Last updated date: 29-May-2023
Originally Written in English
What is liver cancer?
Your liver is the biggest organ in your body, and it aids in digestion. It is also one of the most vital organs, as no one can survive without it. Among the critical functions of your liver are:
- Gathers and filters blood from your intestines.
- Processes and stores nutrients absorbed by your intestines.
- Converts certain foods into energy or compounds required by your body to produce tissue.
- Produces bile, a fluid that aids in fat digestion.
- Digests and stores other nutrients from meals, such as sugar, to provide energy.
- Produces chemicals that aid in blood clotting.
Liver cancer is a type of cancer that starts in the cells of your liver. The liver is a football-sized organ located in the upper right quadrant of your belly, under the diaphragm and above the stomach.
Liver cancer is a potentially fatal disease that is one of the fastest increasing cancer kinds in the United States. Primary and secondary liver cancer are the two types. Primary cancer begins in the liver. Secondary cancer travels from another place of your body to your liver.
Healthcare practitioners, like many other types of cancer, can do more to treat liver cancer in its early stages. Unlike many other types of cancer, healthcare experts understand what raises a person's chance of acquiring liver cancer. With this in mind, healthcare experts are working hard to determine who is at a higher risk of developing primary liver cancer so that it may be detected and treated as early as possible.
Epidemiology of liver cancer
Cancer is a disorder in which the body's cells proliferate uncontrollably. When cancer begins in the liver, it is referred to as liver cancer. In the United States, around 25,000 men and 11,000 women are diagnosed with liver cancer each year, with approximately 19,000 men and 9,000 women dying from the condition. For several decades, the percentage of Americans diagnosed with liver cancer increased, but is presently decreasing. Other countries have higher rates of liver cancer than the United States.
Hepatocellular carcinoma (HCC) and Intrahepatic cholangiocarcinoma (IHC) are more common in males than in women, and they are most commonly diagnosed between the ages of 55 and 64. Persons of Asian/Pacific Islander, Hispanic, or American Indian/Alaska Indian ancestry are more likely to acquire primary liver cancer than people of Black or white ancestry.
What are the risk factors of liver cancer?
Liver cancer develops when the DNA of liver cells changes (mutates). The DNA of a cell is the substance that contains the instructions for every chemical process in your body. Changes in these instructions are caused by DNA mutations. As a result, cells may begin to proliferate uncontrollably, eventually becoming a tumor, a clump of malignant cells.
The etiology of liver cancer is sometimes known, such as in chronic hepatitis infections. However, liver cancer can occur in persons who have no underlying illnesses, and it is unknown what causes it. The following are risk factors for primary liver cancer:
- Chronic infection with HBV or HCV. Chronic infection with the hepatitis B or C viruses raises your chance of developing liver cancer.
- Cirrhosis. Scar tissue forms in your liver as a result of this gradual and irreversible disorder, increasing your chances of getting liver cancer.
- Certain inherited liver diseases. Hemochromatosis and Wilson's disease are two liver illnesses that can raise the chance of developing liver cancer.
- Diabetes. People with diabetes are more likely to get liver cancer than those who do not have diabetes.
- Nonalcoholic fatty liver disease. Fat buildup in the liver raises the chance of developing liver cancer.
- Exposure to aflatoxins. Aflatoxins are poisons created by fungi that develop on improperly preserved crops. Aflatoxin contamination may occur in crops such as grains and nuts, which can then wind up in meals manufactured from these goods.
- Excessive alcohol consumption. Consuming more than a modest amount of alcohol everyday for a long period of time might cause irreparable liver damage and raise your chance of developing liver cancer.
What are the types of liver cancer?
Primary liver cancer is a kind of cancer that develops in the liver. There are several types:
- Hepatocellular carcinoma (HCC) or hepatoma, is the most prevalent kind of primary liver cancer, and it begins in the liver's major cell type, the hepatocytes.
- Cholangiocarcinoma, or bile duct cancer, develops in the cells that line the bile ducts (which connect the liver to the bowel and gall bladder)
- Angiosarcoma, it originates in the blood vessels This is a rare kind of liver cancer that is more common in adults over the age of 70.
Secondary liver cancer is cancer that began in another place of the body but spread to the liver. If you have secondary liver cancer, it may be helpful to learn about underlying cancer as well as this information or about cancer of unknown primary.
Secondary cancer is named after the initial place where it originated, such as bowel cancer with secondary liver cancer. We use the phrase "secondary cancer in the liver" to refer to any cancer type that has spread to the liver throughout this information.
What are the symptoms of liver cancer?
The most common signs and symptoms of liver cancer are caused by liver damage and include skin yellowing (jaundice), right-sided abdominal or shoulder blade pain, and a tumor in the right upper abdomen. However, many of the warning signals, such as weight loss and exhaustion, are non-specific.
Sometimes the earliest indications of liver cancer are problems such as a bile duct blockage, anemia, or bleeding. Because there is no screening test for liver cancer, the only method to detect the illness early is to be aware of the potential signs and symptoms.
In the early stages of liver cancer, like with many other kinds of cancer, there are frequently little symptoms or indicators. As the condition advances, symptoms emerge, urging you to seek medical assistance. Because of the delayed start of symptoms, liver cancer is frequently detected at an advanced stage (unless the tumor originates near a bile duct and causes an obstruction early).
An Abdominal Mass or Lump:
On your right side, you may notice a firm bump or enlargement immediately below your rib cage. This mass is frequently asymptomatic, and if you have pain, you may experience additional discomfort in the areas surrounding the mass. Sometimes liver cancer produces spleen enlargement, which can cause discomfort or a lump in the left upper abdomen.
Right-Sided Abdominal Pain:
The pressure of a liver tumor on other tissues or nerves in this location can cause pain, discomfort, or aching on the right side of the abdomen just beneath the ribs. Take a big breath in and gently touch upward beneath your rib cage on the right side — this is about where your liver is located. If you have an enlarged liver (which can be caused by a variety of factors), the edge of your liver may be felt lower in your belly.
Right Shoulder-Blade Pain:
Shoulder blade discomfort might be a deceptive sign since the problem it alerts you to may not be located near the shoulder blade (due to the way nerves travel in our bodies). This is true of liver cancer. The tumor (or its spread) might irritate nerves, telling your brain that the pain is coming from your shoulder blade when it is actually coming from your liver. This discomfort is usually felt in the right shoulder, but it can happen on either side. The discomfort may also spread to your back. Consult your healthcare physician if you feel this, especially if you haven't engaged in any recent physical activity that may explain it.
Jaundice is a disorder in which the skin and the white region of the eyes look yellow. It is caused by an accumulation of bile salts in the skin. It is easier to notice in natural light, such as outside, than in artificial light, such as inside. In addition to skin yellowing, some persons note that their bowel motions are light and white rather than brown. At the same time, even in the absence of dehydration, urine may seem darker than usual.
The build-up of bile salts in the skin, which results in jaundice, can also cause itching. We don't often think of itching as a serious symptom, but the itching associated with liver dysfunction can be very intense.
Bloat and Shortness of Breath:
Ascites, or fluid buildup in the belly, can be an indication of liver cancer. It may seem like bloating at first; some people observe that their clothes don't fit correctly in the waistline or their belt size changes even if they haven't gained weight. Fluid buildup in the belly might eventually push up on the lungs, causing shortness of breath.
Unintentional Weight Loss or Gain:
Unintentional weight loss may be appreciated by some, but when it is not due to a change in diet or activity, it should always be evaluated by a healthcare physician. Unexplained weight loss is described as losing 5% or more of one's body weight in six to twelve months without attempting. A 200-pound man shedding 10 pounds in six months without changing his lifestyle is one example.
In a 2017 analysis of research, unintentional weight loss was shown to be associated with an underlying disease, including liver cancer, in one-third of the persons studied. Other hazardous causes exist, therefore it's critical to visit a doctor as soon as you notice a change. Rapid and unexpected weight gain is another indicator of liver cancer. This is generally caused by a fast buildup of fluid in the abdomen (ascites).
Loss of Appetite:
A lack of appetite can occur with a variety of illnesses, but it can be more severe with liver issues. This may be accompanied by a feeling of being very full very quickly, even after eating just modest meals. Because these symptoms might be warning signals of not only liver cancer but also other malignancies, a visit to a healthcare specialist is recommended.
Nausea and Vomiting:
There are various reasons why nausea and vomiting can occur with liver cancer, and it is a frequent symptom at all stages of the illness. There are several reasons of nausea and vomiting, but if it occurs regularly or worsens, consult your healthcare professional.
Fatigue and/or Weakness:
Everyone seems to be weary these days, but cancer-related tiredness frequently takes things to a whole new level. Cancer fatigue is not the same as typical weariness, and it does not improve with a good night's sleep. This symptom may be simpler to detect if you go back six to twelve months and compare your energy today to what it was at that time.
A low-grade but persistent fever, sometimes known as a "fever of undetermined origin" or FUO, is a very typical indication of liver cancer. An FUO is defined as a fever of 101 degrees or above that lasts three weeks or longer and cannot be linked to an evident cause after three or more visits to a healthcare practitioner (or three days in the hospital). There are numerous other possible reasons of a prolonged fever, but experiencing one is reason enough to contact your doctor.
General Feeling of Being Unwell:
It's difficult to define intuition as a symptom, but studies show that individuals commonly know when something is "wrong" in their bodies. Consult your healthcare practitioner if you have a general feeling that you are not feeling well. Symptoms might be difficult to define in language like those stated above. If we take the time to listen, our bodies can frequently "inform" us when something is wrong.
Other less common symptoms:
Some types of liver cancer produce hormones that might cause extra symptoms. Low blood sugar (hypoglycemia) can cause lightheadedness and fainting, especially in those who haven't eaten in a while, breast enlargement (gynecomastia), testicular atrophy, and a high red blood cell count are some of the symptoms.
Complications associated with liver cancer
A variety of issues can arise from liver cancer. They may be caused by tumor pressure on the bile duct or other organs, hormones released by cancer cells, liver malfunction resulting in a buildup of toxins in the body, or other processes. Some possible difficulties are as follows:
- Anemia, A low red blood cell count is a typical consequence of liver cancer and can be caused by a number of reasons, including a lack of clotting factors in the blood, which causes bleeding.
- Bile duct obstruction, Tumors in the liver or bile ducts can develop within or near a duct, causing bile duct blockage and jaundice.
- Bleeding tendency, when cancer has taken over a big portion of your liver, clotting factors are no longer created in adequate quantities.
- Portal hypertension, A tumor in the liver, for example, might make it difficult for blood to flow via the tiny veins that feed to the giant portal vein.
- High blood calcium (hypercalcemia), Through a variety of methods, liver cancer can cause a high calcium level in the blood (hypercalcemia of malignancy).
- Hepatorenal syndrome, is a disorder in which liver illness causes kidney disease owing to blood vessel abnormalities and decreased blood supply to the kidneys.
- Hepatic encephalopathy, Toxins that the liver cannot eliminate make their way to the brain. Memory loss, disorientation, personality changes, and extreme confusion can all occur from this.
How is liver cancer diagnosed?
If your healthcare practitioner discovers liver cancer signs and symptoms during your physical examination, they may believe you have the disease. To discover more, they might request the following tests:
- Blood tests: Blood tests for cancer, such as a liver function test, may be performed by healthcare professionals to check on liver enzymes, proteins, and other chemicals that indicate if your liver is healthy or damaged. They could look for alfa-fetoprotein (AFP). High AFP levels may be a sign of liver cancer.
- Ultrasound (sonography): This test generates images of your soft tissue architecture. Ultrasound is used by doctors to detect liver cancers.
- Computed tomography (CT) scan: This specialized X-ray captures comprehensive pictures of your liver, providing information on the size and location of liver tumors.
- Magnetic resonance imaging (MRI): Using a huge magnet, radio waves, and a computer, this test creates highly clear pictures of your body.
- Angiogram: This test allows doctors to evaluate the blood arteries in your liver. During this test, your doctor will inject dye into an artery to monitor blood vessel activity and search for blockages.
- Biopsy: Medical professionals take liver tissue to search for symptoms of malignancy. Biopsies are the most accurate approach to confirm a diagnosis of liver cancer.
If your doctor suspects you have Intrahepatic Cholangiocarcinoma (IHC), he or she may order the following tests:
- Endoscopic retrograde cholangiopancreatography (ERCP): To inspect your bile ducts, an endoscope and a catheter (thin, flexible tubes) are used.
- Percutaneous transhepatic cholangiography (PTC): A PTC, like an ERCP, takes X-rays of your bile ducts. Instead of using an endoscope and catheter, your healthcare practitioner will implant a needle straight into your bile ducts and liver. A PTC is often reserved for patients who are unable to undergo an ERCP.
What are the stages of liver cancer?
HCC is staged by healthcare practitioners utilizing Barcelona Clinic Liver Cancer system guidelines (BCLC). This approach assesses HCC liver based on criteria such as liver function, tumor size, and symptoms. Healthcare practitioners may refer to each BCLC stage differently; for example, stages I through IV or 0-C, or by words such as early and advanced stage HCC.
The following are the phases of hepatocellular carcinoma:
- Stage I/very early stage/stage 0: You have a solitary tumor in your liver that is less than 2 millimeters in size (cm). Your bilirubin level is normal, according to blood testing.
- Stage II/early stage/stage A: You have a single tumor measuring 5 cm or less, or you have many tumors measuring less than 3 cm. It's possible that the tumor has migrated to your blood vessels.
- Stage III/intermediate stage/stage B: At this stage, you may have more than one tumor and/or one that is larger than 5 cm. It's possible that the tumor has progressed to your lymph nodes, big blood arteries, or another organ.
- Stage IV/advanced stage/stage C: The cancer has spread to other parts of your body, including your lungs, bones, and lymph nodes.
What is the treatment of liver cancer?
Several typical therapies for HCC and IHC are available from healthcare professionals, including surgery to remove a portion of your liver, liver transplantation, and liver-directed treatments such as hepatic artery embolization and ablation. They may also employ chemoembolization, radiation treatment, radioembolization, immunotherapy, and targeted therapy.
Is liver cancer curable?
Successful liver transplants can cure liver cancer, but not everyone who requires one will be healthy enough to undergo the procedure or locate a donor. According to studies, persons who have surgery to remove a portion of their liver live longer than those whose condition forbids operation. When this occurs, healthcare experts concentrate on therapies that will allow individuals to live with a high quality of life for as long as feasible.
Healthcare practitioners are making strides in the treatment of liver cancer so that individuals might live longer lives. However, liver cancer is still a fatal illness. According to data, 35% of those treated for early-stage hepatocellular carcinoma (HCC) liver are still living five years later. Five years following diagnosis, around 12% of persons treated with HCC that has progressed to adjacent tissues, organs, or lymph nodes are still living. Five years after diagnosis, around 3% of persons treated for HCC that has progressed further are still alive.
The five-year survival rate for intrahepatic bile duct carcinoma is 24% if the disease hasn't progressed outside of your liver, 9% if it's moved to adjacent lymph nodes, and 2% if it's spread farther.
Liver cancer prevention
While you cannot totally avoid liver cancer, you can reduce your risk by doing the following:
- Avoid habits that contribute to cirrhosis.
- Achieve or maintain healthy body weight.
- Get vaccinated against hepatitis B. Almost everyone is safe from this immunization. Inquire with your doctor about the hepatitis A vaccination.
- Avoid getting hepatitis C.
- If you have any type of liver illness, diabetes, obesity, or are a frequent drinker, talk to your doctor about liver cancer tests.
It is possible to have extremely early-stage liver cancer with no symptoms. Liver cancer screening is how healthcare workers check your liver for symptoms of cancer. While there are no standard liver cancer screening procedures, your doctor may advise you to get ultrasounds and blood tests every six months.
The liver is a big organ located on the upper right side of your stomach. It aids digestion and eliminates pollutants. Liver cancer is a kind of cancer that can occur anywhere in the liver. Liver cancer can begin in the liver (primary) or spread from another organ (secondary). The severity of liver cancer is determined by where it is located in the liver, its size, if it has spread, whether it is primary or secondary, and your overall health.
Liver cancer symptoms may be absent or difficult to detect. If the liver cancer begins in the liver (primary liver cancer) or spreads from another region of the body, the symptoms are the same (secondary liver cancer).
If your doctor thinks that you have liver cancer, he or she will order more tests and scans to confirm the diagnosis. Among these tests are:
- Blood examinations
- Scans, such as an ultrasound, CT, or MRI scan
- Obtaining a tiny sample of cells from the liver (known as a biopsy) to be tested for malignancy.
Being diagnosed with liver cancer can be terrifying. You could be worried about what will happen next. Bringing someone with you to any appointments might be beneficial. Throughout your diagnosis, treatment, and beyond, you will be cared for by a team of professionals. A clinical nurse specialist will be your main point of contact both during and after treatment.