Key facts:

According to information from sources like the World Cancer Research Fund, there were 866,136 new cases of liver cancer in 2022. This means that nearly a million people around the world are diagnosed with liver cancer each year.

Liver cancer is the 10th most common cancer in India, with around 35,000 new cases diagnosed annually. It is more prevalent in males and is often diagnosed in late stages, leading to a high mortality rate.

Primary liver cancer is a disease in which malignant (cancerous) cells form in the tissues of the liver. Cancer that forms in other body parts and spreads to the liver is not primary liver cancer. The liver is one of the largest organs in the body. It has two lobes and fills the upper right side of the abdomen inside the rib cage. The main functions of the liver include the following:

• to make bile to help digest fat that comes from food
• to store glycogen (sugar), which the body uses for energy
• to filter harmful substances from the blood so they can be passed from the body through the stools and urine

Types of liver cancer:

• Hepatocellular carcinoma is the main type of adult primary liver cancer.
• Intrahepatic cancer (IHC) is bile duct cancer (cholangiocarcinoma) in the liver. It accounts for between 10% and 20% of all primary liver cancer cases.
• Most adult primary liver cancers are hepatocellular carcinomas. This type of liver cancer is the third leading cause of cancer-related deaths worldwide.
• Primary liver cancer can occur in both adults and children. However, treatment for children is different from treatment for adults. For more information, see Childhood Liver Cancer.

Signs and symptoms

These and other signs and symptoms may be caused by adult primary liver cancer or by other conditions. Check with your doctor if you have any of the following:

• a hard lump on the right side just below the rib cage
• discomfort in the upper abdomen on the right side
• a swollen abdomen
• pain near the right shoulder blade or in the back
• jaundice (yellowing of the skin and whites of the eyes)
• easy bruising or bleeding
• unusual tiredness or weakness
• nausea and vomiting
• loss of appetite or feelings of fullness after eating a small meal
• weight loss for unknown reason
• pale, chalky bowel movements and dark urine
• 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.

Here's a simple breakdown:

• Surgical Resection: This involves the physical removal of the tumorous liver tissue. The procedure's success depends on the tumor's size, location, and the overall health of the remaining liver.
• Radiofrequency Ablation (RFA) and Microwave Ablation (MWA): These are thermal ablation techniques. RFA uses radio waves to generate heat, while MWA uses microwaves. Both create localized areas of high temperature, causing coagulative necrosis (cell death) in the tumor.
• Transarterial Chemoembolization (TACE) and Transarterial Radioembolization (TARE):
  • TACE involves injecting chemotherapy drugs directly into the hepatic artery (the liver's main blood supply), along with substances that block the artery, starving the tumor.
  • TARE uses radioactive microspheres that are delivered through the hepatic artery, emitting radiation to destroy the tumor.
• Systemic Therapies:
  • Chemotherapy: Cytotoxic drugs that interfere with cell division, targeting rapidly dividing cancer cells.
  • Targeted Therapy: Drugs like sorafenib and lenvatinib inhibit specific molecular pathways involved in tumor growth and angiogenesis (the formation of new blood vessels that feed the tumor).
  • Immunotherapy: Drugs like atezolizumab and nivolumab enhance the body's immune response against cancer cells by targeting immune checkpoints.
• Stereotactic Body Radiation Therapy (SBRT): This delivers high doses of radiation to the tumor with extreme precision, minimizing damage to surrounding 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.

Here's a simplified breakdown:

There are a couple of systems that doctors use to stage liver cancer, the most common being the TNM system and the BCLC system. Here is a simplified explanation of those systems.

• TNM Staging System:

  • This system looks at three main things:
    • T (Tumor): How big the tumor is and if it has spread to nearby blood vessels.
    • N (Nodes): Whether the cancer has spread to nearby lymph nodes.
    • M (Metastasis): Whether the cancer has spread to distant parts of the body.
  • Based on these factors, liver cancer is assigned a stage from 1 to 4, with 4 being the most advanced.

• Barcelona Clinic Liver Cancer (BCLC) Staging System:

  • This system also considers how well the liver is functioning, which is very important in liver cancer.
  • Its classification is done through these stages:
    • Stage 0 (Very Early): Tiny tumors.
    • Stage A (Early): The liver is still functioning normally, with small tumors.
    • Stage B (Intermediate): The liver is still functioning despite larger or more numerous tumors.
    • Stage C (Advanced): Blood vessels or other bodily components have been affected by the cancer.
    • Stage D (End-stage): The liver is severely damaged, also called the terminal stage.

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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.