What is Liver Cancer
Liver cancer occurs in the liver either primarily or as a spread from cancer at some other place in the body.
Understanding Liver Cancer
The liver is the largest internal organ. It has several important functions like storage of vital nutrients, production of bile and clotting factors and breakdown of toxic waste in the blood like alcohol, drugs, etc.
Types of Liver Cancer
1. Primary liver cancer
Cancer that starts in the liver is called primary liver cancer. There is more than one kind of primary liver cancer.
- Hepatocellular carcinoma: This is the most common form of liver cancer in adults. “Liver cancer” usually means hepatocellular carcinoma.
The other uncommon types of primary liver cancer are:
- Intrahepatic cholangiocarcinoma (bile duct cancer)
- Angiosarcoma and hemangiosarcoma
2. Secondary liver cancer (metastatic liver cancer)
Most of the time when cancer is found in the liver it did not start there but has spread (metastasized) from somewhere else in the body, such as the pancreas, colon, stomach, breast, ovaries or lung. Because this cancer has spread from its original (primary) site, it is secondary liver cancer. These tumors are named and treated based on their primary site (where they started). For example, cancer that started in the lung and spread to the liver is called lung cancer with spread to the liver, not liver cancer, and it is treated as lung cancer.
How Common is Liver Cancer?
- The incidence of Hepatocellular carcinoma is increasing; it is becoming the 4th most common malignancy worldwide. HCC is the commonest primary liver malignancy (90%). But in the liver, secondary cancer is the most common malignancy (20 times more common than primary).
- It is more common in cirrhotics and hepatitis B and hepatitis C virus infection.
- The male to female ratio is 4:1
What are the Risk Factors for Liver Cancer?
- Aflatoxin B1, a product of fungus Aspergillus. It is a powerful carcinogen (cancer-causing agent).
- Hepatitis B and hepatitis C virus infection. It is more common in individuals who are chronic carriers.
- Alcoholic cirrhosis: It is co-carcinogen.
- Haemochromatosis (a disorder characterized by an excess of iron in the body)
- Chemicals like DDT, nitrite, and nitrate related food products; trichloroethylene (dry cleaning solvents), biphenyls, carbon tetrachloride, herbicides, solvents like dioxane.
- Anabolic steroids, polyvinyl chloride
- Hepatic adenoma: It is a benign (non-cancerous) tumor of the liver. However, it has the potential to become malignant.
What are the Symptoms of Liver Cancer?
Symptoms of Primary Liver Cancer
- Painless mass in the right upper part of the abdomen just below the ribs.
- Loss of appetite and weight
- Jaundice may be present due to liver dysfunction.
- Ascites (abnormal accumulation of fluid in the abdomen)
- Splenomegaly (enlargement of the spleen)
- Gastrointestinal bleeding like blood in vomitus or stool may be present in about 10% of cases
Symptoms of Secondary Liver Cancer
- The patient may have jaundice depending upon the extent of liver involvement.
- Loss of appetite and weight.
- Clinical features of the primary tumour, e.g. stomach, colon, etc.
How is Liver Cancer Diagnosed?
Liver cancer can be diagnosed using any or some of the following tests:
- Ultrasound abdomen
- CT Scan abdomen
- Liver function tests
- MRI Scan
- Liver Biopsy is also performed in some cases
- Diagnostic laparoscopy
- Alpha-Fetoprotein (AFP) Tumor Marker
- Investigations in relation to hepatitis B and hepatitis C virus infections and also for haemochromatosis
How is Liver Cancer Treated?
The treatment of liver cancer depends on the stage of cancer, as well as a person’s underlying liver function.
While the preferred treatment is the surgical removal of cancer, many people are not eligible for surgery due to the extent of their disease and/or poor baseline liver health. Besides surgery, other treatment options include the following:
- Liver transplant
- Ablation therapy
- Embolization therapy
- Targeted therapy
How Can Liver Cancer be Prevented?
While it’s not always possible to prevent liver cancer, you can reduce your risk by being vaccinated against hepatitis B, being tested for hepatitis C, practicing safe sex, and limiting your consumption of alcohol.
Together, hepatitis B and hepatitis C infections are responsible for 85 percent to 90 percent of liver cancers, so taking measures to prevent these infections, and seeking treatment for them if present, is a great way to not only reduce your risk of liver cancer but other related diseases.
- Vaccination: Unfortunately, there is no vaccine for hepatitis C. The hepatitis B vaccine, however, is recommended for all children.
- Testing: Testing for diseases that can lead to liver cancer can go a long way in catching these risk factors early in an attempt to prevent them from progressing in this way.
- Safe sex: Both hepatitis B and C spread via sexual contact. The consistent use of condoms can reduce the risk of getting these infections to a great extent.
- Reduce alcohol intake: Long term heavy alcohol abuse can lead to liver cirrhosis which is one of the major risk factors for liver cancer.
- Smoking cessation
- Careful needle use: A major cause for hepatitis B and C is the sharing of needles during injection drug use. With no vaccine to protect against hepatitis C, the best way to prevent infection is to not inject drugs or to avoid sharing the needles and injections.
- Water check: Water can be polluted and might become a source for arsenic, which is a carcinogen known to cause liver cancer.
- Workplace safety: several people are exposed to many chemicals known to cause liver cancer
- Weight reduction: Obesity hasn’t been directly linked to liver cancer but it causes certain conditions that act as a risk factor for the same such as Non-alcoholic Fatty Liver Disease (NAFLD) and Type II diabetes.