What is Liver Cancer?
Liver cancer is a cancer that begins in the cells of your liver. The liver is the largest glandular organ in the body and performs various critical functions to keep the body free of toxins and harmful substances.
The liver is located in the right upper quadrant of the abdomen, right below the ribs. It’s responsible for producing bile, which is a substance that helps you digest fats, vitamins, and other nutrients.
This vital organ also stores nutrients such as glucose, so that you remain nourished at times when you’re not eating. It also breaks down medications and toxins.
When cancer develops in the liver, it destroys liver cells and interferes with the ability of the liver to function normally.
Liver cancer is generally classified as primary or secondary. Primary liver cancer begins in the cells of the liver. Secondary liver cancer develops when cancer cells from another organ spread to the liver.
Unlike other cells in the body, cancer cells can break away from the primary site, or where the cancer began.
The cells travel to other areas of the body through the bloodstream or the lymphatic system. Cancer cells eventually collect in another body organ and begin to grow there.
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Before Liver Cancer Treatment
Symptoms
What are the symptoms of liver cancer?
Most people don’t have signs and symptoms in the early stages of primary liver cancer. When signs and symptoms do appear, they may include:
. Losing weight without trying
. Loss of appetite
. Upper abdominal pain
. Nausea and vomiting
. General weakness and fatigue
. Abdominal swelling
. Yellow discoloration of your skin and the whites of your eyes (jaundice)
. White, chalky stools
When to see a doctor
Make an appointment with your doctor if you experience any signs or symptoms that worry you.
Causes
Liver cancer happens when liver cells develop changes (mutations) in their DNA. A cell’s DNA is the material that provides instructions for every chemical process in your body. DNA mutations cause changes in these instructions. One result is that cells may begin to grow out of control and eventually form a tumor — a mass of cancerous cells.
Sometimes the cause of liver cancer is known, such as with chronic hepatitis infections. But sometimes liver cancer happens in people with no underlying diseases and it’s not clear what causes it.
Risk factors
Factors that increase the risk of primary liver cancer include:
. Chronic infection with HBV or HCV. Chronic infection with the hepatitis B virus (HBV) or hepatitis C virus (HCV) increases your risk of liver cancer.
. Cirrhosis. This progressive and irreversible condition causes scar tissue to form in your liver and increases your chances of developing liver cancer.
. Certain inherited liver diseases. Liver diseases that can increase the risk of liver cancer include hemochromatosis and Wilson’s disease.
. Diabetes. People with this blood sugar disorder have a greater risk of liver cancer than those who don’t have diabetes.
. Nonalcoholic fatty liver disease. An accumulation of fat in the liver increases the risk of liver cancer.
. Exposure to aflatoxins. Aflatoxins are poisons produced by molds that grow on crops that are stored poorly. Crops, such as grains and nuts, can become contaminated with aflatoxins, which can end up in foods made of these products.
. Excessive alcohol consumption. Consuming more than a moderate amount of alcohol daily over many years can lead to irreversible liver damage and increase your risk of liver cancer.
Prevention
Reduce your risk of cirrhosis
Cirrhosis is scarring of the liver, and it increases the risk of liver cancer. You can reduce your risk of cirrhosis if you:
. Drink alcohol in moderation, if at all. If you choose to drink alcohol, limit the amount you drink. For women, this means no more than one drink a day. For men, this means no more than two drinks a day.
. Maintain a healthy weight. If your current weight is healthy, work to maintain it by choosing a healthy diet and exercising most days of the week. If you need to lose weight, reduce the number of calories you eat each day and increase the amount of exercise you do. Aim to lose weight slowly — 1 or 2 pounds (0.5 to 1 kilograms) each week.
Get vaccinated against hepatitis B
You can reduce your risk of hepatitis B by receiving the hepatitis B vaccine. The vaccine can be given to almost anyone, including infants, older adults and those with compromised immune systems.
Take measures to prevent hepatitis C
No vaccine for hepatitis C exists, but you can reduce your risk of infection.
. Know the health status of any sexual partner. Don’t engage in unprotected sex unless you’re certain your partner isn’t infected with HBV, HCV or any other sexually transmitted infection. If you don’t know the health status of your partner, use a condom every time you have sexual intercourse.
. Don’t use intravenous (IV) drugs, but if you do, use a clean needle. Reduce your risk of HCV by not injecting illegal drugs. But if that isn’t an option for you, make sure any needle you use is sterile, and don’t share it. Contaminated drug paraphernalia is a common cause of hepatitis C infection. Take advantage of needle-exchange programs in your community and consider seeking help for your drug use.
. Seek safe, clean shops when getting a piercing or tattoo. Needles that may not be properly sterilized can spread the hepatitis C virus. Before getting a piercing or tattoo, check out the shops in your area and ask staff members about their safety practices. If employees at a shop refuse to answer your questions or don’t take your questions seriously, take that as a sign that the facility isn’t right for you.
Seek treatment for hepatitis B or C infection
Treatments are available for hepatitis B and hepatitis C infections. Research shows that treatment can reduce the risk of liver cancer.
Ask your doctor about liver cancer screening
For the general population, screening for liver cancer hasn’t been proved to reduce the risk of dying of liver cancer, and it isn’t generally recommended. People with conditions that increase the risk of liver cancer might consider screening, such as people who have:
. Hepatitis B infection
. Hepatitis C infection
. Liver cirrhosis
Discuss the pros and cons of screening with your doctor. Together you can decide whether screening is right for you based on your risk. Screening typically involves a blood test and an abdominal ultrasound exam every six months.
Diagnosis
Diagnosing liver cancer
Tests and procedures used to diagnose liver cancer include:
. Blood tests. Blood tests may reveal liver function abnormalities.
. Imaging tests. Your doctor may recommend imaging tests, such as an ultrasound, CT and MRI.
. Removing a sample of liver tissue for testing. Sometimes it’s necessary to remove a piece of liver tissue for laboratory testing in order to make a definitive diagnosis of liver cancer.
During a liver biopsy, your doctor inserts a thin needle through your skin and into your liver to obtain a tissue sample. In the lab, doctors examine the tissue under a microscope to look for cancer cells. Liver biopsy carries a risk of bleeding, bruising and infection.
During Liver Cancer Treatment
Liver Cancer Stages
Once liver cancer is diagnosed, your doctor will work to determine the extent (stage) of the cancer. Staging tests help determine the size and location of cancer and whether it has spread. Imaging tests used to stage liver cancer include CTs, MRIs and bone scans.
There are different staging systems doctors can use for liver cancer. The Number staging system is one of these. It divides liver cancer into 4 main stages, from 1 to 4.
Stage 1
Stage 1 liver cancer is divided into stage 1A and stage 1B.
. Stage 1A means there is a single tumor in the liver that is 2cm or less, and it may or may not have grown into a blood vessel (microvascular invasion).
. Stage 1B means there is a single tumor that is more than 2cm, and has not grown into the blood vessels.
Stage 1 liver cancer has not spread to the lymph nodes or anywhere else in the body.
Stage 2
Stage 2 liver cancer means that there is a single tumor that is more than 2 cm, and it has grown into blood vessels of the liver.
Or it means that there are several tumors in the liver and they are all less than 5cm.
Stage 2 liver cancer has not spread to the lymph nodes or other areas of the body.
Stage 3
Stage 3 liver cancer is divided into 2 further stages – stage 3A and 3B.
. Stage 3A
There is more than one tumor, and at least one of them is larger than 5cm. At this stage the cancer has not spread to the lymph nodes or any other part of the body.
. Stage 3B
The cancer has grown into one of the main blood vessels of the liver (the portal vein or hepatic vein).
Or the cancer has spread into organs close to the liver (not including the gallbladder), or through the lining that wraps around the internal organs of the abdomen (the visceral peritoneum). It has not spread to the lymph nodes or any other part of the body.
Stage 4
Stage 4 liver cancer is divided into 2 further stages – stage 4A and 4B.
Knowing the stage of your cancer helps you and your doctors decide about what treatment you need.
. Stage 4A
The cancer is any size and there may be more than one tumor. It may have grown into blood vessels or the organs around the liver. It has spread to lymph nodes but not to other parts of the body.
. Stage 4B
The cancer is any size and there may be more than one tumor. It may have grown into blood vessels or the organs around the liver. It may or may not have spread into lymph nodes, but has spread to another part of the body such as the lungs or bones.
Types of primary liver cancer
What are the different types of primary liver cancer?
The different types of primary liver cancer originate from the various cells that make up the liver. Primary liver cancer can start as a single lump growing in the liver, or it can start in many places within the liver at the same time.
People with severe liver damage are more likely to have multiple cancer growth sites. The main types of primary liver cancer are:
. Hepatocellular carcinoma
Hepatocellular carcinoma (HCC), also known as hepatoma, is the most common type of liver cancer, accounting for 75 percent of all liver cancers.
This condition develops in the hepatocytes, which are the predominant liver cells. It can spread from the liver to other parts of the body, such as the pancreas, intestines, and stomach.
HCC is much more likely to occur in people who have severe liver damage due to alcohol abuse.
. Cholangiocarcinoma
Cholangiocarcinoma, more commonly known as bile duct cancer, develops in the small, tube-like bile ducts in the liver. These ducts carry bile to the gallbladder to help with digestion.
When the cancer begins in the section of the ducts inside the liver, it’s called intrahepatic bile duct cancer. When the cancer begins in the section of the ducts outside the liver, it’s called extrahepatic bile duct cancer.
Bile duct cancer accounts for approximately 10 to 20 percent of all liver cancers.
. Liver angiosarcoma
Liver angiosarcoma is a rare form of liver cancer that begins in the blood vessels of the liver. This type of cancer tends to progress very quickly, so it’s typically diagnosed at a more advanced stage.
. Hepatoblastoma
Hepatoblastoma is an extremely rare type of liver cancer. It’s nearly always found in children, especially those under age 3.
With surgery and chemotherapy, the outlook for people with this type of cancer can be very good. When hepatoblastoma is detected in the early stages, the survival rate is higher than 90 percent.
Treatment
Treatments for primary liver cancer depend on the extent (stage) of the disease as well as your age, overall health and personal preferences.
Surgery
Operations used to treat liver cancer include:
. Surgery to remove the tumor. In certain situations, your doctor may recommend an operation to remove the liver cancer and a small portion of healthy liver tissue that surrounds it if your tumor is small and your liver function is good.
Whether this is an option for you also depends on the location of your cancer within the liver, how well your liver functions and your overall health.
. Liver transplant surgery. During liver transplant surgery, your diseased liver is removed and replaced with a healthy liver from a donor. Liver transplant surgery is only an option for a small percentage of people with early-stage liver cancer.
Localized treatments
Localized treatments for liver cancer are those that are administered directly to the cancer cells or the area surrounding the cancer cells. Localized treatment options for liver cancer include:
. Heating cancer cells. Radiofrequency ablation uses electric current to heat and destroy cancer cells. Using an imaging test as a guide, such as ultrasound, the doctor inserts one or more thin needles into small incisions in your abdomen. When the needles reach the tumor, they’re heated with an electric current, destroying the cancer cells. Other procedures to heat the cancer cells might use microwaves or lasers.
. Freezing cancer cells. Cryoablation uses extreme cold to destroy cancer cells. During the procedure, your doctor places an instrument (cryoprobe) containing liquid nitrogen directly onto liver tumors. Ultrasound images are used to guide the cryoprobe and monitor the freezing of the cells.
. Injecting alcohol into the tumor. During alcohol injection, pure alcohol is injected directly into tumors, either through the skin or during an operation. Alcohol causes the tumor cells to die.
. Injecting chemotherapy drugs into the liver. Chemoembolization is a type of chemotherapy treatment that supplies strong anti-cancer drugs directly to the liver.
. Placing beads filled with radiation in the liver. Tiny spheres that contain radiation may be placed directly in the liver where they can deliver radiation directly to the tumor.
Radiation therapy
This treatment uses high-powered energy from sources such as X-rays and protons to destroy cancer cells and shrink tumors. Doctors carefully direct the energy to the liver, while sparing the surrounding healthy tissue.
Radiation therapy might be an option if other treatments aren’t possible or if they haven’t helped. For advanced liver cancer, radiation therapy might help control symptoms.
During external beam radiation therapy treatment, you lie on a table and a machine directs the energy beams at a precise point on your body.
A specialized type of radiation therapy, called stereotactic body radiotherapy, involves focusing many beams of radiation simultaneously at one point in your body.
Targeted drug therapy
Targeted drug treatments focus on specific abnormalities present within cancer cells. By blocking these abnormalities, targeted drug treatments can cause cancer cells to die.
Many targeted drugs are available for treating advanced liver cancer.
Some targeted therapies only work in people whose cancer cells have certain genetic mutations. Your cancer cells may be tested in a laboratory to see if these drugs might help you.
Immunotherapy
Immunotherapy uses your immune system to fight cancer. Your body’s disease-fighting immune system may not attack your cancer because the cancer cells produce proteins that blind the immune system cells. Immunotherapy works by interfering with that process.
Immunotherapy treatments are generally reserved for people with advanced liver cancer.
Chemotherapy
Chemotherapy uses drugs to kill rapidly growing cells, including cancer cells. Chemotherapy can be administered through a vein in your arm, in pill form or both.
Chemotherapy is sometimes used to treat advanced liver cancer.
Supportive (palliative) care
Palliative care is specialized medical care that focuses on providing relief from pain and other symptoms of a serious illness. Palliative care specialists work with you, your family and your other doctors to provide an extra layer of support that complements your ongoing care. Palliative care can be used while undergoing other aggressive treatments, such as surgery, chemotherapy or radiation therapy.
When palliative care is used along with all of the other appropriate treatments, people with cancer may feel better and live longer.
Palliative care is provided by a team of doctors, nurses and other specially trained professionals. Palliative care teams aim to improve the quality of life for people with cancer and their families. This form of care is offered alongside curative or other treatments you may be receiving.
Alternative medicine
Alternative treatments may help control pain in people with advanced liver cancer. Your doctor will work to control pain with treatments and medications. But sometimes your pain may persist or you may want to avoid the side effects of pain medications.
Ask your doctor about alternative treatments that may help you cope with pain, such as:
. Acupressure
. Acupuncture
. Hypnosis
. Massage
. Relaxation techniques
After Liver Cancer Treatment
Recovery
After surgery for either primary liver cancer or secondary cancer in the liver, you will wake up in a recovery room. You will then be taken back to your bed on the hospital ward. The following is a list of what to expect.
Tubes and drains
When you wake up, you’ll have several tubes in you. This can be frightening, so it helps to know what they’re for.
You might have:
. Drips to give you blood transfusions and fluids usually through a vein in your neck
. Wound drains to drain any blood, bile or fluid from around the operation site
. A tube down your nose into your stomach (nasogastric tube) to drain bile and stop you feeling sick
. A tube into your bladder (catheter) to measure how much urine you pass
. A small tube into a vein or artery to check your blood pressure
. A fine tube into your back that goes into your spinal fluid (epidural) to help relieve pain
You may also have an oxygen mask on.
Electronic pumps may control any medicines you have through your drip.
Wound care
You have a dressing over your wound when you wake up. The dressing stays in place for a couple of days. Your nurse cleans the wound and puts a new dressing on.
The wound drains stay in until they stop draining fluid. Your nurse measures the amount of fluid in the drains. The drains usually stay in for about a week, but it might be longer.
You have the wound stitches or clips taken out after about 10 days. Some wounds are closed with stitches that dissolve and don’t need to be removed.
Pain relief
It’s normal to have pain for the first week or so. You have painkillers to help.
Tell your doctor or nurse as soon as you feel any pain. They need your help to find the right type and dose of painkiller for you. Painkillers work best when you take them regularly.
Immediately after surgery you might have painkillers through a drip into the bloodstream that you control. This is called patient controlled analgesia (PCA).
Or you might have painkillers through a small thin tube that is put into your back. This tube is connected to a pump that gives you a constant dose of painkiller. This is called an epidural.
You get painkillers to take home. Follow the instructions your nurse gives you about how often and when to take them. Contact your doctor if you still have pain or if it gets worse.
Length of hospital stay
You will spend 5–10 days in hospital after a partial hepatectomy, and up to three weeks in hospital following a transplant. If you have a laparoscopy, the recovery time is shorter – you may be able to return to your usual activities within a week. Drips and drains are removed before you leave hospital.
Eating and drinking
You will be able to drink as soon as you wake up and feel able to. Most people start to eat the day after their operation but it depends on how you feel. Your nurse or dietitian might give you nutrition drinks to help until you are able to eat normally.
You might have a tube down your nose and into your stomach called a nasogastric tube. This drains fluid from your stomach and helps to stop you feeling sick. Your nurse will remove the tube once you are eating and drinking normally.
Mobility
A physiotherapist can help with your recovery by giving you exercises to improve your breathing, strength and ability to walk (mobility).
Driving
Your medical team will tell you how long you should avoid driving, which will usually be a few weeks.
Exercise
Talk to your doctor about starting to exercise. Begin with gentle exercise such as walking and build up to more vigorous exercise, depending on how active you were before the surgery.
Making progress
During the first few days after your operation, you’ll start to feel better. The drips and drains will come out, you’ll start eating and can move about better.
You’ll begin to feel like you’re making progress.
Alcohol
Avoid alcohol for at least a month and only drink alcohol in moderation after this time. If you have cirrhosis or a transplant, you must stop drinking alcohol. Your medical team will talk to you about this.
Nutrition
Eat high-protein and high-energy foods to maintain your weight.
Fatigue
You will probably feel quite tired and weak after the operation, but this should improve within a few weeks.
Check-ups
After you return home, you will need frequent check-ups to monitor your health and the success of the surgery. Your doctor will tell you how often you should have check-ups.