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Liver Cancer : Should Ask Questions

Liver cancer is the sixth most common cancer worldwide

What are the different types of liver cancer?

Two broad categories of liver cancer exist: primary and secondary. Primary liver cancer means that the tumor originated in the liver. A tumor can start from any of the different types of cells that exist in the liver.

A secondary liver cancer is a spread of any cancer in the body to the liver. Examples of secondary liver cancer include colon, breast, pancreas, or other cancers.

Hepatocellular cancer is the most common type of primary liver cancer. It is also known as hepatocellular carcinoma or HCC. There is a subtype of HCC called Fibrolamellar Hepatocellular Carcinoma (FCC). It makes up less than 1 percent of all HCCs, occurs mostly in young adults and is usually not associated with any underlying liver disease.

Cholangiocarcinoma is a cancer that arises from the bile ducts within the liver. Mixed hepatocellular and cholangiocarcinoma is a tumor that contains elements of both HCC and cholangiocarcinoma. Hepatoblastoma is a primary liver cancer that occurs in children. Cancer can also arise in the gallbladder.

Are some people more at risk of liver cancer than others?

Hepatocellular carcinoma (HCC) is the fourth most common cause of cancer-related death worldwide. More than 80% of HCC cases occur in low-resource and middle-resource countries

Having chronic hepatitis B, hepatitis C, or cirrhosis, alcohol addiction , metabolic liver disease, particularly nonalcoholic fatty liver disease and exposure to dietary toxins such as aflatoxins and aristolochic acid are significant risk factors for adult primary liver cancer. Liver cancer is more common in men than women. Consult our Experts

What are some of the symptoms of liver cancer?

Please remember most symptoms for liver cancer appear vague and resemble those of many other medical conditions. Also most symptoms do not appear until the cancer is at an advanced stage. Some symptoms could be:

  • Unintentional weight loss
  • Loss of appetite
  • Feeling of fullness after eating, even if the meal is small
  • Nausea and vomiting
  • Abdominal pain
  • Abdominal swelling
  • Yellowing of the skin and the whites of eyes (jaundice)
  • Itchy skin
  • Feeling of tiredness and weakness

If you or someone you know is experiencing similar symptoms, consult our experts

What are some of the inherited metabolic diseases that damage the liver?

Several rare inherited metabolic diseases can cause liver damage and may lead to cirrhosis and/or liver cancer. One of these diseases is called hemochromatosis. It leads to the accumulation of a mineral in the liver and cirrhosis, which increase the risk of liver cancer.

Hemochromatosis is an illness of increased iron absorption and deposition in many organs of the body, including the liver. People who are affected can lead a normal life, but many (especially men) start to have symptoms around the age of 40 years. Affected individuals may start to feel tired and weak and may acquire a shiny tan to their skin in the absence of sun exposure because of iron deposition in the skin.

There are multiple other genetic diseases that might cause inflammation in the liver (hepatitis) and cirrhosis and therefore can lead to the development of liver cancer. Some of these diseases are:

  • Hemochromatosis
  • Wilson’s Disease
  • Alpha-1 antitrypsin deficiency
  • Primary biliary cirrhosis
  • Porphyria cutanea tarda
  • Types 1 and 3 glycogen storage disease
  • Galactosemia
  • Citrullinemia
  • Hereditary tyrosinemia
  • Familial cholestatic cirrhosis
  • Familial polyposis coli
  • Ataxia telangiectasia
  • Biliary atresia
  • Congenital hepatic fibrosis
  • Neurofibromatosis
  • Situs inversus
  • Fetal alcohol syndrome
  • Budd-Chiari syndrome

Am I at risk of developing liver cancer?

Liver cancer rarely occurs spontaneously and for no apparent reason; in most instances, it starts because of an existing abnormality in the liver.

Five main reasons for an abnormal liver are: 1) viral hepatitis B; 2) viral hepatitis C; 3) alcohol use; 4) obesity and diabetes and 5) other inherited metabolic diseases that affect the liver

If you or anyone you know suffers from any of the above mentioned conditions, a regular liver screening is advised

Should I get myself screened for liver cancer on routine basis?

For a person who carries any of the above mentioned risk factors screening for liver cancer is important. People with chronic hepatitis B or C infection should be regularly evaluated by a physician for the development of liver cirrhosis and liver cancer.

This also applies to people with a history of excess alcohol ingestion, especially if they have liver problems; patients with a family history for any genetic disease that carries a risk of developing liver cancer; and patients with an environmental risk, especially if they already have liver problems. Although there are no clear recommendations for screening, if you happen to be diabetic and morbidly obese, many physicians believe that you should be very closely monitored.

It’s always better to be safe than late, write to us to know more

Is screening for liver cancer important even when there are no visible symptoms?

The reason to screen patients who are considered to be at high risk of developing liver cancer is that if a liver cancer does occur, the tumor will more likely be detected when it is small and before it has spread to other parts of the liver or elsewhere in the body.

In other words, screening may allow detection of a cancer in an early stage. Otherwise, many patients with liver cancer may have advanced disease by the time they have symptoms and seek medical attention.

First, the liver does not sense pain very well. Only the outside lining of the liver (called the liver capsule) has nerve fibers. Second, the liver has an enormous functional reserve. As a result, even an advanced tumor may not alter the normal function of the liver and may not cause any abnormalities in blood work.

What is included in liver cancer screening?

Most doctors recommend an ultrasound of the liver and a blood test to measure an alpha-fetoprotein, known as AFP. The test is easy and painless and does not involve any injections or radiation exposure.  Some common investigations include:

Blood tests

  • Liver panel tests to help understand liver function abnormalities
  • Abnormal elevations of alphafetoprotein (AFP), des-carboxy prothrombin (DCP) are suggestive of hepatocellular carcinoma

Imaging Tests

  • Ultrasound scan can provide a diagnosis for cancer
  • Computed Tomography (CT scan) or Magnetic Resonance Imaging (MRI) provide a more detailed 3-dimensional image
  • Liver biopsy is an invasive procedure where a piece of liver tissue is removed. The tissue is seen under a microscope to detect if any cancerous cells are present. This provides a definitive diagnosis of liver cancer

It’s important to note that if a cirrhotic patient who was doing well with good liver functions, suddenly starts deteriorating with weight loss, abdominal swelling, jaundice, then one of the causes of this sudden deterioration, is progression of HCC, which may have been indolent.

Normal time a tumor takes to increase or double in size is around 3 – 6 months. Hence it is important to undergo periodic checkups every 6 months by doing AFP and USG abdomen.

Diagnosing extent of cancer spread

Liver cancers are categorized according to the extent of spread; this is called “staging”. Liver specialists use a combination of different systems to stage liver cancer to include features of both the cancer and the underlying liver function.

Staging of liver cancer also helps in determining survival and how well potential treatments will benefit the patient.

What are the possible treatments for liver cancer?

Several treatment options are available for patients with HCC. In general, the most effective therapy is to remove the tumor. This can be done in two ways.

One method is to remove the part of the liver that contains the tumor. This is caller liver resection or partial hepatectomy. The other option is to remove the entire liver and replace it with a new liver. This is called liver transplantation

Early-stage HCC can be treated curatively by local ablation, surgical resection or liver transplantation. Treatment selection depends on tumor characteristics, the severity of underlying liver dysfunction, age, other medical comorbidities, and available medical resources and expertise

Prevention and treatment of viral hepatitis and mitigation of exposure to aflatoxin and aristolochic acid, the main risk factors in high-incidence regions, are critical for decreasing the risks and burden of HCC.

Treatments for Hepatocellular Cancer

  • Liver resection
  • Liver transplantation
  • Hepatic artery embolization
  • Radiofrequency ablation
  • Alcohol injection
  • Cryotherapy
  • Chemotherapy
  • Investigational chemotherapy
  • Biologic and targeted therapy
  • Supportive care
  • Investigational biologic or targeted therapy

As there are only a few effective ways to prevent or treat liver cancer at this time, there is always a great deal of research going on in the area of liver cancer. Scientists are looking for causes and ways to prevent liver cancer, as well as ways to improve treatments. Ongoing research focusses on prevention, screening, surgery and adding other treatments to surgery, determining recurrence risks after surgery with more advanced therapies.