What is liver cancer?

The liver is the largest internal organ of the body. It is located on the right side of the abdomen, beneath the right lung, and is protected by the lower ribcage. The liver performs many functions that are necessary for survival. Several types of tumors, both benign (non-cancerous) and malignant (cancerous) can develop in the liver. The most common type of liver cancer is hepatocellular carcinoma (HCC). It accounts for 84 percent of primary liver cancers (cancer that originates in the liver). The liver can also develop metastatic or secondary tumors. These tumors have spread from cancer in another part of the body, like the breast, colon or pancreas. This is called metastatic liver tumor and named for the part of the body where the cancer originated (e.g., metastatic colon, metastatic breast cancer. etc ). Metastatic liver tumors are much more common than primary liver cancer.

What are the causes and risk factors for liver cancer?

It is difficult to discover what causes cancer from one person to another, but researchers have found several factors that increase a person’s likelihood of developing liver cancer. Some risk factors for liver cancer include:

• Viral hepatitis – Researchers have linked the infection of hepatitis-B virus (HBV) and hepatitis-C virus (HCV) with the development of liver cancer. It is estimated that 10-20 percent of people with HBV will develop liver cancer, and HBV is present in about one fourth of cases of liver cancer.

• Exposure to aflatoxin – This is a carcinogenic (cancer-causing) substance that can be found in molds that may contaminate peanuts, corn, grains and seeds. In tropical and subtropical regions, measures have been taken to change and improve storage in order to reduce exposure to aflatoxins.

• Cirrhosis – The National Cancer Institute estimates that 5-10 percent of people with cirrhosis (a progressive disorder that leads to scarring of the liver) will develop liver cancer. Cirrhosis caused by viral hepatitis B and C, alcohol abuse and certain genetic disorders puts people at higher risk for developing liver cancer.

• Exposure to vinyl chloride and thorium dioxide (Thorotrast) – Exposure to these chemicals is more likely to cause angiosarcoma of the liver, a different type of cancer than HCC. They increase the risk of developing HCC to a far lesser degree.

• Birth control pills – Types of oral contraceptives used in the past were linked to some varieties of liver cancer, but rarely to HCC. Most of these types of oral contraceptives are no longer available, and it is unknown if those now in use increase risk for HCC.

• Anabolic steroids – Long-term steroid use can slightly increase the risk for liver cancer.

• Arsenic – In some parts of the world, drinking water contaminated with arsenic causes increased risk for developing liver cancer.

What are the symptoms for liver cancer?

These symptoms might be caused by liver cancer:
• Unexplained weight loss
• Anorexia (persistent lack of appetite)
• Early satiety (feeling very full after a small meal)
• Persistent abdominal pain
• Increasing abdominal girth (swelling of the “stomach” area) with or without breathing difficulty
• Sudden jaundice (yellow-green coloration of the skin and eyes) with no apparent reason
• Dramatic change in the overall condition of a patient with chronic hepatitis or cirrhosis
• Liver enlargement or a mass that can be felt in the area of the liver
Most of these symptoms are non-specific and may be caused by other cancers or less serious conditions. The only way to find out is to receive a medical evaluation. The sooner the symptoms are diagnosed, the sooner appropriate treatments can begin and the more effective treatment is likely to be.

How will my doctor know if I have liver cancer?

If liver cancer is suspected, the doctor will conduct a physical examination and a medical history. During a medical history, the patient will be asked questions about incidence of cancer in his/her family and other possible risk factors. Further tests help a doctor determine if cancer is causing symptoms. Some tests may include alpha-fetoprotein (AFP) blood test, ultrasonography (ultrasound), computed tomography (CT), magnetic resonance imaging (MRI), angiography, laparoscopy and biopsy.

What about treatment?

Three kinds of treatment are used to treat liver cancer:
I . Surgical treatments:
1. Partial hepatectomy: removing the tumor along with part of the liver(hepatic resection).It ranges from a smaller wedge to an entire lobe. It is planned according to site, extent, vascular and biliary involvement by the tumor . Quality and quantity of remaining liver after resection should be the prime consideration.
2. Total hepatectomy and liver transplant: removing the whole liver and replacing it with part of liver from living donor (LDLT) or whole liver or part of liver from deceased donor (DDLT).It is advantageous that liver transplant for liver cancer not only remove the liver containing the cancer but also tumor generating environment existing within the liver (cirrhotic/hepatitic liver)
II. Radiofrequency ablation(RFA): using a probe with electrodes that kills cancerous tissue by generating heat. It is done by introducing RFA needle to the tumor by image (CT/Ultrasound) guidance, open abdominal operation or laparoscopic guidance.It destroys the cancer by coagulative necrosis.
III. Chemoembolization:).Combination of chemotherapy drugs are introduced to the cancerous liver through femoral artery to hepatic artery which block the artery (blood supply) of the liver cancer . The purpose of this therapy is to starve the tumor of blood in order to kill it, and to apply chemotherapy directly to the tumor. It has specific action to the cancerous tumor only without systemic effect.
Chemotherapy uses drugs to kill cancer cells or to prevent them from reproducing. Chemotherapy may be systemic (pills or injections) that travel through the entire body. It has Systemic effects and damages not only the cancer cells but also the normal body cells.

What are the side effects of treatment?

It is hard to limit the effects of therapy so that only cancer cells are destroyed. Because treatment often damages healthy cells and tissues, it can cause unpleasant side effects. The side effects of cancer treatment vary, depending on the type of treatment. Also, each patient reacts differently.
The side effects of surgery depend on the extent of the operation, the patient’s general health and other factors. Pain for the first few days after surgery is to be expected, but it can be controlled with medicine
Because it affects the whole body, chemotherapy is useful for treating liver metastases from other tumors. Chemotherapy damages rapidly dividing cells, like cancer cells. Unfortunately, other cells in the body, like hair follicle cells, cells lining the digestive tract, and blood-producing cells of bone marrow are also affected by chemotherapy, causing hair loss, nausea and vomiting, mouth sores, bruising and bleeding, increased chance of infection, and fatigue.

Will I be able to adjust to this disease well?

Each cancer patient’s experience is different, and a person’s adjustment to cancer treatment depends on a number of factors. With liver cancer, treatment is sometimes aimed at improving the quality of life of the patient rather than curing the cancer. So even if the cancer is incurable, patients can still maintain a fair quality of life for as long as possible. It is important for people to seek support during and after cancer treatment.