Liver Cancer
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Liver Cancer

Liver Cancer

Dr. Navneet Sharda provides this information as an educational source. It is not intended as a substitute for a consultation with a qualified healthcare provider.

Liver cancer, also called primary liver cancer, is a form of cancer that develops within the liver tissue. Primary liver cancer differs from those cancers that start in other organs (like the pancreas, colon, stomach, lungs, breasts) and spread to the liver when metastases, which is known as secondary liver cancer.

Normally, the liver’s cells grow and divide in a regulated manner (only a specific number of cells are produced in order to keep the liver healthy and functioning properly). When this process is impaired, the liver’s cells grow and divide uncontrollably and in an exaggerated manner -causing tumors to form. There are two types of tumors: benign (the term refers to a non-cancerous mass or growth which is not life threatening) and malignant (the term refers to a cancerous mass or growth which can invade and destroy the adjacent tissues and organs inside the body causing death).

The liver is one of the few organs that can regenerate (the ability to recreate lost or damaged tissues). In fact, just 25 percent of liver tissue can regenerate into a whole liver.

 

Signs and Symptoms

Unfortunately, liver cancer can be asymptomatic or the symptoms are not noticeable in its early stages. However, when the symptoms do occur, the cancer is already into an advanced stage of development. The most common liver cancer symptoms are:

Unexplained weight loss Loss of appetite Unexplained fever Ascites (accumulation of fluid in peritoneal cavity) Jaundice (yellowing of the skin and the whites of the eyes caused by an accumulation of bile pigment -bilirubin- in the blood) Nausea Dark urine Excessive skin itching Confusion and increased sleepiness Weakness and feeling tired Unexplained muscle wasting Esophageal varices (occurs when the tumor invaded and blocked the portal vein and the blood drains through esophageal veins)

 

Types of Liver Cancer

There are two types of primary liver cancer:

1. Hepatocellular Carcinoma or Hepatoma– is the most common form of primary liver cancer that occurs mostly in adults. When it occurs in children or teens, hepatocellular carcinoma is known as hepatoblastoma or fibrolamellar hepatoma. Hepatocellular carcinoma develops within the hepatocytes, and usually confines itself to the liver and rarely spreads to other organs. It occur mostly in men and patients that suffer from cirrhosis.

2. Cholangiocarcinomas or Bile Duct Cancer – is a form of primary liver cancer that develops in the small bile ducts within the liver. This type of cancer is more common among women.

 

Related Types of Liver Cancer

The following two types of cancer described below do not occur within the liver tissue, but develop within the liver’s blood vessels.

Angiosarcomas is a form of cancer that develops in the blood vessels within the liver. Unfortunately, this type of cancer progresses extremely fast and many patients die not long after the initial diagnosis (in less than 6 months).

Hemangiosarcoma is a rare form of cancer that occurs in the blood vessels within the liver cancer. This type of cancer is common among children younger than 4 years old, and it can be treated effectively if it is diagnosed in early stages. The survival rate is higher than 90 percent.

 

Medical Tests and Diagnosis

Liver cancer symptoms can be similar with other medical disorders and only a doctor can establish a correct diagnosis. The diagnosis procedure involves a certain number of steps:

Anamnesis (detailed medical review of past health state)

Physical examination:During the physical examination, the doctor looks for noticeable signs of lung cancer like jaundice (yellowing of the skin and the whites of the eyes caused by an accumulation of bile pigment bilirubin in the blood) and ascentis (accumulation of fluid in the peritoneal cavity).

Blood Tests For patient that might suffer from liver cancer, there are two main sets of blood tests performed. The first set of blood tests, called a complete blood count, examines the concentration of blood components like the red, white blood cells and platelets . These tests are:

Hematocrit: This test measures the volume of red blood cells as a percent of the total blood volume.

Hemoglobin: This test measures the number of grams of red blood cells in a sample of blood.

Platelet Count: This test measures the number of platelets and assesses the blood’s ability to clot.

White Blood Count: This test measures the number of white blood cells in a sample of blood.

The second set of blood tests, called the liver function tests, examines the blood components closely related to the liver. The purpose of this blood test is to determine the overall health of the liver.

CEA test: This test measures the level of carcinoembryonic antigen (CEA) in the blood. AFP test: This test measures the level of alpha fetoprotein (AFP) in the blood.

 

Imaging Techniques

Computed tomography (CT): This imaging test is similar with an x-ray test, and creates a detailed cross-sectional image of the body.

Magnetic Resonance Imaging (MRI): This imaging technique uses radio waves and strong magnets to reveal a complete image of the liver.

Chest X-ray: An x-ray test uses high energy electromagnetic radiation to penetrate the body and create an image of the body’s interior on a film.

Angiography or CT-Angiogram: This imaging technique is similar with a CT scan, and is used to examine the blood vessels. This test provides useful information on the number and location of the liver tumors.

Ultrasound: Ultrasound imaging is a medical technique that uses high-frequency sound waves to create an interior image of the body on a special computer screen.

Laparoscopy: This is a surgical procedure used to examine the liver and organs around the liver. This procedure uses a thin tube, called a laparoscope, which is inserted through a small incision into the patient’s chest cavity.

Liver Biopsy This is one of the most effective diagnosis procedures which confirms if the tumor or abnormal growth is a malignant tissue or not. A biopsy is a medical procedure where a sample of tissue is removed from the target area.

There are two ways to remove a tissue sample:

Through a needle aspiration. Through a laparoscopy.

 

Treatment Options

Liver cancer treatment varies from patient to patient. The treatment approach is adjusted to the patient’s needs and takes in consideration the following factors: (1) the tumor size and location, (2) the cancer stage, (3) the general health state of the patient, and (4) the patient’s age.

The treatment options for liver cancer are:

Surgery

Surgery, as a treatment option for liver cancer, is available only for those patients whose tumors are no larger than 5 cm, are confined to the liver, and the cancer has not invaded the adjacent blood vessels, organs or lymph nodes.

There are four types of surgery performed in liver cancer patients:

Partial hepatectomy is a type of surgery where only part of the liver, where the tumor is located, is removed. There are three types of partial hepatectomy: (1) wedge resection, where a triangle-shape slice of tissue is removed, (2) lobe resection, where only the liver lobe is removed, and (3) partial resection, where a large portion of the liver is removed.

Total hepatectomy is a complex surgery where the entire liver is removed. This procedure is followed by a liver transplant because the body cannot live without the liver.

Cryosurgery is a type of surgery that kills cancerous cells by freezing them. This procedure uses the advantages provided by the freezing temperature on the cells. The cells, when exposed to low temperatures, form ice crystals inside that tear apart the cell’s body.

RadioFrequency Ablation (or RFA) is another minimally invasive, highly successful procedure that removes the liver tumors. Radiofrequency ablation uses radiofrequency current to kill cancerous cells by “cooking“ them.

Radiation Therapy or Radiotherapy is another treatment approach in the battle against liver cancer. It uses high-energy rays or particles to destroy cancerous cells. Liver cancer patient can receive radiation therapy through several forms.

External radiation therapy uses an external device (linear accelerator) to generate high-energy rays that focuses on the liver tumor.

Internal radiation therapy uses radioactive substances sealed in seeds, wires, needles, or catheters that are placed in the tumor tissue.

Radiolabeled antibodies uses radioactive substances attached to artificially made antibodies to kill cancerous cells.

Chemotherapy Chemotherapy is a systemic treatment (affects cells throughout the entire body) that uses drugs either to stop the abnormal growth and dividing process of the cancerous cells, or to kill them. This type of treatment involves either a single drug, or a combination of several drugs, and it is usually administrated in cycles where a treatment period is followed by a recovery period.

There are several types of regional chemotherapy:

Hepatic Artery Chemoembolization: This treatment uses an anticancer drug that once injected into the hepatic artery blocks the blood flow that goes to the liver.

Hepatic Arterial Infusion: is a treatment option where chemotherapeutic agents are infused in the hepatic artery. The drugs are periodically administrated through a catheter inserted into the artery. In this way, the treatment is directed straight into the liver.

Isolated Liver Perfusion: is an experimental technique used only in clinical trials. The purpose of this treatment is to expose the liver to a high dose of chemotherapeutic agents while the liver blood supply is temporary stopped.

Percutaneous Ethanol Injection: is an innovative, low morbidity risk procedure where the liver cancer is killed with ethanol (alcohol). This substance is administered into the tumor through a needle.

Portal Vein Embolization is a treatment approach where the portal vein blood supply is blocked.Portal vein embolization is a pre-operatory step for those patients that need surgery but the tumor either is to big to be removed, or the tissue that requires to be removed is to big while the healthy liver tissue left behind is to small.

Interstitial Laser Photocoagulation and Microwave are two additional treatment approaches that directly injure or kill the tumor cells. These two treatments do not work as well as other types of cancer treatment in killing big tumors.

Biologic therapy also called immunotherapy is a type of treatment used to improve the body’s natural defenses. This treatment uses the body’s immune system either to fight against cancer, or to decrease the side effects caused by the cancer treatment.

Liver Transplant is a solution for those patients that suffer from hepatocellular carcinoma in advanced stages, when other treatment option do not work. This surgical procedure involves two steps. The healthier liver is removed from a donor (a person that is brain dead) and then implanted into a patient whose own liver does not function normally. The main side effects of a liver transplant include:

High risk for infections. Bleeding (caused by the new liver’s inability to produce enough blood clothing proteins). Clotting in the main blood vessels that provides the liver with blood. Rejection (the new liver is not accepted by the body).

 

Abdominal pain (this is the most common sign of liver cancer)

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