Liver cancers are mainly classified into:
- Primary liver cancer when it begins in the liver. The most common type of liver cancer is hepatocellular carcinoma (HCC), which begins in the main type of liver cell (hepatocyte). Other liver cancers include intrahepatic cholangiocarcinoma and hepatoblastoma, which are much less common
- Secondary liver cancer, where cancer has developed in another part of the body and spread to the liver such as from the colon, lung or breast, also called metastatic liver cancer
Primary liver cancer or hepatocellular carcinoma (HCC) is the seventh commonest cause of cancer and the fourth common cause of cancer related death in the world. It is also the commonest cancer found in a cirrhotic liver. Regular check-ups for liver cancer (surveillance) are often recommended for people known to have a high risk of developing the condition, such as those with cirrhosis. Surveillance ensures the condition is diagnosed early. The earlier liver cancer is diagnosed, the more effective treatment is likely to be.
Liver cells can develop changes (mutations) in their genetic material, the DNA. The cells start replicating at a rapid pace and eventually form a lump of cancerous cells, called tumors.
- Known causes, such as a pre-existing liver disease of which cirrhosis or chronic hepatitis viral infections are the most common causes
- Unknown cause in persons with no underlying diseases
- Drinking excessive amounts of alcohol over many years
- Long-term hepatitis B or hepatitis C viral infection
- Hemochromatosis, which occurs as a genetic disorder in which iron levels in the body slowly build up over many years
- Primary biliary cirrhosis, a long-term liver disease in which the bile ducts in the liver become damaged
- Obesity and an unhealthy diet can increase the risk of liver cancer because this can lead to non-alcoholic fatty liver disease
- Unintentional weight loss
- Loss of appetite
- Feeling of fullness after eating, even if the meal was small
- Nausea and vomiting
- Abdominal pain
- Abdominal swelling
- Yellowing of the skin and the whites of eyes (jaundice)
- Itchy skin
- Feeling very tired and weak
- Liver panel tests may reveal liver function abnormalities
- Abnormal elevations of alphafetoprotein (AFP), des-carboxy prothrombin (DCP) are suggestive of hepatocellular carcinoma
- Ultrasound scan can give provide a diagnosis for cancer
- CT and MRI scan provide a more detailed 3-dimensional image
- Liver biopsy is a procedure to remove a piece of tissue through the skin by a thin long needle. The tissue is seen under a microscope to detect if any cancerous cells are present. This provides a definitive diagnosis of liver cancer
Symptoms of HCC
Are often vague and resemble many other conditions. Most symptoms do not appear until the cancer is at an advanced stage:
Important message: If a cirrhotic patient who was doing pretty 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 has been indolent for a while. Normal tumour doubling time is 3 – 6 months. Hence it is important to reiterate the need for periodic check-up in 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 can 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.
Surgical resection involves removal portion of liver with tumor in it en masse. This is potential curative option when the tumor is detected in early stage, without distant spread and the underlying liver condition is good.
One of the most important discoveries in liver sciences is the curative role of liver transplantation for treatment of HCC. When a patient with liver cirrhosis develops HCC and the tumor is within certain criteria, with no obvious spread in blood vessels or deposits outside the liver, then liver transplantation is the best curative option with 85% survival at 5 years.
Microwave or radiofrequency ablation (RFA) is a procedure where microwaves or radio waves are used to destroy the cancerous cells. This test is done under ultrasound guidance by inserting, one or more thin needles into the tumor. This option is not curative most of the cases are associated with tumor recurrence and need for repeat procedures. However, if the tumor is too close to blood vessel or liver capsule, then this procedure is not doable.
Trans-arterial chemo-embolization/ radio-embolization
By using angiography, chemotherapy or radiation particles are selectively injected into the feeding blood vessel of the tumor followed by blocking its blood supply thereby causing the cancer cells to die from inside. However, option also is not curative most of the cases are associated with tumor recurrence and need for repeat procedures. An important use of this procedure is to reduce the tumor size and bring it within transplant criteria, thereby achieving cure by going for liver transplantation as a long-term definitive option.
When above procedures are not doable, then oral chemotherapy drugs are there which can help to a limited extent.
When patients with advanced liver cirrhosis and poor general condition present, then none of the options are possible and only palliative supportive care is offered. Palliative care is specialized form of medical care that focuses on providing relief from pain and other symptoms of a serious illness and is an important part of treating patients with cancer. Palliative care improves the quality of life for patients with cancer and their families.