Liver Cancer

Cancer that arises in the cells of the liver is known as primary liver cancer. Hepatocellular carcinoma, which begins in the main type of liver cell, is the most common type of primary liver cancer.

Other liver cancer types, including hepatoblastoma and intrahepatic cholangiocarcinoma, are less common.

The organ can also be affected by secondary cancers that arise in other parts of the body and spread to the liver. They are named after the organ in which they originated, such as metastatic colon cancer that has spread to the liver.

Secondary cancers that spread to the liver are more common than primary cancers that begin in the liver cells.
The liver is an important organ of the human body. It fulfils key functions such as:

• Disposal of old cells and toxins from our blood.
• Flushing out chemicals and other waste found in our body through alcohol, medication, processed food etc.
• Bile production – which in turn, aids in the breaking down of fatty acids, which helps with digestion. Bile also helps our body easily absorb fat-soluble vitamins, and it helps throw out excess cholesterol & bilirubin.

Liver cancer can damage the liver and affect how it functions. Research shows that around 800,000 people globally are diagnosed with liver cancer each year.

Primary liver cancer

Primary liver cancers are those cancers that start in the liver. The different primary liver cancer types are:

• Hepatocellular carcinoma: Hepatocellular carcinoma (HCC) can manifest in two ways:
  • As one tumour that grows over a period of time and later breaks off and spreads.
  • As multiple nodules of cancer dotting the liver.

  Some doctors identify different types of HCC, which include:

  • Neutrophil-rich HCC
  • Fibrolamellar HCC
  • Steatohepatitic HCC
  • Scirrhous HCC
  • Clear cell HCC
  • Chromophobe HCC
  • Macrotrabecular-massive HCC
  • Lymphocyte-rich HCC
• Intrahepatic cholangiocarcinoma: Intrahepatic cholangiocarcinoma is also called cancer of the bile duct. Unlike other types of cholangiocarcinoma, intrahepatic cholangiocarcinoma starts inside the lining of the small bile duct inside the liver. Between 10% and 20% of all liver related cancers belong to this type.
• Hemangiosarcoma and Angiosarcoma: Both angiosarcoma and hemangiosarcoma are relatively rare soft-tissue sarcomas that occur within the blood vessels. They are not restricted to the liver.
  But sometimes, these tumours start in the lining of the blood vessels of the liver, causing liver cancer.
• Hepatoblastoma: Hepatoblastoma is one of the rarest liver cancer types, and it predominantly occurs in children under three years old.

Metastatic/Secondary liver cancer

Liver cancer often occurs as a result of other types of cancer having spread from their location of origin and into the liver. This process is called metastasis. Any type of cancer can become metastatic liver cancer.

For example, if gastrointestinal cancer has metastasised to the liver, the doctor would refer to it as metastasised gastrointestinal cancer. However, the treatment would now address tumours in the gastrointestinal tract, liver, and anywhere else it has spread to.

As the disease progresses, the symptoms start showing up. Some common signs and symptoms of liver cancer:

• Unintentional weight loss
• General weakness and fatigue
• Pain in the upper abdomen
• Nausea and vomiting
• Swelling in the abdomen
• Yellow discolouration of your skin
• A lump below your rib cage
• Pain near your right shoulder
• Dark-coloured urine
• White, chalky stools
• Jaundiced appearance (or a Jaundice diagnosis)
• Severe pain in the right shoulder or the right side of the abdomen
• Swelling of the abdomen on the right side or a lump below the rib cage
• Loss of appetite
• Itchy skin
• Flu-like symptoms (that persist after two weeks).

Liver cancer develops as a result of DNA mutations in the liver cells. These DNA mutations may stimulate oncogenes, leading to uncontrolled growth of cells and the development of tumours.

A few major risk factors may increase your chances of getting primary liver cancer.

Risk factors

• Chronic hepatitis B virus (HBV) or hepatitis C virus (HCV) infection.
• Non-alcoholic fatty liver disease
• Liver cirrhosis
• Hereditary liver diseases like hemochromatosis and Wilson’s disease.
• Exposure to aflatoxins
• Previous exposure to certain illnesses:Hepatitis B and Hepatitis C viral infections are the two leading causes of liver cancer causes.
• Alcohol consumption: One of the most prominent liver cancer symptoms is cirrhosis. This is scar tissue that indicates damage to the liver. But cirrhosis can occur in other ways too. Prolonged and consistent consumption of large amounts of alcohol can cause a condition called alcoholic cirrhosis. (In fact, extensive alcohol consumption over many years can also cause alcoholic hepatitis.) Another type of cirrhosis that sometimes occurs is primary biliary cirrhosis. This is a less-known condition where the bile duct gets damaged and causes cirrhosis, which increases the risk of liver cancer.
• Obesity: Individuals who are overweight or diagnosed with lifestyle-induced obesity are more vulnerable to a condition called non-alcoholic fatty liver disease (NAFLD). This disease is one of the major risk factors for developing liver cancer.
• Diabetes: Diabetes often increases a person’s risk of NAFLD. This is why people with diabetes are more frequently observed to be vulnerable to liver cancer.
• Haemochromatosis: A rare genetic condition, Haemochromatosis leads to the body storing excess iron from food or drinks people consume. This excess iron can damage the liver, increasing the risk of liver cancer.
• Aflatoxins: Aflatoxins are toxins that are produced by a type of mould that grows on poorly-kept grains. If the grains are not washed properly before consumption, the toxins may cause liver cancer over a period of time.

If you experience symptoms of liver cancer, then your healthcare provider may order a few tests to make a proper diagnosis.

• Blood tests: Blood tests, such as liver function tests, check the levels of liver enzymes and proteins to determine whether your liver is healthy or inflamed. High levels of the substance alfa-fetoprotein (AFP) may indicate liver cancer.
• Ultrasound: Doctors often use ultrasound to look for tumours in your liver. This test provides images of the soft tissue structures.
• Computed tomography (CT) scan: CT scan is a special type of X-ray that takes detailed pictures of your liver and provides information about the location and size of the tumours present.
• Magnetic resonance imaging (MRI): Liver MRI tests produce clear images of the liver, helping the doctor diagnose your health condition.
• Angiogram: Angiograms examine the liver’s blood vessels for any abnormalities. Your doctor will inject a dye into an artery and track blood vessel activity to look for blockages.
• Biopsy: If your physician suspects you of having liver cancer, then they will remove liver tissue to check for cancer cells. Biopsies are very reliable when it comes to liver cancer diagnosis.

Once liver cancer is diagnosed, your doctor will determine the stage of cancer, and that is done on the basis of the size and location of cancer. CTs, MRIs, and bone scans are used for this process.

The stages of liver cancer are:

• Stage I/very early stage/stage 0
• Stage II/early stage/stage A
• Stage III/intermediate stage/stage B
• Stage IV/advanced stage/stage C

Based on these, liver cancer stages look like this:

• During the early stages, the tumour size is typically under 2cms, and the liver works normally.
• When there is moderate progression, there might be 3 or more tumours on the liver, each of which is under 3 cm in size. The liver functions well most times, but some symptoms of liver cancer may manifest.
• When there is intermediate progression, the number and size of tumours increase and more severe symptoms are observed. Liver damage is observed.
• In the final stages, when there is severe liver damage, the chances that cancer has metastasised to other parts of the body are high.

According to research, the 5-year survival rate for liver cancer is 15% to 20%.

The oncologist also considers the person’s age, overall health, and personal preferences while devising a treatment plan.

Usually, liver cancer treatment includes one or more of the following:

• Cancer removal surgery: Your oncologist may recommend surgery to remove the liver cancer and surrounding tissue.The location of the disease has a major role in determining whether surgery is a good option or not.
• Liver transplant surgery: In some cases, your cancer team may remove the diseased liver and replace it with a healthy liver from a donor.This option is viable only for some people with early-stage liver cancer.
• Radiation therapy: Surgery might not be a viable option for people with advanced liver cancer. In such cases, radiation therapy can help to shrink the tumour and control symptoms.
• Targeted drug therapy: Targeted drug therapy focuses on abnormalities present within cancer cells and works on blocking them to control the disease from progressing.Advanced liver cancer is often treated with targeted drug therapy.
• Immunotherapy: This is a form of treatment that uses your immune system to fight cancer. People with more advanced forms of liver cancer are often given this treatment.
• Chemotherapy: Drugs known to kill rapidly growing cells, including cancer cells, are administered in chemotherapy.This treatment can be given orally in the form of pills or through a vein in the arm.
• Palliative care: Along with regular cancer treatment, one might also opt for palliative care for relief from intense pain.Palliative care providers give you an extra layer of support while going through conventional cancer treatments, such as surgery, chemotherapy, and radiation.

While there are no specific ways of preventing liver cancer, there are a few steps you can take to lower your liver cancer risk:

• Eat a healthy diet
• Limit your consumption of alcohol
• Maintain a healthy weight
• Protect yourself against hepatitis B and C
• Get regular liver cancer screenings if you have diabetes, obesity, or any liver disease.

Getting diagnosed with liver cancer can be a very scary experience. Some people may even choose to ignore the symptoms for months for fear of getting a cancer diagnosis. However, keep in mind that the earlier you are diagnosed, the better the prognosis and the sooner you can start treatment.

For personalised cancer care and customised oncological treatment plans for liver cancer, please visit the CK Birla Hospital. With innovative cutting-edge oncological technologies, it is possible to effectively manage liver cancer symptoms and live a good quality life.

Book an appointment with Dr. Vinay Gaikwad now.