What Is Liver Cancer?

A cancer that develops in the liver is known as liver cancer. When the body's cells start to grow out of control, cancer develops. The liver is the largest internal organ. It's just beneath the right lung and under the right ribcage. Hepatocytes are the cells that make up the majority of the liver. It also has other types of cells, including cells that line its blood vessels and cells that line the bile ducts. Bile is transported from the liver to the gallbladder or to the intestines directly through the bile ducts.

It has many important functions:
  1. It helps absorb nutrients by delivering bile into the intestines (especially fats).
  2. Many of the nutrients absorbed from the gut that our body requires to function are stored by the Liver.
  3. It produces the majority of the clotting factors that prevent excessive bleeding when there is a cut or injury.
  4. It degrades alcohol, drugs, and hazardous wastes in the blood, which are ultimately excreted through urine and faeces.

Primary liver cancer:

A cancer that starts in the liver is called primary liver cancer. There is more than one kind of primary liver cancer.

  • Hepatocellular carcinoma (HCC): It is the most common type of primary liver cancer. Hepatocellular carcinoma occurs most often in people with chronic liver diseases, such as cirrhosis caused by hepatitis B or hepatitis C infection.
  • Intrahepatic cholangiocarcinoma (bile duct cancer): These account for 10% to 20% of malignancies that begin in the liver. The cells that lining the tiny bile ducts (tubes that deliver bile to the gallbladder) within the liver are where these tumours begin. Most cholangiocarcinomas, on the other hand, begin in the bile ducts, which are located outside of the liver.
  • Angiosarcoma and hemangiosarcoma: These are uncommon malignancies that start in the cells that line the liver's blood vessels. These malignancies are more likely to occur in people who have been exposed to vinyl chloride, thorium dioxide (Thorotrast), arsenic, radium, or a genetic disease known as hereditary hemochromatosis. These tumours develop fast and are typically too large to be surgically removed by the time they are discovered. Chemotherapy and radiation therapy can help to delay the progression of the illness.
  • Hepatoblastoma: This is an extremely rare cancer that affects children, most commonly those under the age of 4. Approximately 2 out of every 3 children with these tumours are successfully treated with surgery and chemotherapy.

Secondary liver cancer (metastatic liver cancer)

When cancer is discovered in the liver, it has most often spread (metastasized) from another part of the body, like pancreas, colon, stomach, breast, or lung. It's called a secondary liver cancer because the cancer has spread from its original (primary) location. The primary site of these cancers determines the treatment.

Factors that can increase your risk of liver cancer:
  1. Gender: Hepatocellular carcinoma is much more common in men than in women.
  2. Chronic viral hepatitis: Hepatitis B virus (HBV) or hepatitis C virus (HVC) infection is the most frequent risk factor for liver cancer worldwide. These infections cause liver cirrhosis, which is the leading cause of cancer in many parts of the world. Hepatitis B is more common in Asia and developing countries, but Hepatitis C is the leading cause of HCC in the United States.
  3. Cirrhosis: Cirrhosis is a disease in which the liver cells are destroyed and scar tissue replaces them. Cirrhosis patients are more likely to develop liver cancer. Heavy drinkers or chronic HBV or HCV infections are the common causes
  4. Non-alcoholic fatty liver disease: Obese adults are more likely to develop non-alcoholic fatty liver disease. Cirrhosis can occur in those who have a subtype of this disease called non-alcoholic steatohepatitis (NASH).
  5. Primary biliary cirrhosis: the bile ducts in the liver are damaged and even destroyed which can lead to cirrhosis. People with advanced PBC have a high risk of liver cancer.
  6. the bile ducts in the liver are damaged and even destroyed which can lead to cirrhosis. People with advanced PBC have a high risk of liver cancer.
  7. Heavy alcohol use
  8. Tobacco use
  9. Obesity
  10. Aflatoxins: A fungus that contaminates peanuts, wheat, soybeans, ground nuts, corn, and rice produces these cancer-causing substances. This fungus can grow if it is stored in a moist, warm atmosphere.
  11. Anabolic steroids: Anabolic steroids are male hormones used by some athletes to increase their strength and muscle mass. Long-term anabolic steroid use can slightly increase the risk of hepatocellular cancer

Can Liver Cancer Be Found Early?

It's difficult to detect liver cancer early since signs and symptoms don't always present until it's advanced. Because the majority of the liver is covered by the right rib cage, small liver tumours are difficult to detect on a physical examination.

There are currently no recommended screening tests for early detection of liver cancer.

Symptoms of Liver Cancer

  • Weight loss
  • Loss of appetite
  • Feeling very full after a small meal
  • Nausea or vomiting
  • An enlarged liver, felt as fullness under the ribs on the right side
  • An enlarged spleen, felt as fullness under the ribs on the left side
  • Pain in the abdomen (belly) or near the right shoulder blade
  • Swelling or fluid build-up in the abdomen (belly)
  • Itching
  • Yellowing of the skin and eyes (jaundice)

Tests for Liver Cancer

  • Ultrasound is often the first test used to look at the liver.
  • Computed tomography (CT)/ Magnetic resonance imaging (MRI): It gives information about the size, shape, and location of any tumors in the liver or elsewhere in the abdomen, as well as nearby blood vessels. CT scans can also be used to guide a biopsy needle precisely into a suspected tumor (called a CT-guided needle biopsy).
  • Angiography: Contrast medium, or dye, is injected into an artery to outline blood vessels while x-ray images are taken. Angiography can be used to show the arteries that supply blood to a liver cancer, used to help guide some types of non-surgical treatment, such as embolization
  • Alpha-fetoprotein blood (AFP) test: If AFP levels are very high in someone with a liver tumor; it can be a sign that liver cancer is present. But liver cancer isn’t the only reason for high AFP levels. Many patients with early liver cancer have normal levels of AFP, so high AFP levels aren’t very helpful in determining if a liver mass might be cancer.


Surgery for Liver Cancer

The best option to cure liver cancer is with either surgical resection (removal of the tumor with surgery) or a liver transplant. If all cancer in the liver is completely removed, you will have the best outlook. Small liver cancers may also be cured with other types of treatment such as ablation or radiation.

  • Partial Hepatectomy: Partial hepatectomy is surgery to remove part of the liver. Only people with good liver function who are healthy enough for surgery and who have a single tumor that has not grown into blood vessels can have this operation. People with cirrhosis are typically eligible for surgery if there is only one tumor (that has not grown into blood vessels) and they will still have a reasonable amount (at least 30%) of liver function left once the tumor is removed.
  • Liver transplant When it is available, a liver transplant may be the best option for some people with liver cancer. Liver transplants can be an option for those with tumors that cannot be removed with surgery, either because of the location of the tumors or because the liver has too much disease for the patient to tolerate removing part of it. In general, a transplant is used to treat patients with small tumors (either 1 tumor smaller than 5 cm across or 2 to 3 tumors no larger than 3 cm) that have not grown into nearby blood vessels. With a transplant, not only is the risk of a second new liver cancer greatly reduced, but the new liver will function normally.
  • Ablation for Liver Cancer: Ablation is treatment that destroys liver tumors without removing them. These techniques can be used in patients with a few small tumors (3cm) and when surgery is not a good option (often because of poor health or reduced liver function). They are less likely to cure the cancer than surgery, but they can still be very helpful for some people. These treatments are also sometimes used in patients waiting for a liver transplant. Ablation Techniques:
    1. Radiofrequency ablation (RFA )
    2. Microwave ablation (MWA)
    3. Cryoablation (cryotherapy)
    4. Ethanol (alcohol) ablation
  • Embolization Therapy for Liver Cancer: Embolization is a procedure that injects substances directly into an hepatic artery artery in the liver to block or reduce the blood flow to a tumor in the liver.It can be used for people with tumors that are too large to be treated with ablation (usually larger than 5 cm across) and who also have adequate liver function. Embolization Techniques:
    1. Trans-arterial embolization (TAE)
    2. Trans-arterial chemoembolization (TACE)
    3. Drug-eluting bead chemoembolization (DEB-TACE)
    4. Ethanol (alcohol) ablation
  • Radiation Therapy for Liver Cancer Radiation therapy uses high-energy rays (or particles) to kill cancer cells. It may not be a good option for some patients whose liver has been greatly damaged by diseases such as hepatitis or cirrhosis.Radiation can be helpful in treating Liver cancer that cannot be treated with surgery, ablation or embolization.

Targeted Drug Therapy for Liver Cancer

Researchers have been able to produce newer medications that particularly target the mutations in cells that cause cancer. These are called Targeted Therapy. Standard chemotherapy medications do not act the same way as targeted drugs.

  • Kinase inhibitors: Kinases are proteins that carry essential signals to the cell's control centre and are found on or near the cell's surface. Kinase inhibitors make up a large portion of the targeted medications used to treat liver cancer. These medications inhibit a number of kinase proteins, which aid tumour cell growth
    1. Sorafenib
    2. lenvatinib
    3. Regorafenib
    4. Cabozantinib
  • Monoclonal antibodies Monoclonal antibodies are lab made immune system proteins (antibodies) that bind to a specific target. The ability of a tumour to generate new blood vessels, which it requires to expand beyond a certain size, is affected by monoclonal antibodies used to treat liver cancer.
    1. Bevacizumab (Avastin)
    2. Ramucirumab (Cyramza)
  • Immunotherapy for Liver Cancer Immunotherapy is the use of drugs to enhance a person's immune system in identifying and destroying cancer cells
    1. Atezolizumab (Tecentriq)
    2. Pembrolizumab (Keytruda)
    3. Nivolumab (Opdivo)
    4. Ipilimumab (Yervoy)
  • Chemotherapy for Liver Cancer The most common chemotherapy drugs for treating liver cancer include:
    • Gemcitabine
    • Oxaliplatin
    • Cisplatin
    • Doxorubicin
    • 5-fluorouracil
    • Capecitabine
    • Mitoxantrone
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