Liver Cancer

Liver Cancer, also known as Hepatic Cancer, is a cancer that occurs in the liver. Cancer in the liver destroys liver cells & interferes with its ability to function normally. Liver cancer may be primary or secondary. Primary liver cancer originates in the liver cells while secondary liver cancer spreads to the liver from another organ. There are various types of liver cancer:

  • Hepatocellular Carcinoma (HCC) is the most common type of liver cancer with almost 75% of all liver cancer cases. HCC is also known as Hepatoma & it is common in individuals with severe liver damage due to excessive alcohol consumption
  • Bile Duct Cancer or Cholangiocarcinoma is a cancer that develops in the bile ducts in the liver. It accounts for 10-20% of all liver cancers.
  • Angiosarcoma is a rare type of liver cancer that originates in the blood vessels of the liver.
  • Hepatoblastoma is a form of liver cancer mostly found in children below age of 3. If detected early, the chances of survival are very high. It is an extremely rare form of liver cancer.

Majority of primary liver cancers (over 90 to 95%) arises from liver cells and is called hepatocellular cancer or carcinoma. Liver cancer or Hepatocellular carcinoma (HCC) is one of the commonest cancers in the world. It may be caused by diseases that lead to cirrhosis of the liver such as Hepatitis B, Hepatitis C infections, and alcohol abuse.

Common Symptoms of Liver Cancer.
  • Jaundice
  • Abdominal Pain
  • Unexplained weight loss
  • Enlarged liver, spleen or both
  • Fluid buildup on the abdomen
  • Fatigue
  • Fever

For hepatocellular carcinoma (HCC), doctors often use to describe the cancer and recommend treatment options, based on characteristics of the tumor, liver function, performance status, and cancer-related symptoms.

  • Very early stage: The tumor is smaller than 2 cm. Bilirubin levels, are normal. Surgery is usually recommended
  • Early stage: The tumor is smaller than 5 cm. Liver function varies. normal bilirubin levels, People with early-stage disease may be candidates for a liver transplant, surgery, or radiofrequency ablation (RFA).
  • Intermediate stage: The tumor may be large or there may be multiple tumors. Doctors usually recommend regional therapies, such as trans arterial chemoembolization.
  • Advanced stage:The tumor has invaded the portal vein or spread to other parts of the body, such as the lymph nodes, lungs, and bones. Doctors usually recommend targeted therapy.
Treatments and Procedures

Liver cancer treatment options include a combination of chemo-, biological, radiation, or gene therapy approaches.

  • Surgery: Procedure to remove a portion of the liver. Your doctor may recommend partial hepatectomy to remove the liver cancer and a small portion of healthy tissue that surrounds it if your tumor is small and your liver function is good.
  • Transplant Surgery: During liver transplant surgery, your diseased liver is removed and replaced with a healthy liver from a donor. Liver transplant surgery may be an option for people with early-stage liver cancer who also have cirrhosis.
  • Freezing Cancer Cells: Cryoablation uses extreme cold to destroy cancer cells. During the procedure, your doctor places the instrument (cryoprobe) containing liquid nitrogen directly onto liver tumor.
  • Heating Cancer Cells: In a procedure called radiofrequency ablation, electric current is used to heat and destroy cancer cells. It is also called hyperthermia cancer treatment.
  • Injecting Alcohol: During alcohol injection, pure alcohol is injected directly into tumors, either through the skin or during an operation. Alcohol dries out the cells of the tumor and eventually the cells die.
  • TACE – Trans arterial chemoembolization: A procedure in which the blood supply to a tumor is blocked after anticancer drugs are given in blood vessels near the tumor. Sometimes, the anticancer drugs are attached to small beads that are injected into an artery that feeds the tumor. The beads block blood flow to the tumor as they release the drug. This allows a higher amount of drug to reach the tumor for a longer period of time, which may kill more cancer cells. It also causes fewer side effects because very little of the drug reaches other parts of the body. TACE is used to treat liver cancer.
  • TARE – Trans arterial Radioembolization Radioembolization:TARE is very similar to chemoembolization but with the use of radioactive Yttrium-90 (90Y) microspheres. This therapy is used to treat both primary and metastatic liver tumors. This treatment incorporates the radioactive isotope Yttrium-90 into the embolic spheres. Similar to Radioembolization is Cryoablation, where the energy is delivered directly into the tumor by a probe that is inserted through the skin. But rather than killing the tumor with heat, cryoablation uses an extremely cold gas to freeze it.
  • Radiation therapy: Radiation therapy is the use of high-energy x-rays or other particles to destroy cancer cells. A radiation therapy regimen, or schedule, usually consists of a specific number of treatments given over a set period of time.
  • Stereotactic body radiation therapy (SBRT): SBRT is a term that describes several methods of delivering high doses of radiation therapy to a tumor while limiting the amount of radiation to nearby healthy tissue. This is important because healthy liver tissue can be damaged by radiation. SBRT effectively treats tumours that are about 5 cm or smaller. Side effects of SBRT may include damage to the stomach and lungs. However, these side effects can often be prevented.
  • Systemic therapy for advanced HCC: The treatment plan for later stage HCC may include medications to destroy cancer cells. Medication may be given through the bloodstream to reach cancer cells throughout the body.

The types of medications used for advanced HCC include:

  • Targeted therapy: Targeted therapy is drug treatment that targets the cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. This type of treatment blocks the growth and spread of cancer cells and limits damage to healthy cells.

Common targeted therapy drugs include

  • Bevacizumab with Atezolizumab.
  • Lenvatinib.
  • Sorafenib.
  • Ramucirumab.
  • Cabozantinib.
  • Regorafenib.
  • Immunotherapy: Immunotherapy uses the body's natural defences to fight cancer by improving your immune system’s ability to attack cancer cells. One common type of immunotherapy is called an immune checkpoint inhibitor. Immune checkpoint inhibitors work by blocking the pathways that would otherwise allow the cancer to hide from the immune system.

Immunotherapies for HCC include:

  • Nivolumab.
  • Pembrolizumab.
  • Nivolumab with ipilimumab.
  • Atezolizumab with bevacizumab.
  • Tremelimumab & durvalumab
  • The first-line treatment is the initial treatment given. First-line therapy options for advanced HCC include:
    • The combination of Bevacizumab (Avastin) with Atezolizumab (Tecentriq) may be offered to some patients with advanced HCC.
    • Targeted therapy with sorafenib (Nexavar) or lenvatinib (Lenvima) may be offered to people who are unable to receive atezolizumab with bevacizumab.
  • A second-line treatment is given if the first-line treatment does not work. Second-line therapy options for advanced HCC include:
    • Sorafenib
    • Lenvatinib
    • Cabozantinib (Cabometyx; a targeted therapy)
    • Regorafenib (Stivarga; a targeted therapy)
    • Ramucirumab (Cyramza; a targeted therapy)
    • The combination of atezolizumab and bevacizumab
    • Pembrolizumab (Keytruda) or nivolumab.