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All you need to know about Liver Cancer

Liver cancer symptoms are not evident during the early stages. Some of the symptoms that occur at later stages are-

• A feeling of uneasiness, pain and softness in the abdomen
• Change of skin colour and white of eyes to yellow leading to jaundice
• Excretion of white chalky stools
• Constant feeling of nausea
• Frequent vomiting episodes
• Internal bleeding leading to bruises.
• Feeling of being tired and weak.

There are different types of primary liver cancer. As discussed before, primary liver cancer originates from the liver that can be caused by one of the many cells present in the liver. Primary liver cancer can start to grow as a single lump in the liver or may be found in different places of the liver simultaneously. People suffering from chronic liver damage are more likely to suffer from multiple cancer growth sites. Here are some of the main types of primary liver cancer to consider-

Hepatocellular carcinoma- Hepatoma or hepatocellular carcinoma is the most prevalent type of liver cancer that appears in 75% of patients suffering from primary liver cancer. This cancer cultivates in the main liver cells called hepatocytes. Hepatocellular carcinoma usually affects people suffering from liver damage as a result of alcohol abuse. This type of cancer gradually spreads to other organs in the body such as intestines, stomach and pancreas.

Cholangiocarcinoma- Cholangiocarcinoma originates in the minute tube-like bile ducts present in the liver that carries bile to the gallbladder to process digestion. This cancer is generally known as bile duct cancer. Only 10 to 20 percent of liver cancer patients suffer from this type of cancer. The cancer is known as intrahepatic bile duct cancer when it starts off in a branch of the ducts present inside the liver. When the presence of cancer cells are found in a branch outside the liver it is known as extrahepatic bile duct cancer.

Liver Angiosarcoma- A type of liver cancer that originates from the blood vessels of the liver are called Liver angiosarcoma. This type of liver cancer is very unusual and are diagnosed only at advanced stages of liver cancer.

Hepatoblastoma- Hepatoblastoma is a type of liver cancer that is commonly found in children under the age of 3. This type of liver cancer is very uncommon and can be treated with higher survival rates as it is diagnosed at an early stage.

Liver cancer diagnosis is based on a previous medical condition. If the persisting medical condition is difficult to cure or has worsened, patients will be required to go through a few tests to diagnose liver cancer. Here are a few steps to diagnose liver cancer-

Blood Tests- The function of the liver is established through a blood test that helps in checking the level of liver enzymes, proteins and bilirubin in the blood. The occurrence of alpha-fetoprotein (AFP) in the blood confirms the presence of liver cancer. AFP is a protein that is seen in the liver of the foetus in the womb and the production of this protein stops after birth.

Abdominal CT and MRI Scan- The imaging tests like CT and MRI Scan of the abdomen helps to get accurate images of the liver and other organs. This helps the doctor to locate the tumour easily and also helps in knowing more about the tumour such as the size and the area of infection.

Liver Biopsy- During a liver biopsy, a small piece of tissue from the lungs is removed under general anaesthesia. This procedure can be performed in two ways -

• Needle biopsy- This procedure is performed by inserting a needle through the abdomen and then into the liver to get a small piece of tissue for the sample. This sample is later checked for signs of liver cancer under a microscope.
• Laparoscope Biopsy - This is done by inserting a tube with a camera attached to it. The tube is fine and flexible, which allows the doctor to get a clear view of the liver and the tumour. This procedure helps the doctor in removing the tissue accurately. The procedure also helps in obtaining tissue samples of other organs in cases where the cancer has spread to nearby organs.

Through the diagnosis of liver cancer, the severity of cancer will be concluded. After the size, location and stage of the cancer are confirmed, further treatment of liver cancer is decided.

Treatment - Just like other cancer treatments, the treatment for liver cancer differs from one person to another depending on the size, location of tumour cells, the functionality of the liver, presence of cirrhosis and the stage of cancer. Some of the treatment option based on these conditions are -

Surgery- During the operation to eradicate liver cancer, an infected portion of the liver is removed with a small portion of healthy tissue to avoid the infection to spread. This procedure is called a hepatectomy. After the surgery, the healthy leftover part of the liver helps in recovering and replaces the missing part. If the tumour is small, present in an uncomplicated location and if the liver functions excellently well, the recovery is fast and easy. Another way to treat liver cancer through surgery is a liver transplant. The infected liver is replaced by a healthy liver donated by a donor and this procedure is called transplantation. This treatment does not work on all liver cancer patients and works well only on patients suffering from early stages of liver cancer.

Ablation- In this procedure, the cancer cells are destroyed by heat from an electric current. The images from an ultrasound help the doctor to insert one or many fine needles into the abdomen. An electric current is passed to heat the needles which damage the tumour cells in the liver. Microwaves or lasers are also used to heat the needles. This procedure does not help in recovering liver cancer in patients who have already undergone surgery or transplant.

Freezing of cancer cells- The procedure of killing cancer cells by freezing them is called Cryoablation. In this procedure, the doctor freezes cancer cells and destroys them by placing an instrument called cryoprobe filled with liquid nitrogen directly into the tumour. This is done with the help of ultrasound images.

Chemotherapy- An assertive drug therapy through IV or tablets to kill cancer cells is called chemotherapy. Chemotherapy is an effective treatment to treat liver cancer. However, patients will have to face side effects such as nausea, vomiting, decrease in appetite, chills and an increase in the chance of infections.

Radiation Therapy- The cancer cells are killed using high-energy radiation beams. Radiation therapy can be conducted in two ways-

• External Radiation-In this process, the radiation beams are targeted at the external parts of the abdomen and chest.
• Internal Radiation- This process is conducted by using a catheter to infuse tiny radioactive spheres into the hepatic artery, a blood vessel that supplies blood to the liver. This process helps in reducing the blood flow to the tumour as the hepatic artery is destroyed by the radiation beams. The portal veins continue to feed the liver once the hepatic artery is shut.

Targeted Therapy- Infectious cancer cells are killed by stopping the blood flow to the tumour. During targeted therapy, the Sorafenib (Nexavar) a cancer drug for liver cancer is supplied to target the infectious cells. This therapy is not effective for patients who have undergone hepatectomy and transplant earlier. This therapy also gives out serious side effects.

Embolization and Chemoembolization- A surgery performed to block the hepatic artery in the liver is called Embolization and Chemoembolization. This process is done to decrease the blood flow in the hepatic artery by inserting small sponges and other particles. The process is conducted only after injecting chemotherapy drugs into the artery. This helps in retaining the chemotherapy medicines for a longer period in the liver.

Immunotherapy- The cancer cells produce a protein that blinds the immune system cells and destroys their ability to fight against the cancer cells. Through immunotherapy, the blinding process is interrupted and unblinds the immune system cells to fight against infectious cells. This treatment works well on patients suffering from advanced liver cancer.

Palliative care- It is a supportive treatment along with other cancer treatments that help cancer patients to overcome pain, side effects and stress during their treatment period. It is supportive care which is often preferred by patients suffering from advanced cancer and who do not wish to undergo further medical treatments.

The staging of liver cancer is determined only after the results of the pathology test. There are no defined stages for liver cancer; however, T/N/M and the Barcelona Clinic Liver Cancer staging system (BCLC) are the most common. According to the Barcelona Clinic Liver Cancer staging system (BCLC), there are four liver cancer stages-

Stage A: It is the beginning stage of liver cancer with a tumour, which is at its early stage. The symptoms are not seen at this stage.

Stage B: The presence of multinodular tumours are found in the liver. The symptoms are not shown yet.

Stage C: The multinodular tumours rapidly start invading the healthy parts of the liver and symptoms begin to show.

Stage D: This is the end stage of liver cancer, where symptoms are very evident and need immediate medical attention.

Q.  Are treatments for liver cancer the same as other cancers?

1. Cancer treatments differ from one person to another depending upon the severity of the disease. In liver cancer, most often surgery is suggested to remove the tumour completely. These surgeries involve radiation therapy, ablation, catheter-directed therapy and sometimes the entire liver is replaced with a healthy liver from a donor called liver transplantation.

Q.  Should I be worried if I have a cyst on my liver?

1. There is nothing to worry about a cyst in the liver. It is just a simple cyst which goes off over time. However, if it causes severe pain or discomfort, medical attention is required.

Q.  If a parent had/has liver cancer, are their children at greater risk of getting it?

1. There are chances of getting liver cancer from parents from hereditary diseases such as Hepatitis B and C, hemochromatosis. However, this is not a major cause of the disease in liver cancer patients.

Q.  How to prevent liver cancer?

1. Liver cancer cannot be prevented completely. It is sometimes caused due to a disease which is passed on genetically like Hepatitis B and C, hemochromatosis. In other cases, liver cancer can be prevented by taking precautionary measures such as-

• Limited alcoholic consumption
• Using condoms during sex to avoid exposure to hepatitis C germs
• Using sterilized needles while getting a tattoo or piercing done
• Getting vaccinated for hepatitis B.
• Maintaining a healthy weight
• Maintaining healthy sugar levels in case of diabetes

Q.  How long can you live with liver cancer?

1. The survival rate for liver cancer depends on the condition of the liver, the stage of cancer and personal health conditions to cope up with treatment procedures. If the cancer is diagnosed and treated at early stages, the survival rate is high. However, it is difficult to survive if the condition is diagnosed in the last stage of cancer. It is also important to remember that liver cancer can reoccur post treatment procedures depending upon the lifestyle pattern followed.

Q.  How is liver cancer detected?

1. There are many methods used to detect liver cancer, including many imaging studies (ultrasound, computed tomography scan, magnetic resonance imagining) and routine physical exams including blood tests. Several researchers are looking to find a single blood test that will help identify liver cancer much sooner. Until then, they continue to remain vigilant and screen with a variety of methods to try to detect this disease as early as possible.

Q.  What is the first sign of Liver Cancer?

1. Like any other type of cancer, liver cancer usually has few symptoms or signs in the early stages of the disease. Early signs that may occur include:
   1. An Abdominal Mass or Lump: You may feel swelling or a very hard lump in the region just below your rib cage on your right side.
   2. Right-Sided Abdominal Pain: Discomfort, pain, or aching on the right side of the abdomen just under the ribs might occur due to liver tumours on other structures or nerves in this region.
   3. Jaundice: A condition in which the skin and especially the white part of the eyes, appears yellow. The urine colour also becomes darker than normal, even without dehydration.
   4. Weight Loss or Gain: If the weight loss or gain has nothing to do with diet or exercise, then it is a whistleblower. Such condition is found to be related to underlying cancer, including liver cancer.
   5. Loss of Appetite: A loss of appetite may occur with many disorders, but can be quite profound with liver problems.
   6. Nausea and Vomiting: All stages of liver cancer show the symptoms of nausea and vomiting.
   7. Fatigue or Weakness: Cancer fatigue is different from ordinary tiredness. It's an overwhelming sense of tiredness often described as 'whole body' tiredness, which persists despite rest.

Can liver cancer be detected by a blood test?

1. Some liver cancers can be found by testing people at high risk who don't have symptoms. Few blood tests can help detect Liver Cancer at an early stage:
   Liver function tests (LFTs): As liver cancer often develops in conditions like hepatitis and/or cirrhosis, doctors ofter prescribe this blood test to know the condition of the liver.
   Blood clotting tests: The liver makes proteins that help blood clot when you bleed. A damaged liver might not make enough of these clotting factors. These tests can help to measure the liver functions.
   Kidney function tests: Tests of creatinine levels or blood urea nitrogen (BUN) are often done to assess how well your kidneys are working.
   Complete blood count (CBC): Red blood cells carries oxygen throughout your body; white blood cells fight infections, and platelets help in blood clot. This test gives an idea of how well the bone marrow (where new blood cells are made) is functioning.
   Blood chemistry tests and other tests: Blood chemistry tests check the levels of a number of substances in the blood, some of which might be affected by liver cancer. For example, WBC levels might fall in liver cancer and calcium levels might increase. This test helps to determine liver function.

What are the different stages of Liver Cancer?

1. Staging usually refers to where the cancer is located. There are several staging systems for liver cancer, and not all doctors use the same system. Here is the TNM system, which is based on 3 key pieces of information:
   The extent (size) of the tumour (T): How large has the cancer tumour grown? Is there more than one tumour in the liver? Has cancer reached nearby structures like the veins in the liver?
   The spread to nearby lymph nodes (N): Has cancer spread to nearby lymph nodes?
   The spread (metastasis) to distant sites (M): Has cancer spread to distant lymph nodes or distant organs such as the bones or lungs?

Q.  How does liver cancer spread?

1. Like other cancers, liver cancer may spread in three ways and they are:
1. Liver cancer cells can spread to the near by organs after breaking off from the primary tumor.
2. Once the cancer cells reach into nearby lymph nodes, it makes their ways to spred other body parts by lymphatic circulation.
3. Circulatory system is also a way through which liver cancer cells with in the bloodstream form new tumors anywhere in the body.

Q.  What test will show that my liver cancer is spreading?

1. After diagnosing with liver, your physician will find out how advanced it is. By doing some of the following tests, your physician will detect the additional tumors.
1. X-rays
2. Ultrasound
3. CT scan (CAT Scans)
4. PET scan (positron emission tomography)
5. MRI scan (magnetic resonance imaging)
6. Biopsy

Q.  What are liver cancer signs of spreading?

1. When liver cancer is in the advanced stage, it starts spreading to other parts of the body, it is referred to as metastatic liver cancer. Here we've mentioned metastatic liver cancer signs that vary depending on the location of a new tumor. When the liver cancer spreads to the bones, it becomes the determinant of bone fractures. The very prevalent signs of metastatic liver cancer are:
1. Abdominal pain
2. Loss of hunger
3. Unexplained weight loss
4. Nausea
5. Pale skin
6. Jaundice
7. Abdominal swelling
8. Fever
9. Itching
10. Unit blood / Black stool
If you are undergoing treatment for your liver cancer and have these symptoms, consult your doctor.