Liver Cancer: Types, Diagnosis and Treatment

Liver is a large organ located on the right part of your belly, protected by the ribcage. It has two sections, the right lobe and the left lobe. Below the liver is the gallbladder as well as parts of intestines and pancreas. Liver, along with these organs, orchestrate the functions – Digest, Ingest and Process the food you eat.

The primary function of liver is filtering the blood that comes from your digestive tract. Once the blood is filtered by liver, then only it is transferred to other parts of the body.

Moreover, liver even helps in detoxifying the chemicals and metabolizing the drugs. While performing this function, the liver also secretes a liquid, known as bile, which goes back to the intestines. The liver also produces proteins that play a crucial role in clotting of blood and other vital functions.

There are many conditions that can affect the functioning of liver and impact your overall health. One of such conditions is Liver Cancer, which develops in the cells of the liver.

Types of Liver Cancer

Many cancer types can develop in the liver, of which the most commonly known cancer type is the Hepatocellular Carcinoma. This liver cancer type develops in the main liver cell, known as hepatocyte.. There are some other types too like Intrahepatic Cholangiocarcinoma and the Hepatoblastoma, but these are very rare.

Moreover, all the cancers that affect your liver aren’t really characterized as cancer. Cancer which develops in any other part of your body, like colon, breast or lung and grows into the liver is known as metastatic cancer, not liver cancer. These cancer types are named according to the organ where they develop. For instance, a metastatic colon cancer is the name given to the cancer type that developed in colon and later spread to the liver.

In most cases, it has been observed that cancer types spreading to liver are more common in occurrence as compared to the cancer that develops in the liver cells itself.

As liver is made of different cell types, various tumors form there. Some of these tumors stand to be benign (noncancerous), while some happen to be cancerous and spread to different body parts. The causes and treatment for these tumors vary and the prognosis usually depends on the tumor type you have.

Some of the common but benign tumors that develop in the liver happen to be:

• Hemangioma
• Focal nodular hyperplasia
• Cysts
• Hepatic adenoma
• Lipoma
• Fibroma
• Leiomyoma

The tumors as listed above are not treated as liver cancer and a surgery is only needed to remove them when they lead to pain or bleeding.

Hepatocellular Carcinoma

Hepatocellular Carcinoma (HCC) happens to be the most commonly occurring primary liver cancer type. This liver cancer type mostly occurs in the people who suffer from any chronic liver disease like cirrhosis, which is mostly caused due to Hepatitis B or Hepatitis C infection.

Diagnosis of Hepatocellular Carcinoma

There are various tests and methods used for diagnosing the Hepatocellular Carcinoma, which include:

• Blood tests, which is done to measure the liver function
• Imaging tests like MRI and CT scan done with the help of advanced imaging methods inclusive of Magnetic Resonance Elastography
• Liver biopsy, wherein a small liver tissue is removed for lab testing

Treating Hepatocellular Carcinoma

There are various treatment methods for treating Hepatocellular Carcinoma; however, which treatment type will work best for you will depend on the location and size of the tumor along with the liver functioning quality and your overall well-being.

Some of the commonly used Hepatocellular Carcinoma treatments include:

Surgery: Surgery is recommended in cases where the liver cancer is in its early stage and the liver is functioning normally. In this process, the surgeon removes the cancer and some healthy tissues surrounding it.

Liver Transplant Surgery: This option is considered in the cases where the liver cancer has not spread to any other body parts. During the procedure, the affected liver is completely removed and replaced with a liver from a healthy donor.

Chemotherapy or Radiotherapy: In some cases, chemotherapy or radiation therapy is given directly to destroy the cancer cells. For the process, the doctor will make use of a catheter which will be passed through the blood vessels, to reach the liver where the chemo drugs or radiation beams will be delivered.

Targeted Drug Therapy: Targeted drug deliveries are used in slowing down the progression of the cancer and they are recommended in cases where the cancer has reached its advanced stage.

Ablation: This process calls for destroying the cancer cells using heat or cold. This process is used in cases where a surgery is not possible. The procedure kills the cancer cells in liver through extreme heat or cold. Ablation procedures consist of radiofrequency ablation, ablation with the help of alcohol or microwaves and cryoablation.

Causes of Liver Cancer

Primary liver cancer or Hepatocellular Carcinoma mostly occurs when the liver gets damaged due to alcohol abuse, birth defects, or chronic infection with diseases like Hepatitis B and C, Cirrhosis and Hemochromatosis (it is a hereditary disease marked by presence of excess iron in liver).

As per incidence, most people suffering from Hepatocellular Carcinoma tend to have liver cirrhosis, which is the scarring of the liver commonly caused by alcohol abuse. Hepatitis B, Hepatitis C and Hemochromatosis can lead to permanent damage as well as liver failure. Obesity and fatty liver diseases are also linked to liver cancer.

There are many cancer-causing substances linked with Hepatocellular Carcinoma, such as some types of herbicides and chemicals like vinyl chloride and arsenic. Smoking, and alcohol can also subject you to higher risk of liver cancer.

Aflatoxins, the cancer-causing substances made by a kind of plant mold, are also possible causes of liver cancer. Aflatoxins contaminate wheat, rice, corn, peanuts and soybeans.

Risk Factors Associated

Apart from the causes which majorly include various liver diseases and certain cancer causing substances, there are a few risk factors that can increase your risk of suffering from liver cancer.

Gender: Men are at higher risk of suffering from Hepatocellular Carcinoma as compared to women.

Weight: Obesity is also known to increase your risk of suffering from Hepatocellular Carcinoma.

Anabolic steroid use: Experts state that male hormones as used by athletes for increasing muscle also has a slight probability of increasing the liver cancer risk.

History of diabetes: As diabetes is linked with fatty liver disease, it is said to have a connection with liver cancer as well.

Inherited metabolic diseases: Diseases that can disturb the normal metabolism of your body can also increase your risk of suffering from liver cancer.

Chronic infection: If you have a chronic infection of the liver due to HBV (Hepatitis B virus) or HCV (Hepatitis C virus), then you will be at a greater risk of suffering from liver cancer.

Other than the above mentioned risk factors, some kind of inherited liver diseases like Wilson’s disease and Hemochromatosis can also increase your risk of liver cancer.

Symptoms of Liver Cancer

In most cases, liver cancer signs and symptoms will not surface in the early stages. The symptoms start expressing at later stages of the disease.

However, in some cases, the signs can even appear early. Some of the most common symptoms of liver cancer are:

• Unexplained weight loss
• Loss of appetite
• Feeling full even after a small meal
• Nausea or vomiting
• Swollen liver, it will feel like a mass under your ribs on the right side
• An enlarged spleen
• Pain in the abdomen
• Swelling or build-up of fluid in the abdomen
• Itching
• Yellowing of the skin and eyes (jaundice)

Other signs associated with liver cancer include, swollen veins, fever, abnormal bruising and bleeding.

If liver cancer is being caused due to chronic Hepatitis or Cirrhosis, the person tends to feel worse than normal.

Certain liver tumors can make hormones which tend to act on various organs other than liver. These hormones can lead to:

• High levels of blood calcium (Hypercalcemia), which leads to nausea, constipation, weakness, confusion or muscle problems
• Decreased levels of blood sugar (Hypoglycemia), which can lead to fatigue or fainting
• Breast enlargement (Gynecomastia), and/or contraction of the testicles in men
• Higher counts of red blood cells (erythrocytosis) which makes people look red and flushed
• High levels of cholesterol levels

Many symptoms associated with liver cancer can be caused due to any other medical condition. Consulting the doctor and undergoing proper diagnosis is the perfect way to identify the real reason behind the symptoms.

Prevention of Liver Cancer

Known among the most severe types of cancer, liver cancer has a very low rate of survival. This is because, in most of the liver cancer cases, the disease gets diagnosed at an advanced stage where treatments can only be done for preventing the progression of cancer.

While there are no sure-shot ways of preventing cancer, steps must be taken to cut down the risk and enhance the chances of diagnosing liver cancer at the earliest.

Here are some ways following which you can take care of your health and reduce the risk of liver cancer.

Drink alcohol moderately: Consuming alcohol in higher volume on a regular basis is very harmful for your health and is known to increase liver cancer risk considerably. This is because excess alcohol consumption leads to Cirrhosis of the liver which has all the possibilities of developing into liver cancer. If you can’t give up alcohol completely then you must ensure to limit the intake.

Cut down tobacco usage: Usage of tobacco is also linked with liver cancer as well as cancer of other organs. It is advisable to cut down your risk of suffering from cancer and you should limit your tobacco use or stop it completely.

Hepatitis B Vaccination: Preventing yourself from Hepatitis B can help in reducing the risk of liver cancer and for the same, vaccination is the best solution. Getting a Hepatitis B vaccination is very important for the following individuals:

• people with drug dependency, and those who’ve the habit of sharing needles
• individuals engaging in unprotected sex with partners who are at higher risk of having hepatitis B
• medical professionals, mainly doctors, nurses who stand at risk of getting infected because of their occupations
• individuals who travel frequently, particularly to places with higher incidence of Hepatitis B

Prevention from Hepatitis C: There is no assured way of preventing Hepatitis C and there exists no vaccination for it. To reduce the infection, you must make it a point to have protected sex.

Maintain healthy body weight: Obesity is considered to be a risk factor for various diseases including diabetes, fatty liver and others which can increase your risk of suffering from liver cancer. This is why it is advisable that you stick to a healthy lifestyle and have a healthy body weight. You should have a regular exercise routine and incorporate all healthy foods in your diet.

Treating the underlying conditions: Disorders like Diabetes and Hemochromatosis may enhance the occurrence of cancer of the liver. To keep yourself safe, it is important that you get the underlying conditions treated. This will even help in reducing the complications associated with liver cancer.

Diagnosis of Liver Cancer

There are various tests and diagnostic methods used for detecting liver cancer. Some of the commonly used methods include:

Blood tests: Your healthcare provider will recommend some blood tests that will help in identifying any abnormality related to liver function.

Imaging tests: Imaging tests like the Magnetic Resonance Imaging (MRI), ultrasound and computerized tomography (CT) scan will be recommended that help in identifying the interior parts of your body and close monitoring of the liver cancer cells. These tests offer a detailed analysis of the cancer cells.

Biopsy: In this process, a small sample of the liver tissue is removed for testing in the lab. A liver biopsy is often recommended when your doctor needs a definite diagnosis in case of liver cancer, as it helps in ruling out any other possibility. During the biopsy procedure, the doctor will insert a thin needle passing through the skin, into the liver for taking out a tissue sample. Then the tissue sample will be examined in the lab, under a microscope for identifying the cancer cells. Though it’s a precise way of diagnosing liver cancer cells, it does carry a risk of infection, bleeding as well as bruising.

Post diagnosis, when liver cancer is confirmed, the doctor will then work to identify the stage of the cancer. Knowing the stage helps in deciding the right treatment module and it even helps in knowing how far the cancer has spread and what its size is.

To determine the stage of cancer, several imaging tests are used which include the magnetic resonance imaging (MRI), computerized tomography (CT) scan and bone scans.

Staging methods for liver cancer also vary; one method happens to be the Roman numerals; starting from I to IV. Another method uses the alphabets, from A to D.

Your doctor will use the cancer stage for determining the treatment options as well as the prognosis. If you have entered Stage IV or stage D, then it is indicative of advanced liver cancer which in most cases has the worst prognosis. These are the final stages of cancer where the treatment approaches mainly focus on relieving the pain and discomfort.

Treatment of Liver Cancer

The treatment options for Hepatocellular Carcinoma or the primary liver cancer will mainly depend on the spread of cancer. However, along with it, your age, personal preference for treatment and overall health will also be considered. Some of the commonly used methods for liver cancer treatment are:

Surgery

Surgery is mostly recommended in the early stages of liver cancer when the tumor size small and it is restricted to its location of origin. The treatments done for treating liver cancer include:

• Surgery for removing the tumor: In some cases, you will be recommended a surgery which will help in removing the liver cancer. While removing the tumor, the doctor will even remove some of the healthy tissues around. A surgery will only be done if the tumor is small and you are physically fit for the surgery. Before suggesting surgery, the functioning of your liver will also be checked.
• Liver transplant surgery: This surgery is also done in the early stages of liver cancer wherein the diseased or affected liver is removed and a healthy liver from a donor is transplanted in its place.

Localized Treatments

Localized treatments stand for the treatments that are directly administered to the liver cancer cells or the surrounding tissues. The treatments as available are:

Heating cancer cells: This process is done with the help of radiofrequency ablation, wherein electric current heats and destroys the cancer cells. The surgeon uses ultrasound or CT scan for guiding to the cancer cell location. For this process, the surgeon will insert one or more thin needles into the abdomen by making small incisions. Once these needles reach the cancer cell, they get heated with electric current and the cancer cells are destroyed.

Freezing cancer cells: This procedure uses extreme cold for destroying the cancer cells and is known as Cryoablation. During the process, the doctor will place an instrument known as cryoprobe, which contains the liquid nitrogen, directly on the liver tumors. With the help of ultrasound images, cryoprobe is guided and freezing of the cells is monitored.

Injection of alcohol into the tumor: In this process, pure alcohol will be injected directly into the tumors. This will be done either from the skin or through an operation. Alcohol causes death of the tumor cells.

Injection of chemotherapy drugs into liver: Chemoembolization is a kind of chemotherapy treatment which gives powerful anti-cancer drugs to the liver by placing beads that are filled with radiation.

Radiation Therapy

A radiation therapy can be used as a stand-alone treatment or is given before or after the surgery for relieving the discomfort. During radiation therapy, high-powered energy beams in the form of X-rays and protons are used for destroying the cancer cells and shrinking the tumors. In this process, a radiation oncologist will administer the energy directly to your liver while ensuring that the healthy tissues around are not harmed.

When you are given external beam radiotherapy treatment, you will be made to lie on a table and a machine will be used for directing the energy beams on the precise points.

Targeted Drug Therapy

This therapy for treating liver cancer works by meddling with definite abnormalities in a tumor. Targeted drug therapies are known to slow or stop the progression of advanced Hepatocellular Carcinoma for a few months longer.

Supportive (Palliative) Care

It is a specialized medical care which primarily focuses on offering relief from pain and other symptoms of any serious illness like cancer. This treatment is needed when you undergo any extensive treatment modality like chemotherapy, surgery or radiation therapy. The treatment works with the objective of improving the quality of life.

Conclusion

Managing and living with cancer of liver is not easy. Though advancements in medical sciences have made it easy to diagnose the cancer with precision and the treatment modalities also use the latest technology, coping with liver cancer needs lot of endurance and grit.

You not only need thorough medical assistance but proper support from family and friends is also needed. This helps in managing the pain and discomforts arising from the treatments as well as the side effects of cancer treatment modalities. It requires great expertise to treat cancer and offer improved quality of life.

Shalby Hospitals’ Cancer & Research Institute at Ahmedabad and other centres like, Indore, Jaipur, Naroda (Ahmedabad) are well manned and equipped with latest equipment for diagnosis and treatment of all cancer types, including liver cancer. Our team of expert oncologists, radiologists and chemotherapy specialists help in offering highly effective treatment for cancer with compassionate care.

From surgery to chemo and radiotherapy, our team of experts can design any treatment module which can help in treating the problem.

Shalby Hospital’s SG Unit at Ahmedabad is an approved centre for Liver Transplant.