Liver Cancer or Hepatic Tumour is a cancer of Liver. There are several different types of tumours that can develop in the liver as liver is made up of various cell types. These growths can be benign or malignant. Cancerous tumours can start in liver and spread to other areas of your body, through your bloodstream or your lymphatic system. This spread of cancer is called metastasis. Tumours may also spread from other parts of your body, such as from your bowel, breast or lungs, to your liver.
Symptoms of Liver Cancer
Most people do not have signs and symptoms in the early stages of primary liver cancer. When symptoms do appear, they may include:
• Losing weight without trying
• Loss of appetite
• Upper abdominal pain
• Nausea and vomiting
• General weakness and fatigue
• An enlarged liver
• Abdominal swelling
• Yellow discoloration of your skin and the whites of your eyes (jaundice)
Types of Liver Cancer
There are two broad categories of liver cancer: Primary and Secondary
Primary Liver Cancer
Primary liver cancer starts in the cells, bile ducts, blood vessels or connective tissue of the liver . There are different types of primary liver cancer that include:
• Hepatoma : This is the most common type. It is sometimes called hepatocellular carcinoma (HCC). This type of cancer originates from a liver cell (hepatocyte) which becomes cancerous. The bulk of the liver is made up from hepatocytes. A hepatoma most commonly develops as a complication of liver diseases such as cirrhosis or types of hepatitis (liver inflammation).
• Fibrolamellar : This hepatoma is a rare sub-type of hepatoma. It typically develops in a liver that was previously healthy.
• Cholangiocarcinoma : This is uncommon. It develops from cells which line the bile duct.
• Hepatoblastoma : This is a very rare cancer that occurs in some young children.
• Angiosarcoma : This is very rare. It develops from cells of blood vessels within the liver.
Secondary Liver Cancer
Secondary liver cancer is a cancer that first develops elsewhere in the body and then spreads (metastasizes) to the liver. It is sometimes called metastatic cancer. When a cancer forms in a part of the body, a few cancer cells may break off and find their way into the bloodstream. Because your liver filters your blood, any cancer cells in the bloodstream have a high chance of settling in the liver to form a cancer nodule (metastasis).
People who are most at risk of secondary liver cancer are those with cancers of the large bowel (colon), pancreas, stomach, lung or breast. It is important to know where the cancer started as this will determine the type of cells which are causing the cancer and affect which treatment is best suited for you. Secondary cancer diagnosed in the liver may be a sign of cancer in other organs. Sometimes, secondary cancer is found in the liver and yet, even with thorough medical tests, it’s not possible to find out where the cancer started.
This is sometimes known as cancer of unknown primary.
Staging of Liver Cancer
There are a number of different systems that can be used to stage liver cancer. Many liver cancer specialists use combination-staging systems that include features of both the cancer and liver function to stage a person’s condition.
One combination system for staging liver cancer is known as the Barcelona Clinic Liver Cancer (BCLC) staging system that consists of the following five stages.
• Stage 0 - The tumour is less than 2cm (20mm) in diameter and the person is very well and has normal liver function.
• Stage A - A single tumour has grown but is less than 5cm (50mm) in diameter, or there are three or fewer smaller tumours that are less than 3cm (30mm) in diameter and the person is very well with normal liver function.
• Stage B - There are multiple tumours in the liver, but the person is well and their liver function is unaffected.
• Stage C - Any of the above circumstances, but the person is not so well and their liver function is not so good; or where the cancer has started to spread into the main blood vessel of the liver, into nearby lymph nodes or into other parts of the body.
• Stage D – Where the liver has lost most of its functioning abilities and the person begins to have symptoms of end-stage liver disease, such as a build-up of fluid inside their abdomen.
• Physical exam -- The doctor feels the abdomen to check the liver, spleen, and nearby organs for any lumps or changes in their shape or size. The doctor also checks for ascites, an abnormal buildup of fluid in the abdomen. The doctor may examine the skin and eyes for signs of jaundice.
• Blood tests -- Many blood tests may be used to check for liver problems. One blood test detects alpha-fetoprotein (AFP). High AFP levels could be a sign of liver cancer. Other blood tests can show how well the liver is working.
• CT scan -- An x-ray machine linked to a computer takes a series of detailed pictures of the liver and other organs and blood vessels in the abdomen. The patient may receive an injection of a special dye so the liver shows up clearly in the pictures.
From the CT scan, the doctor may see tumors in the liver or elsewhere in the abdomen.
• Ultrasound test -- The ultrasound device uses sound waves that cannot be heard by humans. The sound waves produce a pattern of echoes as they bounce off internal organs. The echoes create a picture (sonogram) of the liver and other organs in the abdomen. Tumors may produce echoes that are different from the echoes made by healthy tissues.
• MRI -- A powerful magnet linked to a computer is used to make detailed pictures of areas inside the body. These pictures are viewed on a monitor and can also be printed.
• Angiogram -- For an angiogram, the patient may be in the hospital and may have anesthesia. The doctor injects dye into an artery so that the blood vessels in the liver show up on an x-ray. The angiogram can reveal a tumor in the liver.
• Biopsy -- In some cases, the doctor may remove a sample of tissue. A pathologist uses a microscope to look for cancer cells in the tissue. The doctor may obtain tissue in several ways. One way is by inserting a thin needle into the liver to remove a small amount of tissue. This is called fine-needle aspiration. The doctor may use CT or ultrasound to guide the needle. Sometimes the doctor obtains a sample of tissue with a thick needle (core biopsy) or by inserting a thin, lighted tube (laparoscope) into a small incision in the abdomen. Another way is to remove tissue during an operation.
The treatment options are dictated by the stage of Liver Cancer and the overall condition of the patient. The treatment to be given depends mainly on the size, number, and site of tumors in the liver. Before planning the appropriate treatment the functioning of the Liver is checked as also the spread of the cancer within and outside the liver is to be tested. The Various treatment options available are as follows:
Surgery : Surgery is the removal of the tumor and surrounding tissue during an operation. It is likely to be the most successful disease-directed treatment, particularly for patients with small tumors (smaller than 5 cm). A surgical oncologist is a doctor who specializes in treating cancer using surgery.
Hepatectomy : When a portion of the liver is removed, the surgery is called a Hepatectomy. A Hepatectomy can be done only if the cancer is in one part of the liver, and the liver is working well. The remaining section of liver takes over the functions of the entire liver and may regrow to its normal size within a few weeks
Liver Transplantation :Liver transplant may be the best option for some people with small liver cancers. At this time, liver transplants are reserved for those with small tumors (either 1 tumor smaller than 5 cm across or 2 to 3 tumors no larger than 3 cm) that have not invaded nearby blood vessels. In most cases, transplant is used for tumors that cannot be totally removed, either because of the location of the tumors or because the liver is too diseased for the patient to withstand removing part of it.
Chemoembolization: This is a type of chemotherapy treatment in which drugs are injected into the hepatic artery and then the flow of blood through the artery is blocked for a short time so the chemotherapy stays in the tumor longer. Blocking the blood supply to the tumor also kills cancer cells
Radiation Therapy : Radiation therapy is the use of high-energy x-rays or other particles to kill cancer cells. A doctor who specializes in giving radiation therapy to treat cancer is called a radiation oncologist. A radiation therapy regimen (schedule) usually consists of a specific number of treatments given over a set period of time. External-beam radiation therapy is radiation given from a machine outside the body. External-beam radiation therapy is not often used for HCC.
Targeted Therapy : Targeted therapy is a treatment that targets the cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. This type of treatment blocks the growth and spread of cancer cells while limiting damage to normal cells. Recent studies show that not all tumors have the same targets. To find the most effective treatment, your doctor may run tests to identify the genes, proteins, and other factors in your tumor.
• Chemoembolization : Before Insertion of the tiny particles that block the blood flow an anticancer drug is injected into the artery. The drug stays in the liver for longer without blood flow, and thus the impact is more.
• Radiofrequency Ablation : For inoperable liver tumors, radiofrequency ablation (RFA) offers a nonsurgical, localized treatment that kills the tumor cells with heat, while sparing the healthy liver tissue. Thus, this treatment is much easier on the patient than systemic therapy.
• Cryosurgery : It is a treatment that uses an instrument to freeze and destroy abnormal tissue, such as cancerous cells. This type of treatment is also called Cryotherapy. The doctor may use ultrasound to guide the instrument.
• Percutaneous Ethanol Injection : Percutaneous ethanol injection is a cancer treatment in which a small needle is used to inject ethanol (alcohol) directly into a tumor to kill cancer cells. The procedure may be done once or twice a week. Usually local anesthesia is used, but if the patient has many tumors in the liver, general anesthesia may be needed.
• Hyperthermia Therapy : Hyperthermia therapy is a type of treatment in which body tissue is exposed to high temperatures to damage and kill cancer cells or to make cancer cells more sensitive to the effects of radiation and certain anticancer drugs. Because some cancer cells are more sensitive to heat than normal cells are, the cancer cells die and the tumor shrinks.
• Biologic Therapy : Biologic therapy is a treatment that uses the patient’s immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body’s natural defenses against cancer. This type of cancer treatment is also called biotherapy or immunotherapy.
You may want to ask some questions before your treatment begins: