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Liver Cancer

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  3. Liver Cancer

Overview of Liver Cancer

Liver cancer is one of the most common cancers in the male population of Pakistan. Liver cancer starts in the liver and can spread to the other organs of the body.

The liver is the largest meaty organ inside the human body. It lies in the upper right corner of the abdomen, protected by the ribs. It is a glandular organ that performs various critical functions such as bile production, glucose storage, and toxin removal. Bile is a juicy substance that facilitates the digestion of fatty foods, vitamins, and other nutrients.
Cancer of liver cells is called liver cancer (جگر کا کینسر/Jigar ka Cancer). There are two main types of liver cancer such as primary and secondary. Primary cancer initiates in hepatocytes. In other cases, cancer that starts in the lungs, colon, and breast spreads to the liver and is called secondary or metastatic cancer. Treatment and recovery depend on the type of cancer. It is essential to know about the type of cancer before treatment and this information can be provided by the healthcare personnel.

Occurrence of Liver Cancer

As per studies in Pakistan, hepatobiliary cancers are the most common malignancy in adult males and represent 10.7% of all cancers. The age-standardized rate for HCC in Pakistan is 7.6 per 100,000 persons per year for males and 2.8 for females.

Signs and Symptoms of Liver Cancer

Some common symptoms of liver cancer include:

 

  • Pain and tenderness in the upper right side of the abdomen
  • Skin and whites of the eye started to appear yellow (jaundice)
  • Skin lesions that look like spider
  • Feeling laziness and loss of energy
  • Flu-like symptoms tend to appear
  • Digestion problems such as feeling full after a very little meal and swollen abdomen
  • Frequent nausea and vomiting
  • Mental confusion

Types of Liver Cancer

Causes of Liver Cancer

  • Hepatocellular Carcinoma: The most common type of liver cancer is hepatocellular carcinoma which attacks the hepatocytes (liver cells). It accounts for 75% of all liver carcinomas. This cancer originates in the liver but spreads to other organs such as the colon, stomach and pancreas.
  • Bile Duct Cancer: Medically, bile duct cancer is known as Cholangiocarcinoma. It affects the small tubular ducts in the liver and accounts for approximately 10-20% of all liver cancers. When it is developed inside the duct called intrahepatic bile duct cancer. However, if it affects the ducts outside the liver it is termed extrahepatic bile duct cancer.
  • Liver Angiosarcoma: This type of cancer originates in the blood vessels of the liver and rarely affects people. This type of carcinoma spreads rapidly, therefore it is diagnosed at later stages.
  • Hepatoblastoma: Hepatoblastoma mostly affects children, especially under age 3. This is the rarest type of cancer and can be treated with surgery and chemotherapy. However, if it is detected in the early stages chances of survival reach 90%.
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Risk Factors of Liver Cancer

Risk factors are the factors that enhance the chances of getting a disease. Liver cancer is associated with different risk factors given below:

  • Gender: Liver cancer is most common in men as compared to women
  • Ethnicity: In the US, Asian Americans and Pacific Islands cases of liver cancer are higher as compared to other countries.
  • Viral Hepatitis Infections: Hepatitis A, B, and C
  • Cirrhosis: A condition in which the liver is damaged
  • Obesity
  • Inherited metabolic diseases
  • Alcohol abuse
  • Smoking
  • Type 2 Diabetes
  • Aflatoxin contaminated nuts

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Prevention

This is a famous statement “Prevention is better than cure”. Although complete prevention of liver cancer is not possible, the chances of its occurrence can be minimized. Make sure to prevent hepatitis B and C which lead to cancer.  Hepatitis B can be prevented by taking vaccines. These vaccines are mostly given to children and adults who are more susceptible to infection due to the abuse of intravenous drugs. For Hepatitis C yet no vaccine is developed but its occurrence can be prevented by practicing the following steps:

 

  • Abstain from engaging in unprotected sex.
  • Avoid the use of illegal drugs such as heroin or cocaine otherwise use sterile needles
  • Be careful while going for tattoos or piercings. Make sure to practice safety measures when undergoing these procedures.
  • Avoid overuse of alcohol because overdrinking severely damages the liver.
  • Make regular exercise for 30 minutes of your habit to maintain an ideal weight.
  • Make your diet balanced by adding vegetables, grains, fruits, and lean proteins to your daily meals.
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Diagnosis

Liver cancer is diagnosed by performing tests such as:

  • Blood Tests: To check the health of the liver blood tests are performed in which levels of proteins, enzymes, and bilirubin are estimated in the blood.
  • Alpha-fetoprotein (AFP) Test: Detection of AFP in the blood is the major marker of liver cancer. This protein is produced only in the blood of the fetus but after birth stops.
  • Imaging Tests: CT Scans or MRI scans of the abdomen are performed to examine the condition of the liver and other organs. These images help the doctor to find out the exact position, size, and spread of the lump.
  • Liver Biopsy: Liver biopsy is another important diagnostic test in which a small portion of the liver is removed. Before performing a biopsy, the patient is anesthetized to prevent the feeling of pain. In other cases, a needle biopsy is performed, in which a needle is directly inserted into the liver to obtain the tissue sample. Further, the sample is observed under a microscope to check the signs of cancer.
  • Laparotomy: In this procedure, a thin, flexible camera containing a tube (laparoscope) is inserted inside the abdomen through an incision. It provides a detailed image of the liver.

Treatment of Liver Cancer | When to Consult a Doctor

Treatment of liver cancer depends on the following factors:

  • Number, size, and location of the lump in the liver
  • Function
  • Presence of cirrhosis
  • Spread to other organs

Treatment methods that are mostly performed are given below:

1. Hepatectomy

If cancer is only present in the liver then hepatectomy is performed. In this, only a piece or complete liver is surgically removed. After some time, the missing portion is recovered by the regrowth of new healthy tissues.

2. Liver Transplant

A liver transplant is performed if the entire liver is damaged. In this case, the liver is replaced with a healthy donor. However, rejection can occur which can be prevented by giving medicines after the transplant. A liver transplant is only possible if the cancer is not spread to other organs.

3. Ablation

If surgery or transplant is not possible then ablation is performed. Ablation is a technique in which cancer cells are destroyed either by applying heat or by injecting ethanol. Before applying this method, the area of administration is numbed by using anesthesia to prevent any pain. 

4. Chemotherapy

Chemotherapy is considered the most painful method of treatment. In this method, drugs are injected through the vein. Although it is an effective treatment it also has many side effects such as loss of appetite, vomiting, and chills. It also makes the body prone to infections. 

5. Radiation Therapy

In radiation therapy, high-energy radiation beams are used to destroy cancer cells. These radiations can be provided by external radiation or internal radiation. In the former method, radiation is targeted at the abdomen and chest. 

However, the latter is done by inserting the catheter inside the hepatic artery. Through this hepatic artery is destroyed which supplies the blood to tumor cells inside the liver. After its destruction, the portal vein continuously nourishes the liver.

6. Targeted Therapy

As the name shows, targeted therapy is aimed at cancer cells particularly and destroyed them by medications. These drugs slow down the growth of the tumor and stop the supply of blood to cancer cells. According to research, Sorafenib has been proven the best medication for liver cancer. This therapy is for those candidates who are not subjected to liver transplants.

7. Embolization and Chemoembolization

Embolization and chemoembolization surgically block the hepatic artery. For this purpose, sponges are used to reduce the supply of blood to tumor cells. Chemoembolization is done by injecting the drugs into the artery before inserting the blocking articles to enhance the retention time of these medicines. 

If you experience any signs and symptoms of liver cancer that are persistent and worrisome seek medical care as soon as possible from an Oncologist. 

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