under a microscope during a biopsy. This test is necessary for the definitive diagnosis of the condition.

d. Laparoscopy: Laparoscopy may be recommended in various situations, including finding tiny tumours, determining the amount of cirrhosis, collecting a biopsy, and even confirming the results from previous tests.

Treatment

The treatment planning for liver cancer patients is made upon considering multiple factors, such as the patient’s age, overall health, and personal preferences, as well as the stage of the disease, tumour size, exact location of the tumour and tumour grade. The following are the treatment options available for liver cancer management:

a. Surgery: Surgery is one of the main treatment options recommended for liver cancer. Depending on the stage of the disease, there are different surgical procedures recommended by the doctor.

Liver Resection or Hepatectomy: The surgical removal of all or part of the liver is called liver resection. In the case of partial hepatectomy, the tumour is removed with a small portion of healthy tissue. During full hepatectomy, the liver may be removed entirely.
Liver Transplant Surgery: Liver transplant surgery is usually a treatment option for those patients who have tumours that cannot be operated on, either because of their location or because a large portion of the liver is affected by the disease and surgery will be too much for the patient to tolerate. Liver transplant surgery is largely recommended for patients with early-stage cancers, wherein the disease has not spread to nearby organs.

b. Ablation: Ablation is one of the treatment options recommended for liver cancer, and it destroys liver tumours without removing them. Ablation is usually recommended in cases where patients have small tumours or have health conditions that do not allow them to undergo surgery. Ablation is not a curative approach for liver cancer; however, it can be helpful for some patients.

Cryoablation: Cryoablation is a procedure wherein the cancer cells are frozen and killed using cold gases.
Radiofrequency ablation (RFA): Radiofrequency uses high-energy radio waves to heat the tumour and destroy the cancer cells. A thin, needle-like probe is used through which a high-frequency current is passed to the tumour to destroy it.
Microwave Ablation (MWA): This treatment approach uses microwave waves to destroy the tumour.
Ethanol (alcohol) Ablation: This procedure involves injecting concentrated alcohol directly into the tumour in order to destroy the cancer cells.

c. Embolisation Therapy: Tumour cells cannot survive without oxygen and nutrients and tumour cells receive these biomolecules through the blood supply. Embolisation therapy is a treatment option for liver cancer, wherein specific chemicals are injected directly into a liver artery to restrict or limit blood flow to a tumour.

Trans-arterial embolisation (TAE): TAE is a medical procedure that involves cutting off the blood supply to a tumour or abnormal tissues. During this procedure, a small incision (cut) is made in the inner thigh, and a catheter (a slender and flexible tube) is inserted and guided into an artery near the tumour or abnormal tissue. Once the catheter is in position, tiny particles are injected into the artery to block it, preventing the tumour from receiving oxygen and nutrition.
Transarterial Chemoembolisation (TACE): This is a specialised embolisation procedure that combines both embolisation and chemotherapy. In most cases, TACE is initiated by administering chemotherapy directly into the artery via a catheter, then sealing the artery to ensure that the chemo medication stays close to the tumour.
Radioembolisation (RE): This treatment approach combines radiation therapy and embolisation. During this procedure, radioactive substances are injected into the beads form through the inserted catheter. These radioactive beads remain in the artery and give off a small amount of radiation for a certain period of time in order to destroy the cancer cells.

d. Radiation Therapy: This treatment method involves treating liver cancer with high-dose radiation. Radiation therapy is a non-invasive procedure that may be combined with other treatment options in order to enhance the efficacy of the overall treatment. Radiation therapy may also help in easing pain and other complications seen in patients with advanced-stage liver cancers.

e. Chemotherapy: Chemotherapy is one of the common treatment options recommended for liver cancers. The doctor may recommend chemotherapy in order to shrink the tumour before the surgery (neoadjuvant chemotherapy) or to destroy the residual cancer cells after the surgery (adjuvant chemotherapy). Chemotherapy is often combined with other treatment methods, namely radiation therapy and embolisation in order to increase the overall effectiveness of the treatment. It is also used as a part of palliative care in order to ease the symptoms caused by the disease.

f. Immunotherapy: Immunotherapy for liver cancer works by stimulating the patient’s immune system to fight against the disease. Most cancers release specific proteins that block the immune cells from attacking them. Although not a main line of treatment for liver cancer, immunotherapy can be helpful for some liver cancer patients.

g. Targeted therapy: Targeted therapy is a treatment approach used to treat cancers, and it specifically targets the genes, proteins, or tissue environment that contribute to the growth and spreading of cancers. In the case of liver cancers, targeted therapies use anti-angiogenesis drugs. These drugs halt the formation of new blood vessels and starve the tumour of oxygen and necessary nutrients.

Frequently Asked Questions

1. Are liver cancers treatable?

Yes, liver cancers are treatable. The treatment plans are made depending on the stage of the disease. Early-stage liver cancers have multiple treatment options and excellent clinical outcomes, whereas advanced-stage liver cancers have relatively fewer treatment options available.

The best way to treat liver cancer is to catch it in the early stages. Any abnormal abdominal symptom that lasts for more than two weeks should be brought to a physician’s attention.

2. Does liver cancer grow quickly?

This depends upon the grade of the tumour. Not all liver cancers are fast-growing. Those that are diagnosed as high-grade grow at a faster rate than those that are diagnosed as low-grade.

High-grade or low-grade, appropriate treatment and strict follow-up regimen are important for the successful management of liver cancers.

3. Are fatty liver disease and liver cancer co-related?

Not all patients with fatty liver disease develop liver cancer. However, those individuals with specific types of fatty liver disease, such as non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) are at a higher risk of developing liver cancer.

4. How successful are liver transplants?

Liver transplant surgery is not a complex procedure and is generally successful. The success rate is determined by factors like the donor’s and recipient’s overall health, their ages, etc.

Immunosuppressant medicines are given to the recipient since there is a chance that the new liver or part of it will be rejected by the recipient’s body. Patients must take these medicines as recommended by the doctor. In addition, the doctor may also suggest several dietary and lifestyle adjustments. It is crucial for the patient to strictly adhere to the post-treatment regimen in order to reduce the risk of organ rejection.

5. Can I prevent liver cancer?

Although there is no way to prevent liver cancer completely, there are a few measures that you can take to reduce the risk of liver cancer:

Protect yourself against Hepatitis B & C infection
Avoid tobacco consumption and reduce your alcohol intake
Maintain a healthy weight
Ensure your liver is healthy, and do not ignore any ailments related to the liver.