Liver Cancer - Causes, Symptoms, Stages, Risk Factor, Prevention, Diagnosis, and Treatment

Introduction:

Liver, the largest gland present in the human body, weighs about 1500 mg. It is located in the upper right abdomen region and extends to the upper left abdomen under the diaphragm. The liver has two lobes, the right lobe and the left lobe. The blood supply to the liver comes from the hepatic artery and the portal vein. This blood flows out of the liver using the hepatic vein into the portal vein. The microscopic structures present in the liver are hepatocytes with mesenchymal cells and bile duct cells.

What Are the Functions of the Liver?

• It helps in bile production and excretion, which helps carry away waste from the body and fat breakdown in the small intestine during digestion.

• Excretion of bilirubin, hormones, cholesterol, and drugs.

• Helps in the metabolism of proteins, fats, and carbohydrates.

• Enzyme activation.

• Storage of vitamins, glycogen, and minerals.

• Synthesis of plasma proteins, such as clotting factors and albumin.

• It helps in blood detoxification and purification.

What Is Liver Cancer?

Liver cancer is cancer that occurs in the cells of the liver. It is also called hepatic cancer or hepatocellular carcinoma.

What Are the Causes of Liver Cancer?

It is most commonly seen in people with chronic liver diseases like cirrhosis caused by hepatitis C or hepatitis B infections. Other causes are:

• Obesity.

• Autoimmune hepatitis.

• Chronic alcohol use.

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• Diabetes mellitus.

• Non-alcoholic fatty liver disease.

What Are the Warning Signs and Symptoms of Liver Cancer?

The symptoms are usually uncommon in the early stages of liver cancer. Symptoms during the later stages of the disease include,

• Loss of weight without trying.

• Loss of appetite.

• Upper abdominal pain.

• Nausea and vomiting.

• General weakness and fatigue.

• Abdominal swelling.

• Yellow discoloration in the whites of eyes and skin (jaundice).

• White, chalky stools.

• Dark-colored urine.

• Chronic fatigue.

• Swelling in the legs and ankles.

• Itchy skin.

• Bloating sensation.

Who Are All at Risk for Liver Cancer?

• Men are more likely to develop liver cancer than women.

• People who have chronic infections with hepatitis B and C viruses.

• People with liver cirrhosis.

• Non-alcoholic fatty liver disease, most commonly seen in obese people.

• In people with hepatic hemochromatosis, too much iron is absorbed from the food. When more iron settles in the liver, it will lead to cirrhosis and liver cancer.

• People who consume a high amount of alcohol.

• People who are obese.

• People with type 2 diabetes mellitus.

What Are the Stages of Liver Cancer?

1. Stage 1 Liver Cancer - A single mass in the liver that does not spread to any blood vessels.

2. Stage 2 Liver Cancer - A single mass in the liver has invaded the blood vessels or multiple tumors that are less than 5 centimeters in size.

3. Stage 3 Liver Cancer - It is divided into:

• Stage 3 A - Multiple tumors in the liver with at least larger than 5 centimeters. It has not spread to any lymph nodes or outside the liver.

• Stage 3 B - Cancer has spread to one of the main blood vessels, and it has not spread to any lymph node or organ.

• Stage 3 C - Cancer has spread to the nearby organ or the outer tissues, but it has not spread to the lymph nodes or distant organs.

4. Stage 4 Liver Cancer - They are further divided into:

• Stage 4 A - Cancer has spread to the lymph nodes near the liver but has not spread to distant organs.

• Stage 4 B - Cancer has spread to distant organs like bones, lungs, or brain. In this, the tumor may invade the nearby lymph nodes or blood vessels.

What Are the Diagnostic Methods of Liver Cancer?

• The doctor can perform blood tests like liver function tests.

• The doctor can perform imaging tests like ultrasound, CT (computed tomography), and MRI (magnetic resonance imaging).

• Liver biopsy, where a needle is passed through the skin into the liver, and the tissue is collected. These liver tissues are examined under the microscope to check for cancer cells. After a liver biopsy, there is a risk of bruising, bleeding, and infection.

What Are the Differential Diagnosis of Liver Cancer?

• Dysplastic nodules in cirrhosis.

• Fibrous nodular hyperplasia.

• Metastatic disease.

How to Treat a Patient With Liver Cancer?

Liver transplantation is the most effective treatment for patients with liver cancer. The common types of treatment done for liver cancer are surgery, radiofrequency ablation, radiation therapy, and percutaneous ethanol injection.

1. Surgery

Two types of surgery done are:

• Hepatectomy - It is done to remove the tumor, which can be partial or total.

• Liver transplantation.

2. Radiofrequency Ablation - Thisis one of the most common ablation methods used to treat small tumors. Here a thin needle is passed into the tumor through the skin, and high-frequency radio waves are passed through it, which heats the tumor and destroys the cancer cells.

3. Percutaneous Ethanol Injection - This is the first ablative technique used to treat liver cancer. The alcohol is directly injected into the tumor to destroy the cancer cells, which leads to the complete ablation of about 70 percent of the cancer cells. This technique is used when the tumor size is less than or equal to 3 centimeters.

4. Radiation Therapy - It is highly effective in controlling early-stage cancer. Radiation segmentectomy is the minimally invasive procedure used in people with early-stage cancer who cannot tolerate the standard therapy.

5. Targeted Drug Therapy - Targeted therapy is different from chemotherapy. Here the drugs focus only on the cancer cells exempting the healthy cells.

6. Immunotherapy - In this technique, drugs improve the immune system to kill the cancer cells.

7. Palliative Care - This method helps relieve pain and other symptoms from a severe illness. Palliative care is given when the patient is undergoing aggressive treatments like radiotherapy, chemotherapy, or surgery.

8. Chemotherapy - The doctor uses drugs to destroy the cancer cells and stop them from replicating further. Chemotherapy can be done either through pills or injections systemically to travel throughout the entire body.

How to Prevent Liver Cancer?

While no one can prevent liver cancer, you can potentially reduce your risk by following healthy lifestyle measures like regular exercise, eating a healthy diet, taking limited amounts of alcohol, and controlling weight. It is also essential to avoid infection with hepatitis B and C viruses.