Liver Mass - Causes, Types, Symptoms, Stages, and Treatment

Introduction:

The abnormal growth of cells or tissues in the liver is known as a mass (or tumor) in the liver. The lesions can be of two types, cancerous and non-cancerous. A benign (non-cancerous) lesion does not spread to other parts of the body, whereas a malignant (cancerous) lesion spreads to other parts or organs of the body. There are no specific reasons for the cause of liver cancer. Some underlying diseases like viral hepatitis B or C, cirrhosis (scarring of healthy liver tissue), obesity (overweight people), hormones in the oral contraceptives (birth control pills), due to chemicals like arsenic and toxins (harmful substances) like aflatoxin can cause cancer in the liver.

What Causes Mass on the Liver?

Liver cancer can occur in anybody. Though there are no specific reasons for the cause, some underlying liver diseases, and other external causes can result in lesions in the liver.

• Cirrhosis: A chronic liver disease (long term) where the healthy liver tissues are replaced by scar tissues. This causes the liver to harden and does not function properly.

• Hepatitis B and C: Hepatitis B and C occur through contact with another person's body fluids who are infected with hepatitis B or C viruses. Some examples like sharing needles, unprotected sex, or transfer from an infected mother to the baby. This is a serious infection that results in liver damage, liver cancer, and death. Chronic hepatitis B or C causes liver cancer.

• Oral Contraceptives: The birth control pills contain the hormones estrogen and progesterone. When oral contraceptives are taken for a long time, it increases the risk of benign liver tumors.

• Arsenic: Arsenic is a chemical found in soil and groundwater. Large amounts of arsenic intake over time result in arsenic poisoning and causes cancer, liver disease, and coma.

• Obesity: Being obese results in abnormal deposition of fat in the liver, which causes liver diseases like fatty liver, cirrhosis, and liver cancer.

• Aflatoxin: This is a toxic element present in the mold formation (fungus) of nuts and grains when they are not stored properly.

• Alcohol and Smoking: Alcohol consumption and smoking tobacco increase the risk of liver cancer, as it causes a series of liver diseases.

What Are the Types of Liver Lesions?

A mass or a lesion can be of two types depending on the content of the lesion. A solid lesion that has abnormal growth of cells and a fluid-filled cavity called a cyst.

Depending on the spreading nature of the lesion, it can be divided into;

• Benign Lesion: The benign lesion does not spread to other parts of the body. They are common, do not cause symptoms, and do not affect liver function. They are usually found in ultrasound or CT scans while diagnosing another disease or condition. Benign liver tumors are:

  • Hemangioma: This is a common type of benign tumor. It is caused by abnormal masses of blood vessels. It is common in women. Most liver hemangiomas are small and do not require treatment. If the lesions are big and cause symptoms, surgical intervention will be done.

  • Liver Cysts: They are fluid-filled lesions that show no symptoms, and they hardly require any treatment. If the lesion is bigger and causes symptoms, a minimally invasive laparoscopic procedure would be done.

  • Focal Nodular Hyperplasia: This is the second most common benign lesion.Focal nodular hyperplasia (FNH) is filled with hepatocytes (functional cells of the liver), connective tissue cells (support and organize organs in our body), and bile duct cells. They are common in women between 20 and 30 years. These lesions resemble a malignant tumor and are often removed when the diagnosis is not clear.

  • Hepatic Adenoma: Hepatic adenoma is caused by the main functional liver cell called hepatocytes. They form a major part of the liver. It is common in women and is associated with taking birth control pills. They do not cause symptoms and do not require treatment. Sometimes these lesions rupture and can cause blood loss. Hence surgery might be recommended if the lesion is large to avoid complications.

• Malignant Lesions: The malignant lesions spread to other parts of the body. The malignant lesions in the liver are primary liver cancer(formed in the liver) and secondary liver cancer (cancer spread from other organs like the lung, colon, breast, or stomach to the liver). They are severe, affect liver function, and can be difficult to treat in advanced stages.

  • Primary Liver Cancer: Hepatocellular carcinoma (cancer of the liver cells) is the most common type of primary liver cancer. This occurs in people who have chronic liver diseases (long term) like chronic hepatitis B or C, chronic cirrhosis, and alcoholics. They have two growth patterns:

    • Few tumors grow as a single large lesion and spread to other parts of the liver.

    • In the second type, multiple small cancerous nodules are seen in the liver. This is mostly seen in patients with cirrhosis.

  • Cholangiocarcinoma: Cancer of the bile duct. The bile duct is a tubular structure that carries bile from the liver to the gallbladder, stomach, and small intestine. This is a type of primary liver cancer.

  • Angiosarcoma and Hemangiosarcoma: These are cancers of the lining of the blood vessels. They are severe and are hard to treat. They are caused when exposed to chemicals like vinyl chloride (plastic-making chemical), thorium dioxide (a chemical used in welding, aircraft engines, and electron tubes), arsenic (a chemical element used in paper, textile, glass, and metal industries), and radium (a chemical used in making luminous paint). It can also occur in people with hereditary hemochromatosis (excess iron storage in the body). This is a rapidly spreading cancer, and by the time it is detected, it is spread widely and cannot be treated surgically. Chemotherapy and radiotherapy are the only choices.

  • Hepatoblastoma: This cancer is seen in children less than four years. This is a rare type of cancer. Treatment involves surgery and chemotherapy. This becomes hard to treat if cancer spreads to other parts.

  • Secondary or Metastatic Cancer: Metastatic cancer of the liver is spread from cancers of other organs like the stomach, lung, pancreas, or breast. The treatment involves treating the organ that spreads cancer. Most malignant tumors in the liver are metastatic.

What Are the Symptoms of Liver Lesions?

• Abdominal pain (pain in the stomach region).

• Jaundice (yellowish discoloration of the skin and eyes).

• Fever.

• Lump felt in the right upper region above the stomach.

• Nausea and vomiting.

• Feeling weak and tired.

• Abdominal swelling.

• Weight loss

• Loss of appetite.

• Stomach fullness.

What Are the Stages of Liver Cancer?

• Localized Resectable: The tumor is in one place and removed surgically.

• Localized Unresectable: The tumor is in one place but cannot be removed by surgery.

• Advanced: Cancer has spread throughout the liver and to other parts of the body.

• Recurrent: Cancer has come again after complete treatment.

How Are Liver Lesions Found?

• 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.

• Tumor Marker Tests: 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.

• Ultrasound Abdomen: Ultrasound is an imaging technique that uses high-frequency sound waves to capture images of the internal organs or structures to detect any abnormality.

• CT Scan: Computerized tomography 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.

• MRI Scan: This imaging technique uses a combination of magnetic field 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.

• 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 and shows changes in the metabolism, blood flow, regional chemical components, and absorption. Different markers are used for different imaging purposes.

• Liver 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, and the results reveal the type of cancer.

Who Is at Risk?

People with the following conditions:

• Chronic Hepatitis B or Hepatitis C.

• Cirrhosis.

• Inherited liver disease like hemochromatosis (too much iron in the body).

• Nonalcoholic fatty liver disease (excess fat accumulation in the liver).

• Exposure to chemicals like aflatoxins.

• Drinking too much alcohol.

• Women who take contraceptive pills frequently.

What Are the Complications of Liver Tumors?

• Hypercalcemia of Malignancy - Elevated calcium levels in the blood lead to a series of symptoms like nausea, vomiting, severe weakness, coma, and death.

• Bleeding - There is liver damage due to cancer, and the clotting (bold thickening) mechanism is not carried out by the liver properly.

• Anemia - Due to blood loss from bleeding, there is a decrease in the red blood cell count.

• Portal Hypertension - The veins of the liver are blocked due to the tumor, and there is a decrease in the blood flow. This results in increased venous pressure.

• Bile Duct Obstruction - The bile duct is a tube-like structure that carries bile from the liver to the gallbladder, stomach, and small intestine. In the presence of a tumor, there is a block in the bile duct. This blockage results in numerous complications.

• Hepatorenal Syndrome - The kidney fails to function properly due to insufficient blood supply, as the blood flow is blocked by a tumor. This results in kidney failure.

• Hepatic Encephalopathy - The toxins (harmful substances) are not removed from the blood as the liver does not function properly. One of the main functions of the liver is to remove toxins from the blood. These toxins reach the brain and damage the brain cells resulting in disorientation, memory loss, slurred speech, and confusion.

How Are Liver Lesions Treated?

Benign Lesions:

• Benign lesions which are asymptomatic do not need treatment. The doctor will keep checking for any changes in the lesion by repeating ultrasound, CT scan, or MRI scan.

• If the lesions are small and are causing trouble, surgery will be recommended, followed by chemotherapy (medicines that kill cancer cells).

• If the lesions are big and cause symptoms, radiation therapy (a heavy dose of radiation to kill cancer cells and shrink the tumor) will be recommended.

• A liver transplant will be considered, where the liver will be replaced by a whole liver or a portion of a healthy liver, usually from a donor. This is done in cirrhosis.

Malignant Lesions:

• Surgery: If the tumor size is small, surgical removal of the cancerous tissue will be done, followed by chemotherapy.

• Radiation Therapy: High-frequency rays are directed at the liver to kill and shrink the cancer cells.

• 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.

• Chemotherapy: Anti-cancer medications will be given to kill the cancer cells.

  • Intra-Arterial Chemotherapy: The anti-cancer medication is injected directly into the tumor through veins that carry blood supply to the liver.

  • Chemo-Embolization: The liver’s blood supply is blocked by performing surgery, and a high dose of the anti-cancer medication is directly given to the tumor. The medication has a direct and longer effect on the tumor.

What Is the Prognosis of Liver Mass?

The prognosis is good in benign lesions; some benign lesions do not even need treatment. The prognosis for malignant lesions depends on the extent of the spread of cancer. Hepatocellular cancer, if detected early, is curable with a good prognosis. Metastatic cancer cannot be cured, but tumor growth can be slowed down, and symptoms can improve.

How to Prevent Liver Cancer?

• Avoid consuming alcohol. Reduce alcohol intake to one drink a day for females and two drinks a day for males.

• Maintain a healthy weight by exercising regularly. Eat a balanced diet that includes proteins, carbohydrates, fibers, and vitamins and minerals in equal proportions.

• Vaccination against hepatitis B and C.

• Practice safe sex with protection like using condoms. Do not share needles. Use a sterile needle. Consult a doctor if you come in contact with another person's blood. This can prevent you from getting hepatitis B or C, which increases the risk of liver cancer.

Conclusion:

Liver cancer can be life-threatening if not detected and treated early. Benign or non-cancerous lesions are easy to treat, and by following a healthy lifestyle, they can be prevented. Though some metastatic cancers are fast spreading and untreatable, finding them early and getting an appropriate treatment will reduce the growth of the tumor and expand the lifespan.