Any cancerous growth in the liver is termed as liver cancer. Thus, cancerous growth can be either arising from the liver cells itself, termed as primary liver cancer or there may be cancerous deposits that have travelled or migrated to the liver from cancerous lesions starting elsewhere in the body, termed as liver metastasis or secondary liver cancer.
Why is the liver so important?
The liver is a vital organ located below the right lung and under the ribcage and it plays a major role in metabolism and has a number of functions in the body, including glycogen storage, decomposition of red blood cells, plasma protein synthesis, hormone production, detoxification, protein synthesis, and the production of biochemicals necessary for digestion. The liver is necessary for survival; there is currently no way to compensate for the absence of liver function long term.
How common is liver cancer?
Liver cancer is the third most common cancer in the world. Liver cancer occurs more often in men than women. It is usually seen in people aged between 50 - 60 years.
The disease is more common in parts of Africa and Asia than in North or South America and Europe.
What are the types of liver cancer?
Liver cancers can be
1.Primary: The cancerous growth arises from the liver tissue itself. The subtypes includes:
a.Hepatocellular carcinoma (commonest)
b.Sarcoma
c.Hepatoblastoma, a rare tumour developing in children
d.Cholangiocarcinoma, (Bile duct cancer)
e.Angiosarcoma, Cancer arising from the blood vessels of liver
2.Secondary: These are cancerous deposits / metastasis arising from other tumour sites like, colon cancer, carcinoid tumour, breast cancer, prostate cancer, ovarian cancer etc.
What are the risk factors for liver cancer?
The various risk factors / causes of liver cancer include:
1.Alcohol: Cirrhosis caused by chronic alcohol consumption is the most common cause of liver cancer. It is commonly seen in individuals with liver cirrhosis caused by alcoholism, even though the drinking may have subsequently stopped. This is because when the drinking is stopped, the liver cells try to heal by regenerating. It is during this regeneration stage that a cancer-producing genetic mutation can occur. More importantly, if an alcoholic does not stop drinking, he or she is unlikely to live long enough to develop the cancer since alcoholics who are actively drinking are more likely to die 10 years earlier than liver cancer patients, from non-cancer related complications of alcoholic liver disease (for example, liver failure).
2.Hepatitis B and C infections: Individuals having chronic hepatitis infection with either or both Hepatitis B and C virus have a significantly greater risk of developing liver cancer. The hepatitis virus genetic material disrupts the normal genetic material of the liver cells and causes the liver cells to become cancerous.
3.Aflatoxin B1: It is the most potent liver cancer-forming chemical. It is a product of a fungus called Aspergillus flavus, which is found in foods that have been stored in a hot and humid environment. This mould is typically found in foods such as peanuts, rice, soybeans, corn, and wheat.
4.Hemochromatosis: A hereditary disorder in which too much iron gets stored in the body including the liver is a risk factor for liver cancer.
5.Drugs and toxins: Certain medications like estrogen and anabolic steroids and chemicals like vinyl chloride have been implicated in causing liver cancer.
What are the signs and symptoms of liver cancer?
There are no specific symptoms of liver cancer, and in fact, the earliest signs are usually subtle and can be mistaken for simple worsening of liver function.
When fully developed, liver cancer may present with abdominal pain, abdominal mass, weight loss, unexplained fever, fluid in abdomen (ascites), blood in vomit and stools and jaundice.
On examination an enlarged and tender liver is commonly found. Hepatic bruit (sound of increase blood flow) can be heard over the tumour on auscultation (using a stethoscope).
How to diagnose liver cancer, what investigations are to be done?
There are various tests which can help detect liver cancer; however one cannot rely on only one test for making diagnosis. The tests include:
•Liver enzymes (liver function tests)
•Serum alpha fetoprotein
•Abdominal ultrasound (USG)
•Abdominal CT scan
•Liver biopsy
•MRI scan of liver
What are the treatment options for liver cancer?
The treatment options are decided by the overall condition of the patient and the stage of the liver cancer.
•If diagnosed early, aggressive surgery with tumour resection or a liver transplantation can successfully treat small (< 3cm) or slow-growing tumours
•Chemotherapy and radiation treatments are not usually effective. However, they may be used to shrink large tumours so that surgery has a greater chance of success.
•Sorafenib tosylate (Nexavar), an oral medicine that blocks tumor growth, can be tried in patients with advanced hepatocellular carcinoma.
•Cryoabalation, stereotactic radiosurgery, proton beam therapy or Radiofrequency ablation combined with local chemotherapy are other treatment modalities that can be tried in some patients.
How long will I survive with liver cancer?
The usual outcome is poor, because only 10 - 20% of liver cancers can be removed completely using surgery. If the cancer cannot be completely removed, the disease is usually fatal within 3 - 6 months. However, survival can vary, and some people may survive much longer than 6 months.
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