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LIVER CANCER

Liver Cancer
liver_cancer

What is Liver Cancer?

Cancer is when unhealthy cells begin to divide and grow uncontrollably to form a malignant growth or tumor. These cells can metastasize and spread to other body parts.

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 cancer originates in the liver cells, while secondary cancer spreads to the liver from another organ. Over 90% to 95% of primary liver cancers originate from liver cells and are known as hepatocellular cancer or carcinoma.

Types of Liver Cancer:

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 primarily found in children below the age of 3. If detected early, the chances of survival are very high. It is an extremely rare form of liver cancer.

What are the signs and symptoms of liver cancer?

  • Jaundice
  • Fatigue
  • Fever
  • Nausea and vomiting
  • Loss of appetite
  • Abdominal swelling
  • Weight loss
  • Enlarged liver, spleen, or both
  • Fluid buildup on the abdomen
  • A lump down the rib cage on the right side
  • Discomfort in the back or close to the right shoulder blade

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

When should I see a doctor?

Schedule an appointment with your general practitioner if you have any bothersome, unexplained symptoms. The physician might suggest a few diagnostic tests to rule out liver cancer in addition to other medical issues. If the tumor is confirmed, you will be referred to a hepatologist, gastroenterologist, or oncologist for liver cancer treatment.

See our hepatologists, gastroenterologists, and oncologists for more details and appropriate liver cancer treatment.

What causes liver cancer?

Liver cancer occurs when the DNA of liver cells goes through changes or mutations. Occasionally, it occurs due to chronic hepatitis infections. Liver cancer can also happen without underlying diseases and an unknown cause.

What are liver cancer risk factors?

The known risk factors for liver cancer are:

  • Prolonged hepatitis B or C infection
  • Smoking tobacco
  • Type 2 diabetes
  • Exposure to harmful chemicals
  • Excess alcohol consumption
  • Obesity
  • Consuming foods that have aflatoxin
  • Fatty liver disease or genetic disorders

What are the methods for diagnosing liver cancer?

  • Physical examination and medical history: A patient's medical history and physical exam check, such as signs of disease, lumps, or anything unusual.
  • Blood tests: Blood tests may reveal liver function abnormalities, e.g., liver function tests.
  • Imaging tests: A patient's medical history and physical exam check, such as signs of disease, lumps, or anything unusual.
    • Ultrasound:An ultrasound helps to diagnose primary liver cancer. It can locate abnormal tissue in your liver.
    • Computed tomography (CT) If an ultrasound reveals any liver abnormality, your doctor may recommend a CT scan. An abdominal CT scan can detect many types of liver tumors and find out if it has spread to other organs as well.
    • Magnetic resonance imaging (MRI) MRI scans help inspect liver tumors. Additionally, MRI can be used to look for obstructions in the blood vessels in and around the liver and determine whether liver cancer has spread to other areas of the body.
    • PET-CT scan This diagnostic imaging test plays a vital role in detecting and monitoring liver cancer. It assists in detecting and identifying the type and stage of liver cancer.
    • Liver Biopsy During a biopsy, tissues or cells are taken out to be examined under a microscope for cancer indications.

For liver cancer diagnosis, a liver biopsy is not always necessary. Based on the findings of imaging tests like CT and MRI scans, physicians can occasionally make the diagnosis of liver cancer.

Liver Cancer Staging:

  • 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 transarterial chemoembolization.
  • Advanced stage -  The tumor has invaded the portal vein or spread to other body parts, such as the lymph nodes, lungs, and bones. Doctors usually recommend targeted therapy.

What are liver cancer 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.
  • Liver 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 the liver tumor.
  • Heating Cancer Cells: Electric current is used to heat and kill cancer cells during radiofrequency ablation. Another name for it is 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 cancer, 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 cancer. Sometimes, the anticancer drugs are attached to tiny beads injected into an artery feeding 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 more extended period, which may kill more cancer cells. It also causes fewer side effects because very little of the drug goes to other parts of the body. TACE is used to treat liver cancer.
  • TARE – Trans arterial Radioembolization: Radioembolization is similar to chemoembolization but uses 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. Radioembolization is Cryoablation, where the energy is delivered directly into the tumor by a probe inserted through the skin. But rather than killing the tumor with heat, cryoablation uses an extremely cold gas to freeze it.
  • Radiation therapy: It uses 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.
  • 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 tumors 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: \
  • Combining 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.

How to prevent liver cancer?

The preventive measures for liver cancer are:

  • Healthy weight
  • Hepatitis B vaccination
  • Test yourself for hepatitis C and get treated for it.
  • Stop smoking
  • Avoid drinking excess alcohol

FAQS:

1. Is liver cancer hereditary?

If there is a family history of liver cancer, an individual's chance of getting liver cancer rises.

2. Is liver cancer painful?

An enlarged stomach can make you feel uncomfortable or painful, lose your appetite, or quickly feel full.

Your right shoulder may hurt if your liver is enlarged and swollen. This occurs due to the enlarged liver stimulating nerves that link to shoulder nerves. It's known as referred pain.

3. What is hepatitis C infection?

Hepatitis C is a disease that affects the liver and is caused by the hepatitis C virus. It can be a mild illness lasting only a few weeks or a chronic infection lasting longer.

4. Is it mandatory to take a hepatitis B vaccination?

It is recommended to get a hepatitis B vaccination as it will protect you against severe hepatitis B infection.

5. Can one prevent liver cancer?

Having the hepatitis B vaccine, avoiding excessive alcohol use, eating a healthy diet, staying away from toxins, and scheduling routine liver exams if your liver health is at risk are all examples of preventive measures.

6. What alternatives exist for treating liver cancer?

Surgery, radiation therapy, immunotherapy, chemotherapy, ablation therapies, targeted therapy, chemoembolization, radioembolization, and supportive care are available to control symptoms and enhance quality of life.

7. Which risk factors are commonly associated with liver cancer?

The common risk factors for liver cancer are excess alcohol consumption, obesity, smoking tobacco, type 2 diabetes, and chronic hepatitis B or C infection.

8. How to diagnose liver cancer?

Liver cancer can be diagnosed by abdomen ultrasound, CT scan, MRI scan, PET-CT scan, and liver biopsy.

9. What is the liver cancer prognosis?

The cancer patient's overall health, the stage of the disease at diagnosis, and other variables all affect the prognosis. Early detection and proper care lead to successful treatment options.

10. Which doctor specializes in liver cancer treatment?

Medical professionals like oncologists, hepatologists, or gastroenterologists will treat liver cancer.

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