Liver Cancer Treatment

What is Liver Cancer?

Liver cancer is a type of cancer that starts in the liver cells. The liver is the largest internal organ in the human body that is located in the upper right part of the abdomen, beneath the diaphragm and above the stomach. Several types of cancer can develop in the liver however, the two main types of liver cancer are; primary and secondary. Primary liver cancer starts in the liver and secondary cancer spreads to the liver from another part of the body. Cancer that spreads to the liver from another body part is more common than cancer that starts in the liver. Cancer that starts in another area of the body, for example colon, breast or lung cancer, and then spreads to the liver is known as metastatic cancer.

Liver Cancer Types

• Primary Liver Cancer

Liver cancer that starts in the liver itself is referred to as primary liver cancer. However, there is more than one type of primary liver cancer. They can be as follows: 

1. HCC (Hepatocellular Carcinoma): HCC is the most common type of primary liver cancer in adults. Also, a majority of adult primary liver cancers are hepatocellular carcinomas.  

2. IHC (Intrahepatic Cancer): Intrahepatic cancer is a type of bile duct cancer and starts in the liver’s bile ducts.

3. Angiosarcoma: A very rare type of liver cancer, it begins in the lining of blood cells in the liver. Individuals who are exposed to thorium dioxide or vinyl chloride are at a greater risk of developing liver cancer.

Note: Angiosarcoma can also affect other organs.

4. Hepatoblastoma: This is a rare type of cancer that develops in children, usually below the age of four.

Secondary Liver Cancer (Metastatic Liver Cancer)

This type of cancer spreads from its primary (original) site to the liver and is referred to as secondary liver cancer. These tumours are named and treated based on where they start (primary site).

Liver Cancer Symptoms

Most people do not experience any signs and symptoms in the early stages of primary liver cancer. However, when the signs and symptoms do appear, they can be:

• Loss of appetite

• Weight loss

• Upper abdominal pain

• Abdominal swelling

• Nausea and vomiting

• Fatigue and general weakness

• Fever

• Jaundice

Liver Cancer Causes

Liver cancer happens when healthy liver cells develop mutations (changes) in the DNA. In hepatocellular carcinoma, DNA mutations activate oncogenes and/or deactivate tumour suppressor genes. In some cases, the cause of liver cancer is known, for example chronic hepatitis infections. In some other cases, liver cancer occurs with no underlying cause and it’s unclear what causes it. Additionally, long-term inflammation in the bile ducts can potentially increase the risk of intrahepatic cancer. 

Liver Cancer Risk Factors

Factors that can potentially increase the risk of primary liver cancer include:

• Chronic infection with HCV or HBV: Chronic infection with hepatitis C virus or hepatitis B virus increases the risk of liver cancer.

• Cirrhosis: Liver cirrhosis is a progressive and irreversible condition that causes scar tissue to form in the liver, increasing the risk of liver cancer.

• Some inherited liver diseases: Inherited liver disease such as hemochromatosis and Wilson’s disease can increase the risk of liver cancer.

• Diabetes: People with diabetes are at a greater risk of liver cancer than those who don’t have diabetes.

• Non-alcoholic fatty liver disease: Accumulation of fat in the liver can increase the risk of liver cancer.

• Exposure to aflatoxins: Aflatoxins are poisonous substances produced by moulds that grow on poorly stored crops. Consuming grains and nuts contaminated with aflatoxins can increase the risk of liver cancer.

• Excessive alcohol consumption: Consuming more than a moderate amount of alcohol on a daily basis for a prolonged period of time leads to irreversible liver damage and increases the risk of liver cancer. 

Liver Cancer Diagnosis

A doctor may suspect liver cancer if they find liver cancer symptoms during a physical examination. They may order the following tests to learn more:

• Blood Tests

A doctor may recommend blood tests for liver cancer, such as a liver function test to check on liver enzymes, proteins and other substances that indicate whether the liver is healthy or damaged. A test for alpha-fetoprotein (AFP) may also be recommended, as high AFP levels may indicate liver cancer.

• Imaging Tests

A doctor may recommend imaging tests such as an ultrasound, MRI and CT scan.

• Angiogram

An angiogram examines the liver’s blood vessels. During this test, a healthcare provider injects a dye into an artery to track blood vessel activity and blockages.

• Biopsy

During a biopsy, a doctor inserts a thin needle through the skin and into the liver to obtain a tissue sample and look for signs of cancer. A biopsy is the most reliable way to confirm a liver cancer diagnosis.

Liver Cancer Treatment

Primary liver cancer treatment depends on the stage (extent) of the disease, age of the patient, overall health and personal preferences.

• Surgery
  
  

1. Surgery to Remove Tumour

In some cases, a doctor may recommend surgery to remove liver cancer and a small portion of healthy liver tissue surrounding the tumour. This treatment option depends on the location of cancer within the liver, how well the liver functions and overall health.

2. Liver Transplant Surgery

In a liver transplant surgery, the liver is removed and replaced with a healthy liver from a donor.

Note: Liver transplant surgery is an option for only a small percentage of people with early-stage liver cancer.

• Localised Treatments

Localised treatment for liver cancer is administered directly to cancer cells or the area surrounding cancer cells. These treatment options may include:

Heating cancer cells (radiofrequency ablation)

Freezing cancer cells (cryoablation)

Injecting chemotherapy drugs in the liver (chemoembolization)

Placement of beads filled with radiation in the liver

1. Radiation Therapy

This type of treatment uses high-powered energy from sources like X-rays and protons to shrink tumours and destroy cancer cells. Radiation therapy might be an option if other treatments are not possible or have not helped.

2. Targeted Drug Therapy

Targeted drug therapy focuses on specific abnormalities in the cancer cells. By blocking the abnormalities, targeted drug treatment can cause cancer cells to die.

3. Immunotherapy

Immunotherapy utilises an individual’s immune system to fight cancer. Immunotherapy is generally reserved as a treatment option for advanced liver cancer.

4. Chemotherapy for Liver Cancer

Chemotherapy uses anticancer drugs to destroy rapidly growing cancer cells. In some cases, it is used for advanced liver cancer treatment. 

5. Supportive (Palliative) Care

Palliative care is specialised medical care that focuses on providing relief from pain and symptoms of a serious illness. Palliative care can be employed with other aggressive cancer treatments, such as surgery, chemotherapy or radiation therapy.

How to Prevent Liver Cancer?

• Reduce the Risk of Cirrhosis

Cirrhosis is scarring of the liver and can increase the risk of liver cancer. Limiting alcohol consumption and maintaining a healthy weight reduces the risk of cirrhosis.

• Get Vaccinated Against Hepatitis B

Hepatitis B vaccine helps reduce the risk of hepatitis B and can be administered to almost anyone, including older adults, infants and individuals with compromised immune systems.

• Take Measures to Prevent Hepatitis C

Even though no vaccine exists for hepatitis C, it is possible to reduce the risk of infection by taking steps like not injecting illegal intravenous drugs and knowing the health status of a sexual partner.

• Liver Cancer Screening

People with conditions that can increase the risk of liver cancer must consider liver cancer screening.  Screening for liver cancer involves an abdominal ultrasound and blood test every six months.

FAQs

Is liver cancer curable?

If diagnosed early, it is possible to remove liver cancer completely. Treatment options in the early stages of liver cancer may include: 

Surgical resection 

Liver transplant

Microwave or radiofrequency ablation 

Can a liver transplant cure liver cancer?

Yes, this depends on the type of cancer and the stage at which it is detected. In fact, a liver transplant is the most effective treatment for hepatocellular carcinoma, a common liver cancer type. 

Does liver cancer spread fast?
A significant concern with untreated liver cancer is that cancer cells can migrate to other parts of the body, also known as metastasis. The speed of the spread varies but is often rapid, emphasising the importance of early intervention.

Is liver cancer hereditary?

Even though liver cancer lacks a strong genetic component, a family history of the disease can potentially increase the risk of liver cancer.