Liver Cancer

1 What is Liver Cancer?

Liver cancer is a type of cancer that originates in the cells of your liver. The most common type of liver cancer, hepatocellular carcinoma, begins in hepatocytes (main type of liver cells). Other types of cells in liver don’t often turn cancerous. Your liver, a large glandular organ, is situated in the upper right quadrant of your abdomen, beneath diaphragm and above stomach.

Not all cancers that affect the liver are considered liver cancer. Cancer that has spread to the liver from other parts of body is called a metastatic cancer. Metastatic cancers are named after the organ where it first originated, for example a metastatic colon cancer is a cancer with its origin in the colon and has spread to the liver.

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2 Symptoms

Most people don’t experience signs and symptoms in the early stage of liver cancer. Signs and symptoms may include:

  • Unexplained weight loss
  • Nausea and vomiting
  • Pain in your upper abdomen
  • Loss of appetite
  • Extreme tiredness
  • Abdominal swelling
  • Jaundice (yellowish discoloration of skin and eyes)
  • White, chalky stools

When to see a Doctor

Talk to your doctor if have signs and symptoms of liver cancer.

3 Causes

The cause of liver cancer, in most cases, has not been explained yet while the cause can be identified in a few cases. For instance, people with chronic infection by certain hepatitis viruses can develop liver cancer.  

Changes in the genetic material that determines biochemical processes in your body, DNA mutations, result in abnormal growth and eventually formation of tumor.

4 Making a Diagnosis

Making a diagnosis of liver cancer is done by performing several tests,

You may start with visiting your doctor if you suspect you might have liver cancer. Then s/he may refer you to a hepatologist (a doctor who specializes in liver disorders) or oncologist (a doctor who specializes in cancer).

How to prepare yourself for the visit?

Getting prepared for the visit can optimize the therapy and help make the visit more fruitful. You may:

List out all the symptoms.

Write down your key medical information.

Write down the names of all your medications, vitamins or supplements.

Ask a close friend or a family member to accompany you for the visit.

Make a list of the questions to ask your doctor. Some typical questions can be:

  • Do my symptoms indicate liver cancer? If yes, what is its type and stage?
  • Do I need any other tests?
  • What are my treatment options and side effects of each option?
  • Will my treatment affect my daily activities?
  • Can you give me printed materials or brochures?

What your doctor wants to know?

A clear talk with your doctor can optimize the therapy and improve the outcomes. Prepare yourself to answer some essential questions from your doctor. Your doctor might ask you typical questions like:

  • When did you start experiencing symptoms?
  • Are your symptoms continuous or occasional?
  • How severe are your symptoms?
  • Does anything relieve or worsen your symptoms?

Different tests are performed to diagnose liver cancer which can include:

  • Blood tests: Blood tests are performed to determine if your liver is functioning well.
  • Imaging tests: Imaging tests like an ultrasound, computerized tomography (CT) scan and magnetic resonance imaging (MRI) may also be recommended.
  • Liver biopsy: A sample of liver tissue is removed from your liver and analyzed under a microscope to see if cancer has developed. Tissue sample are obtained by inserting a thin needle through your skin and into your liver. Liver biopsy is associated with risk of bleeding, bruising and infection.

If liver cancer is confirmed, your doctor recommends imaging tests to determine the size and location of cancer, and if it has spread. Imaging tests can include CT, MRI and bone scan. Liver cancer is staged by using either roman numerals (I to IV) or alphabets (A-D). There are different methods of staging liver cancer. Stage IV or stage D indicates liver cancer is advanced and has the worst prognosis.

5 Treatment

Treatment for liver cancer is selected according to disease stage, your age, general health status and personal preferences. The treatment options may include:

  • Surgery: It involves surgical removal of a portion of the liver. In some cases, your doctor may recommend partial hepatectomy, removal of liver cancer and a small portion of healthy tissue that surrounds your tumor, provided your tumor is small and liver function is good. Choice of partial hepatectomy also depends on the location of your cancer within the liver.
  • Liver transplant surgery: Your cancerous liver is replaced by a healthy liver from a donor. It is an option for only a few people who have early-stage liver cancer.
  • Cryoablation: It is a process in which cancer cells are destroyed by using extremely cold substance like liquid nitrogen. It involves placing a cryoprobe (instrument that contains liquid nitrogen) directly into tumors in liver. Ultrasound images guide the cryoprobe and monitor freezing of the cells.
  • Radiofrequency ablation: In this procedure, cancer cells are destroyed by the heat obtained from electric current. Ultrasound or CT scan can be used to direct thin needles into your abdomen through small incisions. Soon after the needles reach tumor, they're heated with an electric current that destroys cancer cells.
  • Injecting alcohol into the tumor: Pure alcohol induces death of tumor cells. Injections can be administered directly into tumors, either through the skin or during an operation.
  • Chemoembolization: It is a type of chemotherapy in which chemotherapy drugs are directly injected into the liver. During this procedure, the drugs are injected into the hepatic artery, the artery that supplies to liver cancers. The artery is then blocked to cut supply to the cancer cells and to deliver chemotherapy drugs.
  • Radiation therapy: Ionizing radiations are used to destroy cancer cells and shrink tumors. Stereotactic radiosurgery technique may be used to precisely deliver the radiation to cancer cells.
  • Targeted drug therapy: Targeted drugs interfere with a tumor's ability to generate new blood vessels. Studies have found that targeted drugs can slow or stop progression of advanced hepatocellular carcinoma. However more studies are required to actually figure out how targeted therapies, such as the drug sorafenib work, so that they may be used to control advanced liver cancer.

6 Prevention

Although there is no proven way to completely prevent liver cancer, you may be able to lower your risk.

Cirrhosis, permanent scarring of your liver, increases the risk of liver cancer. Here are some tips to reduce your risk of cirrhosis:

  • Drink in moderation: Not more than one drink a day for women and not more than two drinks a day for men is recommended to lessen the risk of cirrhosis.
  • Maintain a healthy weight: A healthy weight is the secret to good health. Aim for a weight that’s healthy and makes you feel good. Focus on a healthy diet and exercise regimen to maintain health and avoid getting overweight. A combination of low calorie diet and increased physical activity can help you lose some pounds. Gradual weight loss of 1 or 2 pounds (0.5 to 1 kilograms) every week, is recommended.
  • Get vaccinated against hepatitis B to reduce your risk of hepatitis B infection. The hepatitis B vaccine can be given to almost anyone, including infants, older adults and those with compromised immune systems.
  • Take measures to prevent hepatitis C: Till now, there is no vaccination for hepatitis C but you can work to reduce your risk of infection. Here are the things to do:

 Avoid unprotected sex unless you're certain your partner isn't infected with HBV, HCV or any other sexually transmitted infection. Alternately, you can use condoms if you are not sure about health status of your partner.

 Don't use intravenous (IV) drugs, but if you do, do it safely. Use a needle that is sterile and don't share it.

 If you are thinking of getting a piercing or tattoo, chose a safe place. Before getting a piercing or tattoo, inquire staff members about their safety practices. In case they don’t seem to cooperate, go for another safe facility.

Ask your doctor about liver cancer screening. In liver screening ultrasound examination of liver is done once or twice every year.

Liver cancer screening is recommended to those who are at high risk and include:

 People with Hepatitis B
 If you are Asian or African, have liver cirrhosis, or have a family history of liver cancer
 Hepatitis C infection and liver cirrhosis. Liver cirrhosis can occur due to different conditions, such as autoimmune disease, excessive alcohol use, nonalcoholic fatty liver disease and inherited hemochromatosis

7 Alternative and Homeopathic Remedies

Alternative remedies may help you cope with pain, if you have advanced liver cancer.

Alternative therapies include:

  • acupressure,
  • acupuncture,
  • deep breathing,
  • listening to music (music therapy),
  • massage.

8 Lifestyle and Coping

Lifestyle modifications are necessary in order to cope with liver cancer.

Knowing that you have liver cancer, a life-threatening illness, can be overwhelming. Following suggestions may be helpful:

  • Learn enough about liver cancer to make sound decision about your care.
  • Stay close to family and friends. Sharing what you feel could help you manage your burden and bring your needs to light.
  • Join support group: Join a support group near your community. You may also find them online.
  • Discuss with your doctor whether you need end-of-life care.

9 Risks and Complications

Following conditions increase the risk of developing liver caner:

  • Chronic infection with Hepatitis B virus (HBV) or Hepatitis C virus (HCV)
  • Cirrhosis: It is scarring of liver tissue. It often increases the possibility of developing liver cancer
  • Certain inherited liver diseases, such as hemochromatosis and Wilson's disease, are associated with increased risk of liver cancer
  • Non-alcoholic fatty liver disease: Accumulation of fat in the liver can increase the risk of developing liver caner
  • Exposure to aflatoxins: Aflatoxins are poisons produced by molds that often grow in poorly stored crops, such as corn and peanuts. Aflatoxin contamination is more common in certain parts of Africa and Asia.
  • Excessive alcohol consumption: Heavy alcohol consumption can damage liver irreversibly and increase risk of developing the cancer.
  • Obesity: If you are obese, your chances of developing liver cancer increases.

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