Cancer of the Liver

   

THE HUMAN LIVER

Liver cancer affects liver cells.Liver  is the largest internal organs in the body. It’s function includes detoxification,protein synthesis and production of biochemicals for digestion. It is necessary for survival.The liver lies to the right of the stomach and lies over the gall bladder

WHAT IS LIVER CANCER

It is the types of cancer that begins in the cells of the liver. This is called primary liver cancer. It affects more men than women and usually affects people of age 50 and over. Liver cancer is one of the most common types of cancers. There are other types of cancers that affects the liver. They may not have originated from the liver but have spread from other organs to the liver. This is metastasized or secondary cancer even though it is found in the liver.

CAUSES

Liver cancer is caused by uncontrolled growth of liver cells. This may be caused by genetic mutation in the DNA of these cells. The abnormal cells do not die and eventually form a mass called a tumor. Various chronic liver diseases, alcohol abuse, overweight and chemical may all be a contributing factor to liver cancer

RISK FACTORS

Cirrhosis This severe liver disease causes a scar tissue to form on your liver and increases your chances of liver cancer

Sex This disease is more common in men than women

Age. In places like north america, the disease usually affects adults whereas in africa it is more common in the young population ages between 20 and 50 years.

Diabetes. Diabetes increase your chance of liver cancer.

Inherited liver disease. Certain inherited  liver disease like Wilson’s disease make you more prone to liver cancer

Chronic infection with  hepatitis B virus (HBV) or hepatitis C virus (HCV) increases your risk of liver cancer.

Obesity This gives your higher risk for the disease

Alcohol abuse. Excessive alcohol abuse damages your liver making you more susceptible to liver cancer

Aflatoxins Foods contaminated with aflatoxins increases your risk for this type of cancer.

Other factors include Inflammation of the liver that is long-term (chronic),Iron overload in the body (hemochromatosis), Autoimmune diseases of the liver and anabolic steroid use

TYPES OF LIVER CANCER

Hepatocellular carcinoma (HCC)  This types of cancer starts from the main liver cells, hepatocytes and it the most common primary liver cancer. Older people, men and people with cirrhosis are more susceptible to this types of liver cancer.A subtypes of this is fibrolamellar HCC and this is more common among young people who do not have cirrhosis. It is much more easily treated.

Cholangiocarcinoma. Cancer can begin anywhere on the bile duct. This cancer develops in section of the bile duct inside the liver. It is therefore called intrahepatic cholangiocarcinoma. Sometimes though cancer may develop on the section of the bile duct outside the liver. This is called bile duct cancer.

Angiosarcoma It is a very rare cancer. It begins in the blood vessels of the liver.

Hepatoblastoma It is a very rare liver cancer that affects infants and young people.

SYMPTOMS

Symptoms of liver cancer mainly shows when the cancer is well active and quite advanced. The main symptom is jaundice, which is the yellowing of skin and white part of the eye. Other symptoms include

  • intense loss of weight
  • loss of appetite
  • darker urine
  • nausea and vomiting
  • intense pain or discomfort on the right side of the abdomen
  • uncomfortable pain on the right shoulder area
  • weakness and fatigue
  • abdominal swelling
  • enlarged liver
  • white chalky stool

STAGING OF LIVER CANCER

Staging describes how advanced the cancer has spread

TNM System

This uses three codes to describe the location and size of cancer, whether cancer has spread to the lymph nodes and if cancer has spread to other organs.

T is used to describe size and location of tumor

TX  Primary tumor cannot be evaluated due to incomplete information

T0 There is no evidence of a primary tumor

T1 Just one tumor found. The tumor can be any size and have not spread to blood vessels

T2 – One tumor of any size has spread into the blood vessels. It could also indicated several tumors in the liver . Tumor size is 5cm or smaller

T3 – Several tumors larger than 5 cm (about 2 inches).It may also indicate one tumor involves a major branch of the major liver blood vessels, that is the portal or hepatic veins.

T4 – The cancer has spread to organs near the liver  or into the abdominal lining. The gall bladder however has not been affected.

N stands for node

NX  Surrounding  lymph nodes cannot be evaluated because of incomplete information.

N0 – Cancer has invaded the surrounding lymph nodes.

N1 – The cancer has invaded surrounding lymph nodes near the tumor.

M stands for if the cancer has metastasized to other parts of the body.

MX– Distant metastasis cannot be evaluated .

M0 – The cancer has not spread to distant lymph nodes or other parts of the body.

M1 – The cancer has metastasized to distant lymph nodes or other parts of the body.

The doctor will then  use the TNM staging information to assign stage (I to IV) to  the cancer

  • Stage I– The liver has one tumor that has not invaded  nearby blood vessels or lymph nodes
  • Stage II – A single tumor of any size has spread to nearby blood vessels or several tumors that are not bigger than 5 cm .
  • Stage IIIA -Several tumors and at least one is bigger than 5 cm, or the liver has one tumor that has invaded the branch of the hepatic vein
  • Stage IIIB – The tumor has spread to organs near the liver or it has spread into lining of the abdomen. Gall bladder not affected
  • Stage IIIC – One or more tumors of any size have invaded surrounding lymph nodes
  • Stage IV – One or more tumors of any size have spread to other parts of the body, such as the lungs or bones.

TEST AND DIAGNOSIS

Blood test. This is done to check for liver functions such as high alpha-fetoprotein (AFP) . High AFP in adults may indicate liver cancer but babies have high AFP and it becomes normal as they grow. Therefore high AFP in children does not mean  liver cancer

Liver Biopsy A sample of tissue is removed from your liver and examined under a microscope for cancer cells

Imaging tests  such as an ultrasound, computerized tomography (CT) scan and magnetic resonance imaging (MRI) is done to check the liver and see if it has spread to other organs . It is also used in staging the cancer.

TREATMENT

Treatment for liver cancer depends on the stage of the cancer, your overall health,age and preference. The main goal of treatment is to eliminate the cancer cells completely. In some cases of advanced cancer when cancer can’t be cured, comfort care is the only option.

Surgery Partial hepatectomy is when a portion of your liver is removed. This is recommended when your tumor is small and liver is not damaged. The part of the liver along with some healthy tissues may be removed.

Liver transplant surgery. This is removing cancerous liver and replacing it with a healthy liver from a donor.

Radiation therapy High-powered energy beams  are used to destroy cancer cells and shrink tumors. Side effects include nausea , vomiting and fatigue

Chemotherapy  This is when strong anti cancer drugs are directed to the kidney. This is done through an injection into the hepatic artery. This procedure kills the cancer cells

Radiofrequency ablation Electric current is used to heat and destroy cancer cells. This is done by inserting needles through abdominal incision to the tumor. When the needle reaches the tumor, electric current is used to heat the needle to kill the tumor.

Cryoablation Extreme cold is used to freeze the cancer cells.Cryoprobe containing liquid nitrogen is directed onto liver tumors to freeze it. This kills the tumor.

Targeted drug therapy Sorafenib (Nexavar) is a targeted drug that  interferes with a tumor’s ability to generate new blood vessels. It slows down or stops the growth of the cancer cells.

Injecting alcohol into the tumor. Pure alcohol is injected directly into tumors to kill the cells

PREVENTION

  • get vaccinated against hepatitis B
  • drink alcohol in moderation
  • control your weight
  • avoids direct contact with chemicals
  • consider liver cancer screening
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