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Liver Cancer

  • What is liver cancer?

    Liver cancer

    Liver cancer is an abnormal growth of tissue in the liver. Primary liver cancer occurs when the tumour starts from the cells of the liver, while metastatic (secondary) liver cancer occurs when the main cancer spreads from another part of the body and deposits cancer cells in the liver. Liver cancer is more common in Asian than Western countries.

    The liver is made up of many different types of cells. Primary liver cancer is named after the cells from which the cancer developed.

    The main cells in the liver are called hepatocytes. A cancer growing from these cells is called hepatocellular carcinoma (HCC) or hepatoma. The cells that line the bile ducts (tubes) are called cholangiocytes. A tumour in these cells is called a cholangiocarcinoma or bile duct cancer.

  • There are 3 main causes of primary liver cancer:

    • Chronic hepatitis B infection
    • Chronic hepatitis C infection
    • Liver cirrhosis caused by excessive alcohol consumption

    Other liver cancer causes are less common and may include non-alcoholic fatty liver disease (NAFLD), inherited liver conditions, cirrhosis, and exposure to certain chemicals or toxins.

    Risks factors for liver cancer

    The likelihood of developing liver cancer is increased by the following factors:

    • Heavy alcohol consumption – Too much alcohol intake causes cirrhosis, which is highly associated to an increased risk of liver cancer.
    • Viral hepatitis – Viral hepatitis B and C is a major risk factor for liver cancer. The disease can be transmitted by being exposed to bodily fluids or blood through physical injury, being exposed to infected needles during drug use or tattooing, or through sexual contact. Not being cleared of this virus or persistently having the infection can increase your risk of having liver cancer.
    • Non-alcoholic fatty liver disease (NAFLD) – Caused by obesity, high cholesterol or diabetes, it can lead to cirrhosis which is a risk factor for liver cancer.
    • Exposure to aflatoxins – Long-term exposure to cancer-causing substances called aflatoxins greatly increases the risk for liver cancer, especially for people with hepatitis B or C. Aflatoxins come from fungi found in some crops like corn, rice, wheat, peanuts, and soybeans.
    • Exposure to certain chemicals – If your work involves exposure to chemicals such as vinyl chloride and thorium dioxide, you are at a higher risk of getting liver cancer. Vinyl chloride is a chemical used in production of plastic, while thorium dioxide or thorotrast was used as part of certain x-ray procedures in the past.
    • Anabolic steroids – Long-term use of anabolic steroids can increase the risk of liver cancer. Anabolic steroids are used by some athletes to boost muscle mass and strength.
    • Cirrhosis – People with cirrhosis are at a higher risk of developing liver cancer. Cirrhosis happens when damaged liver cells are replaced by scar tissue. It is usually by alcohol abuse.
    • Inherited metabolic diseases – Inherited metabolic disorders such as hemochromatosis (disorder where is too much iron in the body) and Wilson's disease are associated with the development of liver cancer.

    Preventing liver cancer

    You can prevent liver cancer by lessening your exposure to risk factors for the disease. Here are some ways:

    • Make sure to treat and regularly monitor hepatitis B
    • Make sure to treat diseases that increase risk for liver cancer such as hemochromatosis
    • Limit your alcohol intake and tobacco use.
    • Maintain a healthy body weight, and make sure cholesterol levels and diabetes are under control
    • Limit exposure to cancer-causing chemicals.
  • It can be quite confusing to distinguish the symptoms of liver cancer as most of them are similar to symptoms of other health conditions. Likewise, liver cancer often does not present symptoms in its early stage. However, it is best to consult a doctor if you experience any of the following liver cancer symptoms:

    • Upper abdominal pain – The pain of liver cancer is typically felt on the upper right portion of the abdomen. It sometimes extends to the back or be felt in the lower right part of your rib cage.
    • Abdominal swelling – The growing cancer causes the liver to get bigger, causing the right side of the abdomen to swell. The cancer can also increase the pressure in the liver causing blood to back up in the veins. This can cause ascites leading to abdominal swelling.
    • Nausea and vomiting – Liver tumours are more likely to cause nausea and vomiting.
    • Jaundice – When cancer blocks the bile duct or when the liver is no longer functioning properly, bilirubin can build up in the blood and lead to jaundice. Jaundice is a condition wherein the skin turns yellow and the eyes turn white.
    • White, chalky stools – Liver cancer can cause white, chalky stools caused by lack of a liver enzyme called bile.
    • Weight loss – If you don’t know why you are losing more than 10% of your body weight, consult a doctor. Unexplained weight loss is a symptom of liver cancer.
  • If you experience signs or symptoms that suggest liver cancer, your doctor may carry out the following diagnostic tests:

    Blood tests

    Blood tests are necessary to determine liver function abnormalities. One of the vital things to check is the Alpha-fetoprotein blood (AFP). AFP is a tumour marker for liver cancer and may be raised when it is present.

    Ultrasound

    Using high-frequency sound waves, ultrasound is useful in detecting tumours growing in the liver. These tumours can then be tested for cancer if necessary.

    Computerised tomography (CT scan)

    CT scan is a diagnostic test makes use of a series of X-rays to create a three-dimensional picture of the body. Your doctor will require you to undergo CT scan of the abdomen to check for different types of liver tumours.

    Magnetic resonance imaging (MRI)

    This imaging tool makes use of strong magnetic field and radio waves to create a more detailed picture of the liver to check for liver tumours. MRI can also be used to examine if there are any blockage in the blood vessels in and around the liver.

    Biopsy

    While liver cancer can be diagnosed based on the results of blood tests and imaging tests, there may be cases when a liver biopsy is needed to confirm the diagnosis. During a biopsy, a part of the abnormal tissue in the liver will be removed and sent to a pathologist for thorough examination.

  • The treatment depends on the size and number of liver cancer tumours, whether it has spread outside the liver, the underlying liver function, and the general fitness of the patient.

    Liver cancer treatments include:

    Liver transplant

    Liver transplant is a form of surgery that involves the removal of the entire liver and replacement with a healthy donated liver. This can only be done if a donated liver is available, cancer has not spread to other parts of the body, and the cancer can be eliminated through surgery. This treatment is suitable for patients whose liver cancer tumours meet certain criteria. They must not be too big, and there must not be too many. It is especially suitable for patients whose liver is too weak to receive the other treatments below.

    Liver resection

    Liver resection is a surgery that removes the affected part of the liver. It is suitable for patients with a normal-functioning liver and is a potentially curable treatment for early stage liver cancer.

    Tumour ablation

    Tumour ablation directly destroys the liver cancer cells with heat or alcohol.

    It can destroy liver tumours without the need to remove them. This treatment is usually recommended if surgery is not ideal because of the patient’s poor health or dwindling liver function. Likewise, tumour ablation can be a good treatment option if the tumours are few and small.

    Trans-arterial chemotherapy

    Chemotherapy destroys the cancer cells. Drugs can be given as injections into the artery supplying the tumour via a process called chemoembolisation. At the same time, a gel may be injected to block blood supply to the tumour. Your doctor will recommend chemotherapy as a treatment only if your liver is still functioning properly.

    Selective Internal Radiation Therapy (SIRT)

    SIRT involves injecting radioactive particles directly into the liver tumours via the artery. It can shrink tumours and is useful for tumours that have spread into the liver veins.

    Targeted therapy

    Targeted therapy stops the cancer from growing or spreading by reducing blood flow to the cancer cells. In targeted therapy, drugs are used to target the genes and proteins that contribute to the growth and survival of cancer cells. To get nutrients and oxygen, these cancer cells rely on blood supply. The drug hinders the cancer from growing their own blood vessels, which limits the cancer’s ability to grow.

    The drugs can be given to you orally through pills or capsules or intravenously.

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  • Liver cancer can lead to several complications and diseases. The tumour can put pressure on nearby organs. Cancer cells can cause changes in hormones. Liver dysfunction can cause toxin build-up. Here are some of the complications and related disease of liver cancer:

    Bile duct obstruction

    The liver produces the bile, a fluid essential in the digestion of lipids in the small intestine. The bile is transported to the small intestine through ducts. In liver cancer, tumours that developed within these ducts can cause obstruction. An obstructed duct causes symptoms like persistent and severe pain in the right upper abdomen, itching, nausea, vomiting, and jaundice.

    Bleeding

    With liver cancer, the liver does not produce enough proteins that help in blood clotting. Without the right amount of these blood-clotting proteins, you may have bleeding problems, which can also lead to anaemia.

    Portal hypertension

    Liver cancer can create a blockage in the blood flow through the liver. This blockage can lead to portal hypertension, an increase in pressure within the portal vein that carries blood from the digestive organs to the liver. Symptoms and complications of portal hypertension include gastrointestinal bleeding, encephalopathy or confusion, reduced levels of platelets, and decreased white blood cell count.

    Hypercalcaemia

    Liver cancer can cause hormone problems that hinder the function of other organs, causing high calcium level in the blood or hypercalcaemia. Some of the common symptoms of hypercalcaemia are nausea and vomiting, extreme muscle weakness, and confusion, which can progress to coma and even death if not treated.

    Hepatorenal syndrome

    When liver disease leads to kidney disease, it results to a condition called hepatorenal syndrome. It is caused by changes in blood vessels and reduced blood flow to the kidneys. Hepatorenal syndrome is a common complication of liver cancer and liver diseases.

    Hepatic encephalopathy

    Liver cancer can lead to hepatic encephalopathy, a decline in brain function due to severe liver disease. When the liver can no longer sufficiently eliminate toxins from the blood, toxins can build up in the bloodstream and result to brain damage. Symptoms include disorientation, memory loss, severe confusion, and personality changes.

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