Introduction:
Cirrhosis (scarring of liver tissues) and hepatocellular carcinoma (cancerous tumor in the liver) are chronic liver diseases. Most patients with cirrhosis develop hepatocellular carcinoma. The symptoms are similar in both disease conditions. The symptoms include pain in the right upper region above the stomach, yellowish discoloration of the skin and the eyes, nausea, vomiting, loss of appetite, weight loss, dark-colored urine, feeling weak and tired, pale-colored stool, and enlargement of the stomach. These diseases are diagnosed with the help of liver function tests, complete blood count, imaging techniques like ultrasound abdomen, MRI scan, CT scan, tumor marker tests, and liver biopsy. Treatment involves resection of the diseased part of the liver, chemotherapy (administering anti-cancer medications), radiation therapy (a high dose of radiation is targeted at the tumor to shrink the size), or liver transplant. Patients who have cirrhosis are likely to develop hepatocellular carcinoma.
What Is Hepatocellular Carcinoma?
Hepatocellular carcinoma is the most common type of cancer in the liver. It is formed in the liver and is called a primary tumor. Liver cells are called hepatic cells, and abnormal growth of these hepatic cells is called hepatocellular carcinoma.
What Causes Hepatocellular Carcinoma?
Cirrhosis most commonly causes hepatocellular carcinoma. Other diseases like viral hepatitis B or C, alcoholic hepatitis (inflammation of the liver due to too much alcohol consumption), hemochromatosis (too much iron storage in the liver), taking anabolic steroids (a man-made hormonal medication used to increase muscle mass), obesity and diabetes, and aflatoxin (a toxin found in the mold formation of peanuts, grains, nuts, and cereals) also cause HCC.
How Is Hepatocellular Carcinoma Treated?
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Surgery: If the tumor size is small, surgical removal of the cancerous tissue will be done, or a part of the liver along with the tumor will be removed (partial hepatectomy), followed by chemotherapy.
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Radiation Therapy: High-frequency rays are directed at the liver to kill and shrink the cancer cells.
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Radiofrequency Ablation: This procedure is done when the tumor size is small. A thin, needle-like probe is inserted into the tumor through a small cut made in the stomach. A high-frequency current is passed, which kills the cancer cells by generating heat.
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Chemotherapy: Anti-cancer medications will be given to kill the cancer cells.
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Liver Transplant: If the tumor is not removed through partial hepatectomy, the whole liver is transplanted. A liver transplant will be planned when the donor organ is ready for replacement. The donor will usually be a recently deceased person with the same blood group and a similar physique.
What Are the Stages of Hepatocellular Carcinoma?
According to TNM (tumor size, lymph node involvement, and metastasis - spreading to other organs), staging:
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Stage IA: T1aN0M0 (tumor size less than 2 cm, no lymph node involvement, and no metastasis).
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Stage IB: T1bN0M0 (tumor size more than 2 cm with involvement of blood vessels, no lymph node involvement, and no metastasis).
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Stage II: T2N0M0 (tumor size more than 2 cm with involvement of blood vessel, or many tumors less than 5 cm, no lymph node involvement, and no metastasis)
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Stage IIIA: T3N0M0 (many tumors with one tumor more than 5 cm, no lymph node involvement, and no metastasis).
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Stage IIIB: T4N0M0 (multiple tumors in nearby organs, no lymph node involvement, and no metastasis)
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Stage IVA: Any TN1M0 (any type of tumor with lymph node involvement and no metastasis)
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Stage IVB: Any T, any N M1 (any type of tumor with lymph node involvement and metastases to other organs).
What Is Cirrhosis?
Cirrhosis is a chronic liver disease that causes scarring of liver tissues.
What Causes Cirrhosis?
Cirrhosis results due to repeated damage to the liver tissues caused by consuming excess alcohol. The liver removes toxins (harmful substances) from the blood circulation while processing medications and alcohol consumed. When there is a continuous presence of alcohol in the blood, the toxins build up and damage the liver cells. This continuous damage to the liver results in scarring of the liver tissues, and this hardens the liver.
Cirrhosis is also caused by non-alcoholic fatty liver. It is the excess deposition of fat in the liver due to an underlying condition like obesity or diabetes. These fat deposits clog the liver and lead to poor liver functioning. This leads to liver dysfunction and liver failure. Cirrhosis is one of the main reasons for hepatocellular carcinoma.
How Is Cirrhosis Treated?
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Quitting alcohol and enrolling in alcohol addiction treatment programs.
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A low-sodium diet is recommended.
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Weight loss.
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A liver transplant is recommended for severe liver damage.
What Tests Are Performed to Find Hepatocellular Carcinoma and Cirrhosis?
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Liver Function Tests (LFT): A group of blood tests that involve screening of liver enzymes like alanine aspartate (ASP), alkaline phosphatase (ALP), and alanine transaminase (ALT), and proteins like albumin, globulin, and alpha-fetoprotein in the blood. An increased level of alpha-fetoprotein (AFP) suggests liver cancer.
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Complete Blood Count: This is a blood test where all the components of the blood, like red blood cells, white blood cells, platelets, and hemoglobin, are checked. Changes in any of these components denote an infection.
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Ultrasound Abdomen: Ultrasound is an imaging technique that uses high-frequency sound waves to capture images of internal organs or structures to detect any abnormality.
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CT Scan: Computerized tomography (CT) is an imaging technique that contains cross-sectional X-ray images of the internal organs at different angles with the help of a computer. It gives a detailed view of the targeted structure to view any abnormality.
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MRI Scan: This imaging technique uses a combination of magnetic fields and radio waves from a computer to capture the internal structure and tissues of the body. It gives a very detailed view of the organ or structure.
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Liver Biopsy: In biopsy, a small portion of the liver tissue is removed and visualized under a microscope to check for pathological changes. This is a confirmatory test.
PET scans and tumor marker tests are additional tests performed to find any type of cancer.
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PET Scan: Positron emission tomography (PET) uses a radioactive drug to detect both normal and abnormal metabolic activity. A radioactive substance (a nuclear medicine procedure to treat and find out specific diseases) called radiotracer is injected. It shows changes in metabolism, blood flow, regional chemical components, and absorption. Different markers are used for different imaging purposes.
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Tumor Marker Tests: A tumor marker is a type of protein that is present in blood, urine, and body tissues. The increase in the levels of these tumor markers indicates cancer.
Does Hepatocellular Carcinoma Develop in Cirrhosis Patients?
Most patients with cirrhosis develop cancerous lesions in the liver. Hepatocellular carcinoma is the most common lesion associated with cirrhosis.
How Is Hepatocellular Carcinoma in Cirrhosis Patients Treated?
Resective surgery is the procedure where a portion of the liver in which the tumor is present is removed. If the tumor size is small and involves a minimal part of the liver, resective surgery will be done. If the tumor size is large and a major portion of the liver is affected, a liver transplant will be recommended. Chemotherapy involves administering anti-cancer medications to HCC patients.
What Is the Survival Rate in Patients With Cirrhosis and Hepatocellular Carcinoma With Resective Surgery?
The 1, 2, 3, and 5-year survival rates in patients with cirrhosis and hepatocellular carcinoma with resective surgery are around 84.9 %, 71.0 %, 60.1 %, and 51.6 %. The 1, 2, 3, and 5-year progression-free survival rates where the patient lives with the disease and the condition does not worsen are around 43.6 %, 33.0 %, 29.0 %, and 26.8 %.
What Is the Prognosis for Patients With Hepatocellular Carcinoma in Cirrhosis?
The prognosis is poor, with a median survival of 16 and 17 months.
Conclusion:
Cirrhosis is an irreversible and chronic liver disease. Cirrhosis patients are at high risk of developing liver cancer. Hepatocellular carcinoma is the common type of cancer seen in cirrhosis. Most symptoms of hepatocellular cancer appear in a later stage, and the treatment becomes complicated. It becomes life-threatening, and the survival rate is very low. Though cirrhosis is a chronic disease and has an increased risk of getting liver cancer, regular monitoring and finding the disease earlier can delay the disease's progress. This regular monitoring of liver function helps the doctor to detect the disease early and start appropriate treatment to extend the lifespan.
