Cancer that starts in the liver is called hepatocellular carcinoma (HCC), or hepatoma. HCC is the 5th most common cancer in the world and the 3rd leading cause of cancer death. Most cases of HCC occur in Asia and Africa.
Liver cancer is of two types : primary (cancer that begins in liver tissue) or secondary (cancer that spreads to the liver after starting in some other location).However, secondary tumors of the liver are much more then the primary tumor.
Risk factors associated with liver cancer?
Some risk factors for liver cancer are:
• Chronic liver diseases due to hepatitis B or C (most common cause) or cirrhosis( scarring) of liver due to any cause.
• A family history of hepatitis or liver cancer
• Gender , men are more likely to get liver cancer than women .
• Effects of various drugs and toxins.
• Liver cell adenoma, Pill tumor of liver( prolonged use of contraceptive pills)
Symptoms of liver cancer?
There may be no symptoms in the early stage. A lump below the rib cage on the right side of the abdomen may be felt.
• Pain near the right shoulder or on the right side of the abdomen
• Jaundice (a disease that causes skin to yellow)
• Unexplained weight loss
• Loss of appetite
• Dark-colored urine
Diagnosis of liver cancer:
Liver cancer is asymptomatic in most of the time, if lumps or other symptoms are found during a physical examination. Tests includes:
• Blood tests : Viral markers like hepatitis B & C, Liver function tests ,Liver enzymes like Serum AST,ALT may be elevated .Serum total protein & Albumin may be reduced. The tumour marker – alpha-fetoprotein (AFP) may be increased.
• Ultrasography: It may show soft tissue mass (s) in the liver.
• Computed tomography (CT scan): Mass lesion with irregular contrast enhancement. It reveals the site , extent ( segmental involvement), vascular encasement , metastasis to remaining part of liver or extra hepatic tissues, lymph nodes or other brogans.
Magnetic resonance imaging (MRI ) : Vascularity of the lesion and extent of involvement.
Biopsy or cytology: Needle biopsy or fine needle aspiration cytology (FNAC) is the final diagnostic tool. But it should not be done routinely in every case. It should be avoided in early cases, especially those are potentially respectable liver cancers. Because of possibility of needle tract dissemination leading to compromise success rate of hepatic resection after FNAC. However, it should be done for cases of advanced liver cancer to plan further management strategy (ablation/chemotherapy).
What are the stages of liver cancer?
One of the biggest concerns about cancer is whether the cancer has spread (metastasized) beyond liver.
Liver cancer progresses through stage I through IV. The higher the number, the more the cancer has spread.
Liver cancer stages include the following:
• Stage I: One tumor is found in the liver only.
• Stage II: One tumor is found, but it has spread to the blood vessels, OR more than one tumor is present, but they are all smaller than 5 cm.
• Stage III: In Stage III liver cancer, there is more than one tumor larger than 5 cm, OR the cancer has moved beyond the liver to blood vessels, another organ, or to the lymph nodes.
• Stage IV: the cancer has spread to other locations in the body, such as the lungs or bones, as well as blood vessels or lymph nodes.
Liver cancer may also be categorized as recurrent, if it comes back. Recurrent liver cancer could come back in the liver or anywhere else in the body.
How is liver cancer treated?
Liver cancer may be treated using one or more of three methods: Surgery, ablation & chemotherapy.
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.
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).
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.
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.