Liver cancer, also known as hepatocellular carcinoma, is a serious and often life-threatening medical condition characterized by the uncontrolled growth of malignant cells within the liver. It is a significant global health concern, with risk factors including chronic viral hepatitis, excessive alcohol consumption, non-alcoholic fatty liver disease, and exposure to certain toxins. Liver cancer often presents with few symptoms in its early stages, making it challenging to diagnose until it has reached an advanced and more difficult-to-treat state. Timely diagnosis and treatment are crucial for improving the prognosis of individuals affected by liver cancer. Treatment options may include surgery, chemotherapy, radiation therapy, targeted therapies, and in some cases, liver transplantation. As with many forms of cancer, prevention and early detection play key roles in reducing the impact of this disease on individuals and communities.
Types of liver cancer
There are several types of liver cancer, but the most common primary liver cancer is hepatocellular carcinoma (HCC). Primary liver cancer originates in the liver itself. The main types of liver cancer include:
Hepatocellular Carcinoma (HCC)
HCC is the most common form of primary liver cancer, and it typically develops in the hepatocytes, the main type of liver cells. It is often associated with chronic liver diseases, such as cirrhosis, and is more common in individuals with a history of hepatitis B or C infection.
Intrahepatic Cholangiocarcinoma
This type of liver cancer originates in the bile ducts within the liver. It is less common than HCC but can be quite aggressive.
Hepatoblastoma
Hepatoblastoma is a rare liver cancer that primarily affects children, usually those under the age of 3. It develops from immature liver cells and has a relatively good prognosis when diagnosed and treated early.
Angiosarcoma and Hemangiosarcoma
These are rare types of liver cancer that originate in blood vessels in the liver. They can be quite aggressive and are often challenging to treat.
Fibrolamellar Carcinoma
This is a rare form of liver cancer that typically affects young adults and is associated with a better prognosis compared to HCC.
Mixed Hepatocellular-Cholangiocarcinoma
This is a rare type of liver cancer that contains a combination of both hepatocellular and cholangiocarcinoma features.
Undifferentiated Liver Carcinomas
These are liver cancers that do not show clear differentiation into specific cell types and are often quite aggressive.
Liver cancer symptoms
Liver cancer, also known as hepatocellular carcinoma (HCC), often does not cause noticeable symptoms in its early stages. As the cancer progresses, some of the common symptoms and signs may include:
Jaundice
Yellowing of the skin and the whites of the eyes is a common symptom of liver cancer. It occurs when the cancer interferes with the liver’s ability to process bilirubin, a substance produced when red blood cells break down.
Abdominal pain or discomfort
Pain in the upper right side of the abdomen or near the right shoulder blade can be a symptom of liver cancer. This pain may be persistent or intermittent.
Unexplained weight loss
Sudden and unexplained weight loss is a general symptom of various cancers, including liver cancer. Foods to Eat to Help You Lose Weight
Fatigue and weakness
Feeling excessively tired and weak is a common symptom, often related to the body’s energy balance being disrupted by the cancer.
Loss of appetite
Many people with liver cancer experience a reduced appetite, which can lead to weight loss.
Nausea and vomiting
These symptoms may be present, especially as the cancer progresses and affects the liver’s ability to process toxins.
Abdominal swelling
Liver cancer can cause fluid buildup in the abdomen, leading to swelling and discomfort.
Enlarged liver and spleen
An enlarged liver (hepatomegaly) and spleen (splenomegaly) can be observed in some cases.
Itchy skin
Pruritus, or itchy skin, is sometimes associated with liver cancer, and it can be a result of bile buildup in the bloodstream due to liver dysfunction.
White, chalky stools
Changes in the color and consistency of stools can occur when bile flow is obstructed by the cancer.
How is liver cancer diagnosed?
The diagnosis of liver cancer typically involves a combination of medical history review, physical examination, and various diagnostic tests. Here are the common steps and tests involved in diagnosing liver cancer:
Medical History and Physical Examination
The process usually begins with a thorough review of your medical history, including risk factors such as hepatitis B or C infection, cirrhosis, alcohol consumption, and family history of liver cancer. A physical examination may also be performed to check for any signs of liver enlargement, jaundice, or other symptoms.
Blood Tests
Blood tests are often conducted to assess liver function and to look for specific markers that may indicate liver cancer. These markers can include alpha-fetoprotein (AFP) and des-gamma-carboxy prothrombin (DCP). Elevated levels of these markers can be a sign of liver cancer, although they are not definitive.
Imaging Tests
- Ultrasound: Ultrasound imaging is a common first step to evaluate liver abnormalities. It can help identify liver tumors and their size.
- Computed Tomography (CT) Scan: CT scans provide detailed cross-sectional images of the liver, allowing for better visualization of tumors and their location.
- Magnetic Resonance Imaging (MRI): MRI scans can provide detailed images of the liver and are often used to further assess liver tumors.
Liver Biopsy
In some cases, a biopsy may be necessary to confirm the diagnosis. A small sample of liver tissue is taken and examined under a microscope to determine the presence of cancer cells and their type.
Endoscopy
In some cases, an endoscopy procedure may be performed to visualize the inside of the digestive tract, specifically the esophagus and stomach. This is particularly relevant when screening for esophageal varices, which can be associated with liver cirrhosis.
Angiography
Angiography involves injecting a contrast dye into blood vessels to visualize the blood supply to the liver. It can help identify the location and extent of liver tumors.
Laparoscopy
In certain situations, laparoscopy may be used to directly inspect the liver and obtain biopsy samples. It is a surgical procedure where a thin, flexible tube with a camera is inserted into the abdomen.
How is liver cancer treated?
The treatment of liver cancer depends on several factors, including the stage of the cancer, the patient’s overall health, and the specific type of liver cancer. The main types of liver cancer are hepatocellular carcinoma (HCC), which is the most common type, and cholangiocarcinoma, which starts in the bile ducts within the liver.
Here are some common treatment options for liver cancer:
Surgery
- Surgery may be an option if the cancer is detected early and is confined to a specific area of the liver. Surgical options may include:
- Hepatectomy: This is the surgical removal of part of the liver.
- Liver transplant: In some cases, a liver transplant may be recommended, especially for patients with small tumors or cirrhosis.
Ablation therapy
Ablation techniques are used to destroy cancerous tissue in the liver. These methods include:
- Radiofrequency ablation (RFA)
- Microwave ablation
- Ethanol injection
- Cryoablation
Transarterial chemoembolization (TACE)
TACE is a procedure that delivers chemotherapy drugs directly to the tumor while blocking the blood supply to the tumor.
Targeted therapy
Targeted therapy drugs are designed to interfere with specific molecules involved in the growth and spread of cancer cells. Sorafenib and lenvatinib are examples of targeted therapy drugs used for liver cancer.
Immunotherapy
Immune checkpoint inhibitors, such as nivolumab and pembrolizumab, may be used to boost the immune system’s ability to recognize and attack cancer cells.
Radiation therapy
Radiation therapy can be used to target and kill cancer cells. It may be used as an option for treating liver cancer in certain situations.
Systemic chemotherapy
Systemic chemotherapy involves using drugs that are delivered throughout the body via the bloodstream. It is typically used for advanced cases of liver cancer when other treatments are not effective.
Supportive care
In some cases, palliative care may be recommended to manage symptoms, provide pain relief, and improve the patient’s quality of life, especially in advanced stages of the disease.
How can liver cancer be prevented?
Preventing liver cancer involves reducing the risk factors associated with the disease. While not all cases of liver cancer can be prevented, there are several steps you can take to lower your risk:
Hepatitis B and C vaccination
Getting vaccinated for hepatitis B can significantly reduce your risk of developing liver cancer, as chronic hepatitis B infection is a major risk factor. For hepatitis C, there is no vaccine, but effective treatments are available to cure the infection. It’s important to get screened and treated if you are at risk.
Practice safe sex and avoid sharing needles
Hepatitis B and C can be transmitted through unprotected sexual contact and the sharing of needles, so practicing safe sex and not sharing needles are important preventive measures.
Limit alcohol consumption
Excessive alcohol consumption can lead to liver damage and increase the risk of liver cancer. If you choose to drink, do so in moderation. The recommended limits for alcohol consumption vary by country, but generally, moderate drinking is defined as up to one drink per day for women and up to two drinks per day for men.
Maintain a healthy weight
Obesity is a risk factor for liver cancer. Maintaining a healthy weight through a balanced diet and regular physical activity can reduce your risk.
Eat a healthy diet
A diet that is high in fruits, vegetables, and whole grains and low in processed and red meats can help reduce the risk of liver cancer. Avoiding aflatoxin-contaminated foods, such as improperly stored grains and nuts, is also important.
Control diabetes and metabolic conditions
Individuals with diabetes and other metabolic conditions, such as non-alcoholic fatty liver disease (NAFLD), are at an increased risk of liver cancer. Managing these conditions through proper medical care, diet, and exercise can help reduce the risk.
Limit exposure to toxins
Avoid exposure to environmental toxins and chemicals that are known to be harmful to the liver, such as industrial chemicals and pesticides.
Regular medical check-ups
Regular health check-ups can help identify liver problems early, and early detection of liver conditions can lead to more effective treatment and lower the risk of liver cancer.
Reduce the use of tobacco products
Smoking and the use of other tobacco products have been linked to an increased risk of liver cancer. Quitting or avoiding tobacco can reduce this risk.
Take prescribed medications cautiously
Some medications can have adverse effects on the liver. It’s essential to take medications only as directed by a healthcare provider and to report any unusual symptoms to your healthcare team.
The Bottom Line
The bottom line for liver cancer is that early detection and timely intervention are crucial for improving prognosis. Lifestyle modifications, such as reducing alcohol consumption and managing risk factors like hepatitis, can help lower the risk of liver cancer. Additionally, advancements in medical treatments and therapies offer hope for those diagnosed with this condition. Regular check-ups, screenings, and a healthy lifestyle are key to managing and preventing liver cancer.
