Liver is a small flesh colored organ found below the diaphragm and just above the stomach. Liver is one of the vital organs of our body which performs various functions like cleaning toxic materials from the blood, secreting bile (indirectly helping digestion) and releases substances that helps in clotting of blood. But the major function of liver is filtration of blood for which the entire blood of the body should pass through it thus giving access for cancerous cells to enter the liver easily.
There are two types of liver cancer, one is primary liver cancer which begins in hepatocyte cells of the liver and the other is secondary liver cancer wherein cancerous cells starts elsewhere in the body and moves towards the liver. This is called metastatic cancer which begins in the lungs or colon and gradually spreads to liver. Primary liver cancer targets elderly men rather than women.
Liver cancer targets adults and elderly people but even teenagers can develop hepatoblastoma and hepatocellular liver cancer. Apart from cancer causing tumors the liver can contain other types of masses or tumors that are benign (non-cancerous) like hepatic adenoma, lipoma and fibroma. Such types of tumors (even not harmful) should be removed by surgery.
Liver Cancer Symptoms :
Often liver cancer would not show any symptoms until it matures and advances to high grade of cancer. Some of the common signs of liver cancer are loss of appetite, loss of weight (without any effort), stomach pain, nausea, vomiting and general weakness. For some people stomach would bulge forward due to swelling. Sometimes the skin becomes yellow color and even the eyes would turn yellow like jaundice. Liver tumors can influence the normal level of sugar and calcium causing unwanted consequences.
Exact reason of liver cancer is not known. It is believed to occur due to repeated liver infection like hepatitis virus. The cells of the liver normally undergo mutations in the genetic material in routine manner. But in rare cases these cells begin to multiply in uncontrolled fashion developing into a tumor causing cancer. Liver cancer can also develop due to over usage of alcohol and chronic infection. Some people are born with hemochromatosis (excess of iron in the liver) causing scarring of tissue which can lead to cancer. In rare cases obesity and fatty liver disease can also cause liver cancer.
Risk Factors :
More men than women are prone to develop hepatocellular (primary liver cancer). Being over-weight, being diabetic, being Asian Americans, and born with inherited metabolic problems increases the risk of liver cancer. A person getting chronic hepatitis infection is likely to develop liver cancer. Alcohol abuse is one of the major causes of liver cancer in under developed countries.
Based on your symptoms, your doctor may request for series of testing procedure like blood test, liver function test, CT or MRI scan of the liver. To confirm the diagnoses, he might do a liver biopsy by removing a small tissue sample from the liver through a tiny needle. In developed countries screening tests are done for targeted people or people with high risk to detect liver cancer in early stages. Ultrasound of liver is done and alpha fetoprotein blood test may also be done for screening.
Before deciding on the course of treatment, the doctor would determine the stage of liver cancer. This factor is crucial in determining the chance of survival of the patient. Liver cancer is graded from I to IV. Lower the number lesser is the risk and higher the number more is the risk. Grade 4 indicates the cancer has metastasized and spread to other tissues nearby.
For the purpose of treatment, often doctors categorize the liver cancer in terms of “resectable” meaning there are still chances for removing cancer surgically. Potentially resectable cases are one that is healthy enough for surgical procedure of removing cancer. In case the tumor is smaller in size then the patient is grouped under potentially transplantable (Liver transplantation can be done).
If the cancer cells are larger in size it cannot be operated by surgery it is known as unresectable and here the cancer has spread outside the liver also. Finally, some patients are not healthy enough for undergoing surgery even when the cancer is resectable they are grouped under “inoperable cases”. Grade 3 and 4 cases are at high risk and mostly the cancerous cells would have metastasized to other parts.
Liver Cancer Treatment :
Based on the factors like age of the patient, intensity of cancer, its growth and stage your doctor would make a decision and discuss with you to choose the best mode of treatment. Surgery, liver ablation, radiation, chemotherapy and targeted therapy are some of the options available for liver cancer. Many times combination of one or more treatment gives the best result.
- Surgery :
Surgical process involves either removing part of liver (hepatectomy) or liver transplant. Partial hepatectomy is the process of removing some portion of the liver that contains tumor. Often this surgery is the choice for people having single tumor with Grade 1 or 2. The function of the liver would be more or less normal in such patients. This surgery involves risk of liver bleeding and for some cases the leftover portion of the liver may not function properly leading to liver failure.
- Liver Transplantation :
Patients with more number of tumors and those with poor function of liver are fit for liver transplant. But it is very difficult to find a suitable donor and often it takes too long time. This surgery also involves the same risk of bleeding of liver and also possibility of developing liver infections.
- Ablation :
In this process tumor present in the liver is destroyed without surgery. Here the doctor uses radio waves or microwaves for killing the tumor. Ethanol injection is also another option in ablation. This method of ablation is done for patients with small sized tumors and also for cases that are waiting for liver transplant.
- Embolization :
In this method, suitable drugs are injected into the artery that supplies blood to the tumor which would subsequently block the blood flow thus causing death of tumor. Risks are minimal in this procedure and the results are effective.
- Radiation :
High energy power beam is sent through the tumors for destroying them. This can be done either externally or internally. In external method, the patient is suitably positioned to receive radiation at particular part of the liver only. But this procedure should be repeated for a week or more depending on the tumor size and growth. It can cause adverse effects like nausea, vomiting, muscle weakness and tiredness.
- Chemotherapy :
Here powerful drugs are either injected into the vein or given as oral pills to destroy tumors. This might give the same side effect as radiation.
- Targeted Therapy :
New drugs are given to focus destruction of cancer causing cells only. In this method, side effects are minimal. Clinical trial is the method in which the patient would volunteer himself for new research process by getting state of art treatment for liver cancer.
- Alternative Approach :
This cannot be taken as cure for liver cancer though some improvement is seen with the symptoms. Acupuncture and ayurvedic treatment is given for reducing the intensity of symptoms.
Follow Up :
Post operative care is extremely important in any surgery. Whether you are done with surgery or chemo or radiation you need to make regular visits to your clinic. Your doctor will order for several tests like before to make sure that new tumor has not developed in the liver. You should stick on to the instructions of your doctor and follow healthy lifestyle and diet. Eat the right choice of foods and quit smoking and alcohol. Do regular exercise to reduce fatigue and improve your mood.
You cannot totally prevent liver cancer but you can always reduce the risk factors. Taking a shot of hepatitis B would help in preventing liver infection. Reduce the intake of alcohol and quit smoking with help from your doctor. Stay at healthy weight and go for regular checkups.