Liver cancer

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at February 16, 2016
StartDiseasesLiver cancer

Liver cancer can be classified as primary or secondary. Primary liver cancer has various types. Treatment is dependent upon individualized factors, and prevention involves reducing risk factors such as obesity, diabetes, alcohol abuse and cirrhosis.

Contents

Definition & Facts

The liver is the largest glandular organ in the body and is necessary for critical functions such as keeping the body free of harmful substances and toxins, producing bile, storing nutrients such as glucose, and breaking down medications.

Liver cancer can be classified as primary or secondary. Primary liver cancer begins within the cells of the liver, and secondary liver cancer develops when cancer cells from another organ metastasize and invade the liver. There are various types of primary liver cancer. Hepatocellular carcinoma accounts for 75 percent of all liver cancers, making it the most common. This cancer develops in the hepatocytes, which are the liver's predominant cells.

Cholangiocarcinoma, also known as bile duct cancer, develops within the small, tube-like bile ducts in the liver. This cancer accounts for approximately 10 to 20 percent of all liver cancers. Liver angiosarcoma is the rarest form of liver cancer that develops in the blood vessels of the liver. This type of cancer progresses quickly and is typically diagnosed in the advanced stages.

Symptoms & Complaints

Often, symptoms may not be experienced in the early stages of primary liver cancer. If symptoms are present, they may include:

It is estimated that 80 to 90 percent of those who have primary liver cancer also have cirrhosis. Therefore, symptoms may be present such as ascites (excess fluid in the abdomen) or confusion.

Causes

It is still unclear as to what the exact cause of primary liver cancer is; however, there are believed to be several risk factors for developing this cancer including:

  • Obesity
  • Diabetes
  • Family history of hepatitis and liver cancer
  • Diagnosis of viral hepatitis B or hepatitis C
  • Diagnosis of cirrhosis of the liver, which is an irreversible formation of scar tissue that impairs the liver's function
  • Diagnosis of hemochromatosis, which is a condition that causes excess accumulation of iron in the body
  • Excessive alcohol consumption, having two or more alcoholic drinks daily over many years increases the risk
  • Liver cancer is more common in those over the age of 50
  • Exposure to aflatoxin, which is a toxic substance that is produced by a type of fungus that can grow on corn, peanuts or grains.

Diagnosis & Tests

The diagnosis of primary liver cancer begins with a thorough medical history and physical examination. Individuals should inform doctors of risk factors such as long-term history of alcohol abuse or a chronic hepatitis B or C infection. Liver function tests can determine the health of the liver by measuring protein, bilirubin, and liver enzyme levels in the blood. A sign of liver cancer is the presence of alpha-fetoprotein (AFP) in the blood.

Imaging tests such as an abdominal CT scan or MRI can show detailed images of the liver and other bodily organs in the abdomen. This allows for tumor detection and assessment of tumor size and evidence of the spread of cancer to other organs.

An ultrasound may also be performed to screen patients who are at high risk, such as those with cirrhosis. If cholangiocarcinoma (bile duct cancer) is suspected, a cholangiography may be performed to look at the bile ducts. In some cases, a liver biopsy is performed. This involves obtaining a small sample of the liver tissue and examining it under a microscope.

If primary liver cancer is diagnosed, the next step would be to stage the cancer. This is done to determine how far the cancer has spread. A CT scan or bone scan can evaluate the extent of liver cancer.

Treatment & Therapy

Treatment of liver cancer varies and is dependent upon the number, size and location of the tumors affecting the liver, whether cirrhosis is present, how well the liver is functioning, and whether the cancer has spread to other organs. When cancer is confined to the liver only, a hepatectomy can be performed. This is a surgical procedure used to remove all of the liver or only the portion affected.

If cancer hasn't spread to other organs a liver transplant can be performed. This replaces the cancerous liver with a healthy liver from a donor. Some individuals who are not candidates for transplant or surgery may receive an ablation, which involves the use of ethanol or heat injections to kill the cancer cells.

Other treatments include the use of chemotherapy drugs or radiation therapy to destroy the cancer cells. Chemotherapy drugs are typically administered intravenously (through a vein) in an outpatient setting, and high-energy radiation beams are used for radiation therapy.

Targeted therapy can be used to decrease tumor growth and shut down the blood supply to the cancerous tumor. This involves the use of chemotherapy drugs that are specifically designed to target cancer cells where they're vulnerable. Also, surgical procedures such as chemoembolization and embolization may be performed. These procedures block off the hepatic artery, which decreases the amount of blood flow to the cancerous tumor and keeps chemotherapy medications in the liver for a longer time period.

Prevention & Prophylaxis

The best way to prevent liver cancer is to reduce risk factors. Hepatitis B can be avoided by receiving the hepatitis B vaccination. Hepatitis C can be prevented by having safe sex, avoiding use of intravenous drugs and being cautious when getting piercings or tattoos to be sure the needles and equipment used are all sterile.

Liver cirrhosis can be prevented by only drinking alcohol in moderation. It is recommended that women only have one drink daily and men have two daily. Also, risk factors such as obesity and diabetes can be prevented by maintaining a healthy weight by eating a balanced, healthy diet and sticking to an exercise regimen.