The human body is incredible. You have a stomach that digests the food for you. You have a heart that pumps blood throughout your body. You have a kidney that filters the blood for you. And then comes the liver, this giant extremely vital organ.

The liver is shaped like a cone. It is dark reddish-brown. It weighs about 3 pounds.

It is located in the upper right portion of the abdomen just below that diaphragm.

This huge organ has a very important role in the human body. It regulates most of the chemical processes in the body and excretes a compound called “bile”.

The liver’s main job is to filter the blood coming from the digestive tract before passing it to the rest of the body. It absorbs nutrients and drugs from the digestive tract and converts them into ready-to-use compounds.

It also detoxifies and gets rid of harmful chemicals and metabolized drugs. Besides, the liver also makes certain proteins for blood plasma and makes clotting factors.

Unlike other organs, liver cells can divide and regenerate fast to compensate for any damage or loss in any portion of the liver.

But what if this division or regeneration can’t be stopped? What if the cells keep dividing uncontrollably?

In this case, it might be liver cancer.

What is Liver Cancer?

Liver cancer is cancer that begins in the liver cells “primary cancer”. it can also be affected by cancer that forms elsewhere in the body then spreads to the liver “secondary cancer”. But our video today is about primary cancer that arises from liver cells. However, cancer that spreads to the liver is more common than that which begins in the liver and it is called metastatic cancer such as metastatic colon cancer that begins in the colon and spreads to the liver.

Several types of tumors can begin in the liver because there are several types of cells, some of them are benign, non-cancerous, and others are cancerous. However, the most common type is hepatocellular carcinoma which origins from the main type of liver cells, hepatocytes.

Benign tumors, on the other hand, include:

Hemangioma.
Hepatic adenoma.
biliar cysts.
Focal nodular hyperplasia.
Fibroma.
Lipoma.

These benign tumors are not treated like cancer, but they should be removed if they cause pain or bleeding.

So, a tumor in this gigantic organ, how can one feel it? What are the symptoms of liver cancer?

Liver cancer doesn’t symptomatize initially in its early stages, or it may have some vague symptoms like fatigues, fever, or night sweats. But when symptoms appear, they include:

Unintentional loss of weight.
Loss of appetite.
Upper abdominal pain.
Nausea.
Vomiting.
General weakness and fatigue.
Abdominal swelling.
Jaundice, which is a yellowish coloration of the eye white and the skin.
White bulky stools.
Itching all over the body.
Swollen legs.

In severe cases, the function of the liver will be affected, and the patient may suffer from:

Loss of sex drive.
Mentale confusion.
Pain in the left side of the abdomen due to enlargement of the spleen.
Skin lesions that resemble a spider, called spider naevi.
General weakness.

As long as there is no treatment, patients will experience these symptoms as the disease advances over time.

The question is, why does it happen? What are the causes of liver cancer?

As we mentioned earlier, secondary metastatic liver cancer is the most common type. It usually comes from the colon, prostate, breast, or lung.

But when cancer starts in the liver cells, it is most probably due to changes or mutations that happened in the DNA of the liver cells. These mutations tell the cells to grow out of control and continue dividing without stopping, forming a tumor or a cancerous mass.

Sometimes the cause of liver cancer is known, for example, in chronic hepatitis, the patient might turn into a liver cancer patient. However, liver cancer might develop in a healthy person and the reason is still unclear.

But there are risk factors that are known to cause liver cancer, such as:

Chronic infection with HBV or HCV. Chronic infection with hepatitis B virus or hepatitis C virus and the chronic irritation of the liver cells increase the risk of getting liver cancer.
Non-alcoholic fatty liver disease. Accumulation of fat in the liver irritates the cells and increases the risk of cancer.
Cirrhosis. Cirrhosis is a progressive and irreversible inflammation and it’s the scarring of the liver tissue that can lead to cancer eventually.
Diabetes. Some studies show that people with blood sugar disorders have a higher risk of liver cancer than normal people.
Some inherited liver diseases. Hemochromatosis and Wilson’s disease can predispose to liver cancer.
Excessive alcohol consumption. Consuming alcohol in large quantities over years can lead to irreversible damage to the liver and may turn into cancer.
Anabolic steroids use. Athletes who use anabolic steroids for long periods are at higher risk of developing liver cancer.
Exposure to aflatoxins. Aflatoxins are the poisons produced by moulds that grow on poorly stored grains and nuts.

If we look at these risk factors carefully, we will find that many of them can be avoided, and so, we can protect ourselves from the risk of liver cancer. For example, we can limit our use of alcohol. We can get vaccinated against the hepatitis B virus. We can maintain a healthy weight and avoid fatty food. We can also take measures to prevent the spread of the hepatitis C virus, including:

Avoiding engagement in an unprotected sexual relationship.
Using clean needles when we take intravenous medications.
Seeking clean and safe shops when getting a tattoo or a piercing.

All these measures can be a turning point in the rates of liver cancer.

But how would one know if they have liver cancer or not?

Screening programs will help you answer this question.

Screening can decrease the rate of liver cancer. It is not done routinely, it is only recommended for people who have conditions that increase the risk for liver cancer such as cirrhosis, HBV infection, or HCV infection.

Screening wouldn’t promise to reduce the risk of dying of liver cancer, but it would help discover cases earlier and start treatment as soon as possible.

If the screening shows that someone is highly suspected to have liver cancer, it is then necessary to do further investigations.

Diagnosing liver cancer is not as hard as before because several tests have made it easier for doctors, including:

Blood tests. They may reveal an abnormality in liver functions.
Imaging tests. Imaging using ultrasound is the initial line. It can detect tumors as small as 1 cm. Other imaging options like CT scans and MRI are used for smaller tumor detection and for staging of the cancer.
Biopsy or tissue sample. Sometimes it is necessary to take a tissue sample and examine it in the laboratory to detect the type of cancer and make a definitive diagnosis.

Once the diagnosis is confirmed to be liver cancer, the next step is to see the extent of the tumor. Staging tests are done to determine the location of the tumor and whether it has spread or not.

Now, after diagnosis and staging, it is time to learn about the different available treatment options for liver cancer.

First of all, we should emphasize the fact that treatment depends on the stage, age of the patients, and their overall health.

Let’s start with the surgical option

Surgeries for liver cancer are either to remove the tumor or to replace the liver as a whole. In certain situations, and with certain stages, your doctor will recommend removing the tumor with a safety margin from the healthy tissue of the liver.

Liver transplantation is an option for a small percentage of patients in their early stages of the disease.

Science always dazzles us with new methods of treatment and innovative solutions to health problems especially in cancers.

And for liver cancer, there are several solutions for localized tumors, including:

Heating cancer cells by using electrical current to heat and destroy cancer cells.
Freezing cancer cells. Using extreme cold to destroy cancer cells.
Alcohol injection into the tumor.
Chemotherapy injection into the tumor.
Putting beads that emit radiation into the tumor.

Another traditional option is radiation therapy where doctors use sources of high-powered energy to destroy cancer cells.

Chemotherapy is also a traditional option. The idea of using chemical drugs to kill the rapidly dividing cells has always been around the corner.

Also, there are new options like targeted drug therapy and immunotherapy.

Our role today is to answer most of your questions regarding liver cancer. Today we have Doctor Choi who is a renowned doctor at Hanyang University Hospital in Seoul, Korea. He is going to discuss with us about liver cancer from an experienced point of view.

Interview

What is liver cancer?

Liver is something everyone knows, so there is no need to explain what the liver is. Liver cancer is cancer that starts in the liver. But this does not develop for no reason. There are many causes and in Korea for example, Hepatitis B and in the USA alcohol related liver issues and if left as is for a prolonged period, cancer develops. So, in Korea Hepatitis B, and related inflammation in the USA and the West it is alcohol related conditions. Recently, fat people who have fatty livers can also develop cancer…and that is recently increasing a lot. So, liver cancer develops from a variety of conditions. Liver cancer has a variety of causes, but the key point is that if liver inflammation is left without any treatment for a prolonged period, it can develop into cancer.

From what I understood, it starts from diet, or it’s related to either alcohol…

Hepatitis, liver inflammation and obesity. Those people can develop inflammation. Some people only develop inflammation, but if left as it is for long periods it develops into cancer.

Is it like other cancers where it doesn’t have symptoms?

Even liver cancer does not have any symptoms. Pancreatic cancer, gallbladder cancer and liver cancers also do not have any symptoms, so they are very scary illnesses. With liver if there is any symptom, it is always the late stage. So, liver cancer really does not have any symptoms. The only notable symptoms are decreased appetite and lowered digestion ability. If jaundice is shown, it is always at a late stage.

Is it like other cancers where it has levels? Like level 1, level 2, level 3…

The most important level is the early stage, what is often called stage 1 or level 1, when the cancer is small, that is when surgery can be performed. If not done, the cancer grows and becomes more difficult to treat. So, like other cancers, if one thinks there is liver inflammation, he must do periodic exams to make sure it does not turn into cancer, and if caught in the early-stage, surgery can be done successfully either through excision alone or with even transplant. Also with other methods that can be used such as high frequency radiation or other methods, it is more successful if done early.

It’s really important to know at the beginning.

Yes.

How about the treatments…what are the treatment options for liver cancer.

That is a good question. The most preferred treatment is removal surgery, partial removal, or complete removal and transplant. But only about 20% of cases qualify for this type of surgery. Of the remaining 70%, 50% cannot be treated, 20% to 30% can undergo other treatments such as high frequency radiation and others. But the best results are from removal surgery. Right? If the cancer is removed it is the best. However, in order to do this surgery, the liver has to be in decent condition, but many have carried the inflammation for long periods and cannot be removed. So, the best situation is to detect early and remove a small part of the liver, and even if detected later it is better if the liver is in decent condition so that the transplant can be successfully done, and in cases where surgery is difficult we treat with radioembolization or high frequency radiation.

Doctor Choi, you talked about liver transplant. You said only 20% of people can do it?

Actually not even, it is actually less than 10%, the patients who can get transplants are 10% to 20%. Most patients get diagnosed when it is at a late stage, because they do not get regular checkups. In Korea it is better, but in less developed nations, regular exams are rare, so when they show up for exams, it’s usually when it is at a late stage. So, treatment procedures such as surgery cannot be successfully done.

What are the conditions for liver transplants to be successful? Does it like have to come from a family member for…

The most important thing is that there has to be donors, but in Korea, there are not that many. In one year, there are only 300 to 400 donors, so most get the transplant from brothers or children. So, about 1500 transplants are from family members while donated ones from strangers is about 300. In the West it is reversed. The key of transplant is there having to be someone willing to give his liver. So, in Korea, unless a family member is willing to give his or her liver, the transplant does not happen, and it’s especially in Korea.

In the case of liver cancer it has nothing to do with your history or family? For example, if you had someone in your family who had liver cancer?

There is a little bit of relation. More important is if one’s parent has Hepatitis, it can be passed on. Most commonly in such situations is when a mother has hepatitis, and her blood contaminates her child and becomes passed on. Nowadays, a lot of that has decreased due to vaccinations. But long ago, when hepatitis vaccines were not yet available, many became infected like that and used to be the top cause of liver infection.

For liver cancer, if you for example cut the liver, does it come back the cancer? Can it come back?

Yes, recurrence is common. So, even after surgery, frequent exams are needed because it can recur. This is because even if we remove an infected portion, the remainder might still be infected. So, it is really not recurrence but more like a new cancer develops in a new area. This is because in the entire liver there are conditions that are ripe for liver cancer development. So, even if we remove the area, it can develop again in a new one. So, frequent and periodic screening is key so that if new cancers develop, quick treatment can be done successfully.

My last question, what is the way to prevent liver cancer?

First, Hepatitis B or C should be prevented. Second, limit alcohol intake. Third, stay away from becoming fat. So, limiting the conditions that can foster liver cancer and prevent liver infection. Liver infection may develop into cancer, as liver cancer rarely forms with those without infection. So, the best way to prevent liver cancer is to not get liver infection. But the reason the liver gets infected depends on the country. Alcohol is the top reason, then hepatitis B or C, and eating too much resulting in obesity and fatty liver. We can see the top three causes. After that, immunity, heredity but those are rare. So, the top three mentioned are the most common causes so one prevents the top causes, he or she would prevent liver cancer.

Conclusion

Liver cancer is cancer that starts in the liver. But this does not develop for no reason. There are many causes and in Korea for example, Hepatitis B, and in the USA alcohol related liver issues and if left as is for a prolonged period, cancer develops. So, in Korea Hepatitis B related inflammation, and in the USA and the West it is alcohol related conditions. Also, fat people who have fatty livers can also develop liver cancer …and that is increasing lately. So, liver cancer can develop from a variety of conditions. But the key point is that if liver inflammation is left alone for a prolonged period, it can develop into cancer.

With liver if there is any symptom, it is often the late stage since liver cancer really does not have many early symptoms. The only notable symptoms are decreased appetite and lowered digestion ability. If jaundice is shown, it is always at a late stage.

The most preferred treatment is removal surgery. One is partial removal, and another is complete removal and transplant. But only about 20% qualify for this type of removal surgery. Of the remaining 70%, 50% cannot be treated. The remaining 20% to 30% can undergo other treatments such as high frequency radiation. But the best results are from removal surgery. However, in order to do this surgery, the liver has to be in decent condition, but many have carried the inflammation for long periods and the tumor cannot be removed. So, the best situation is to detect early and remove a small part of the liver. But even if detected later it is better if the liver is in decent condition so that the transplant can be successfully done, and in cases where surgery is difficult, treatment with radioembolization or high frequency radiation are options.

Recurrence after surgery is common, especially if bad habits remain. It is important to limit fat intake and avoid alcohol.