LIVER CANCER

Key facts:

The World Cancer Research Fund estimates there were 866,136 new cases of liver cancer in the world during the year 2022. This means that each year almost one-million people worldwide are diagnosed with the disease.

In addition to being one of the leading causes of death worldwide from cancer, liver cancer is the 10th most commonly diagnosed cancer and has approximately 35,000 new cases diagnosed every year in India. It is generally more common in males and frequently diagnosed in later stages across all ethnicities, which contributes to a high rate of mortality for patients diagnosed with the disease.

Primary liver cancer is classified as a form of cancer that starts to grow in the liver. Cancer that spreads to the liver from a different part of the body is not classified as primary liver cancer, but rather as metastatic liver cancer. The liver is one of the largest organs in the human body having 2 lobes resting in the upper-right quadrant of the abdomen and encased by the rib cage. There are 3 primary functions of the liver including:

• production of bile to aid in digestion and help break down fats coming from foods
• storing sugar (glycogen) that can be used by the body for energy
• filtering out hazardous substances from the blood so they may be eliminated through stool or urine.

Types of Liver Cancer:

Hepatocellular carcinoma - The Major Type of Adult Primary Liver Cancer

Intrahepatic Cancer (IHC) is Bile Duct Cancer (Cholangiocarcinoma) that Develops in the Liver. It Represents Approximately 10-20% of All Primary Cancers of the Liver.

Hepatocellular Carcinoma is the Most Common Type of Liver Cancer in Adults and is the Third Leading Cause of Cancer Deaths Globally.

Adult Primary Liver Cancer Can Occur in Children as Well as Adults, However, Their Treatment Differs. For More Information, Refer to Childhood Liver Cancer.

Signs and Symptoms

These and other signs and symptoms may be caused by adult primary liver cancer. These Types of Symptoms Can Also be Caused by Other Conditions. If You Have Any

of The Following Symptoms Please Contact Your Physician for Further Evaluation:

• Compressed/Hard Lump on the Right Upper Abdomen (Under the Rib Cage).
• Discomfort in the Right Upper Abdomen.
• Swelling of The Abdomen.
• Pain to The Right Shoulder Blade or Extension to The Back.
• Jaundice (Yellowing Of Eyes and Skin).
• Easy Bruising or Bleeding.
• Extreme Fatigue.
• Nausea/Vomiting.
• Loss of Appetite/Post-Prandial Early Satiety.
• Unexplained Weight Loss.
• Pale/Clay Colored BMs and Dark Urine.
• Any Fever.

Treatment:

When doctors treat liver cancer, they have a few different tools they can use, and the choice depends on how far the cancer has spread and how healthy the liver is.

A simple breakdown:

• Surgical Resection: Here, the tumor-affected parts of the liver are removed. The success of this method is related to the tumor size and the health condition of the remaining portion of the liver.
• Radiofrequency Ablation (RFA) and Microwave Ablation (MWA): RFA and MWA are thermal ablation modalities. Both techniques involve the use of radio waves and microwaves to produce local hotspots of thermal energy, leading to cell death and necrosis of the target tumor.
• Transarterial Chemoembolization (TACE) and Trans: In the process of TACE, anti-cancer drugs are injected directly into the hepatic artery, which is the major artery providing the liver with blood, as well as occlusive agents.
• It utilizes radioactive microspheres that are injected through the hepatic artery, which then emit radiation to kill the tumor.
• Systemic Therapy
  • Chemotherapy: Cytotoxic agents, which are poisonous to cells and disrupt their division, often targeting faster-growing cells.
  • Targeted Therapy: These agents, like sorafenib and lenvatinib, block specific molecular signals that can fuel cancer cell growth and the development of new blood vessels that may supply the tumor.
  • Immunotherapy: Immunotherapies like atezolizumab and nivolumab boost the immune system’s ability to combat cancer cells.
• Stereotactic Body Radiation Therapy (SBRT): This modality allows for high levels of radiation to be precisely focused at the tumor site, minimizing damage to healthy tissue.

Stages:

It's important to understand that when doctors talk about "stages" of liver cancer, they're describing how far the cancer has spread. This helps them figure out the best way to treat it.

There are just a couple of systems utilized by doctors for the staging of liver cancer, the most well-known of these being the TNM and BCLC Systems. Here is a simple overview of the two systems:

• TNM Staging Systems:
  • This system focuses on three major issues:
    • T (Tumor): The size of the tumor and whether or not it has invaded nearby blood vessels.
    • N (Nodes): Nodes refer to whether the cancer has spread to lymph nodes.
    • M (Metastasis): Whether the cancer has spread to distant parts of the body.
  • Based on these factors, liver cancer is staged from 1 to 4, where 4 is the most advanced.

• Barcelona Clinic Liver Cancer (BCLC) Staging System:
  • Also, this system looks into the effectiveness of the liver, which is a critical factor in liver cancer.
  • Its classification is performed through these stages:
    • Stage 0 (Very Early): "Tiny tumors."
    • Stage A (Early): The liver is functioning normally, and there are small tumors.
    • Stage B (Intermediate): The liver is still functioning, but the tumors are now larger or more numerous.
    • Stage C (Advanced): In this stage, blood vessels and/or other body parts have been impacted.
    • Stage D (End-stage): In this stage, the liver is severely damaged and referred to as the terminal stage.

FAQs:

• Q: What is liver cancer?
  • A: Your liver is an important organ that helps clean your blood and do other jobs. Liver cancer happens when cells in the liver start to grow out of control and form a tumor.
• Q: What causes liver cancer?
  • A: There are a few things that can make someone more likely to get liver cancer. Some of these include:
    • Hepatitis B or C: These are viruses that can damage the liver.
    • Cirrhosis: This is when the liver gets scarred from long-term damage.
    • Too much alcohol: Drinking a lot of alcohol can hurt the liver.
    • Certain diseases: Some rare diseases can also increase the risk.
• Q: What are the symptoms of liver cancer?
  • A: Sometimes, liver cancer doesn't cause any symptoms at first. But as it grows, someone might experience:
    • Pain in the upper right side of their tummy.
    • Feeling tired or weak.
    • Losing weight without trying.
    • Yellowing of the skin or eyes (jaundice).
    • Swelling in the tummy.
• Q: Can liver cancer be cured?
  • A: It depends on how early the cancer is found. If it's found early, there's a better chance of curing it with treatments like surgery or a liver transplant. If it's found later, treatments can help slow it down and make someone feel better.
• Q: How is liver cancer treated?
  • A: Doctors have different ways to treat liver cancer, including:
    • Surgery: Taking out the tumor.
    • Liver transplant: Replacing the damaged liver with a healthy one.
    • Ablation: Using heat or cold to destroy the tumor.
    • Chemotherapy: Using medicine to kill cancer cells.
    • Targeted therapy: Using medicine that attacks specific parts of the cancer cells.
    • Immunotherapy: Helping your bodies immune system to fight the cancer.
• Q: Can you prevent liver cancer?
  • A: Yes, there are ways to lower your risk:
    • Get vaccinated against hepatitis B.
    • Protect yourself from hepatitis C.
    • Don't drink too much alcohol.
    • Maintain a healthy weight.