FACING LIVER CANCER
Liver :
1. Gathering and purifying blood from the intestines.
2. Processing and storing essential nutrients absorbed from the intestines.
3. Transforming certain nutrients into energy or substances required for tissue repair and growth.
4. Manufacturing certain blood-clotting factors.
5. Detoxifying the body by eliminating harmful substances.
6. Regulating and sustaining the body's optimal blood sugar levels.
Liver Cancer :
This section exclusively focuses on cancer originating in the liver, referred to as primary liver cancer. It is more common for cancer to originate in another part of the body and then spread to the liver, a condition known as metastatic cancer. It's essential to differentiate between primary liver cancer and metastatic cancer because they require different treatment approaches. When cancer begins elsewhere and spreads to the liver, it is still classified by the organ where it originally started. For example, if pancreatic, colon, stomach, breast, lung, or any other type of cancer spreads to the liver, it retains its designation based on the organ of origin. This distinction is crucial, as primary liver cancer and metastatic cancer demand distinct treatment strategies.
TYPES OF LIVER CANCER
In adults, there are various types of primary liver cancer, and their names are based on the specific type of cell from which the cancer originates.
There are different types of primary liver cancer in adults, and they are classified based on the cell type from which the cancer originates:
1. Hepatocellular Carcinoma (HCC):
- Hepatocellular carcinoma can exhibit various growth patterns. Some tumors spread with tentacle-like growths through the liver, which is the most common pattern in the United States. Others begin as a single tumor and subsequently spread to different parts of the liver as the disease progresses. Some may develop as nodules at multiple sites within the liver, and occasionally, the pattern is not clearly defined. Approximately 73% of primary liver cancers in adults are hepatocellular carcinomas.
2. Cholangiocarcinoma (Bile Duct Cancer):
- Cholangiocarcinoma arises from cells in the bile duct of the liver, a slender tube that extends from the liver to the small intestine. The bile duct originates as multiple smaller tubes within the liver that merge together. About 18% of primary liver cancers in adults are cholangiocarcinomas.
3. Angiosarcoma:
- Angiosarcoma originates in the blood vessels of the liver and tends to grow rapidly. Approximately 1% of primary liver cancers in adults are angiosarcomas.
RISK OF LIVER CANCER
The following factors can increase a person's risk of liver cancer. The primary risks in the United States are cirrhosis of the liver and nonalcoholic fatty liver disease (NAFLD), as explained below:
Cirrhosis: Cirrhosis occurs when liver cells are damaged and replaced by scar tissue. Most cirrhosis cases in the United States result from excessive alcohol consumption, known as alcohol abuse. Other causes include NAFLD, viral hepatitis (types B and C), excessive iron buildup in the liver from hemochromatosis, reduced blood flow to the liver due to portal hypertension, and some rare types of chronic liver diseases. Combining alcohol abuse with hepatitis virus infection significantly raises the risk of cirrhosis and hepatocellular carcinoma (HCC).
Obesity, NAFLD, and diabetes: Obesity
leads to fat accumulation in the liver, resulting in NAFLD. Recent evidence suggests that NAFLD and its related condition, diabetes, have become increasingly important risk factors for HCC in the United States.Viral hepatitis: Hepatitis viruses infect the liver, with hepatitis B and C being the most common types. Viral hepatitis is the most significant risk factor for liver cancer globally. Hepatitis C has become more prevalent than hepatitis B because there is no vaccine for hepatitis C. Transmission can occur through contact with blood or bodily fluids, such as through injuries, needle-sharing during drug use or tattooing, and sexual contact. Hepatitis B can be transmitted from an infected mother to her baby, but this risk can be reduced through vaccination.
Age: Liver cancer in the United States primarily affects people over the age of 60.
Gender: Men are at a higher risk of developing liver cancer than women.
Environmental factors: Some environmental factors can increase the risk of liver cancer, including exposure to specific chemicals and consumption of aflatoxin-contaminated food. Aflatoxin is a toxin produced by molds that can grow on stored nuts and grains. The risk of aflatoxin exposure is lower in the United States. It’s important to note that risk factors are cumulative, meaning that having more than one risk factor increases the likelihood of developing liver cancer. For example, a person who has both hepatitis B and C faces a higher risk than someone with just one type of the virus. Similarly, a person with hepatitis C who also consumes alcohol has an elevated risk.
PREVENTION
Various factors contribute to the development of liver cancer, and researchers continue to investigate these causes and ways to prevent the disease. While there’s no foolproof method to entirely prevent liver cancer, there are measures you can take to lower your risk. Discussing your personal risk factors with your doctor is essential for a more tailored approach to prevention.
In the United States, the most effective way to prevent hepatocellular carcinoma (HCC) is by addressing the underlying causes, which are viral hepatitis and cirrhosis. Here are some key prevention strategies:
1. Hepatitis B Vaccination:
A vaccine is available to protect healthy individuals from contracting hepatitis B. The U.S. Centers for Disease Control and Prevention recommends that all children receive this vaccination.
2. Blood Safety:
To prevent hepatitis transmission through blood transfusions, blood banks in the United States rigorously screen donated blood for hepatitis viruses.
3. Alcohol Abstinence:
Avoiding alcohol abuse is crucial in preventing cirrhosis, which is a significant risk factor for liver cancer.
4. Regulations on Carcinogenic Chemicals: Regulations on carcinogenic chemicals are prevalent in many industrialized nations, aimed at safeguarding individuals from exposure to cancer-causing agents. In the United States, these stringent regulations have significantly diminished the prevalence of chemicals linked to hepatocellular carcinoma (HCC). This proactive approach has contributed to lowering the risk of encountering these harmful substances, thus potentially decreasing the incidence of HCC cases.
5. Medications for Chronic Hepatitis B and C:
Advancements in antiviral therapy, particularly for chronic hepatitis C, have been made in recent years. These medications can help control these infections, reduce liver inflammation, and limit the damage caused by the viruses. Early treatment, before cirrhosis develops, can have a substantial impact on liver cancer prevention. Discuss these treatment options with a hepatologist, a specialist in liver diseases.
6. Healthy Lifestyle:
Maintaining a healthy lifestyle is key in reducing the risk of liver cancer, especially concerning nonalcoholic fatty liver disease (NAFLD), a significant risk factor. This involves keeping a healthy weight, following a balanced diet, and engaging in moderate physical activity. Your doctor can assist in crafting a tailored exercise and dietary plan that suits your specific needs and fitness level. Regular check-ups and open communication with your
SIGNS AND SYMPTOMS
1. Pain: Often felt in the upper right abdominal area, near the right shoulder blade, or in the back.
2. Unexplained Weight Loss: A significant and unintended reduction in body weight.
3. Hard Lump: A palpable mass under the ribs on the right side of the body, which may be the tumor or a sign of an enlarged liver.
4. Weakness or Fatigue: A persistent feeling of tiredness.
5. Jaundice: Yellowing of the skin or eyes, which is a result of liver dysfunction.
It’s important to note that when hepatocellular carcinoma (HCC) is diagnosed, individuals may already have cirrhosis and may be under the care of a healthcare provider. Some symptoms experienced by individuals with HCC may actually be due to cirrhosis rather than the tumor itself. These symptoms may include abdominal swelling due to fluid accumulation (ascites), an increased need for diuretics to manage fluid retention, mental confusion (hepatic encephalopathy), and bleeding from the esophagus or stomach. Any worsening of these conditions may indicate the presence of cancer.
If you notice any concerning changes in your health, it is advisable to discuss them with your doctor. During a medical evaluation, your doctor will inquire about the duration and frequency of your symptoms, among other questions, to help determine the underlying cause of the problem, leading to a diagnosis.
If liver cancer is diagnosed, managing symptoms is an important aspect of cancer care and treatment. This is often referred to as “palliative care” or “supportive care,” and it typically begins soon after diagnosis and continues throughout the treatment process. It’s crucial to maintain open communication with your healthcare team regarding any symptoms you may experience, including any new symptoms or changes in your existing symptoms. This ensures that you receive appropriate care and support during your cancer journey.
DIAGNOSIS
1. Physical Examination: The doctor will conduct a physical examination to assess the abdomen, check for lumps, swelling, and changes in the liver, spleen, and surrounding organs. They will also look for signs of jaundice (yellowing of the skin and eyes) and the accumulation of fluid in the abdomen (ascites)
2. Blood Tests: Blood tests are often performed alongside the physical examination. These tests may include assessing the levels of alpha-fetoprotein (AFP), which can be elevated in people with HCC. Additionally, blood tests can determine the presence of hepatitis B or C and assess the overall liver function.
3. Imaging Tests: Ultrasound: This non-invasive test uses sound waves to create images of the liver and other abdominal structures. It helps visualize tumors and assess their location. Computed Tomography (CT) Scan: CT scans provide 3D images of the body using X-rays taken from different angles. A contrast medium may be administered to enhance image quality. Magnetic Resonance Imaging (MRI): MRI uses magnetic fields to produce detailed images of the body, helping to measure the tumor’s size. Angiogram: An angiogram is an X-ray of the blood vessels, typically using a contrast medium to visualize the liver’s blood supply
4. Laparoscopy: a minimally invasive procedure, employs a thin, illuminated tube (laparoscope) to visualize the body’s interior. However, its use in diagnosing liver cancer remains infrequent due to other more prevalent diagnostic methods. This technique isn’t typically the primary choice for identifying liver cancer, with healthcare providers often opting for alternative diagnostic approaches. it allows for minimal invasion during procedures, reducing recovery times and the risk of complications compared to traditional open surgeries.
5. Biopsy: A biopsy involves the removal of a small tissue sample for microscopic examination. Biopsies are often performed when cancer is suspected, but the diagnosis isn’t definitive based on other tests. There are different types of biopsies, including fine-needle aspiration and core biopsy. Fine-needle aspiration collects cells using a thin needle, while a core biopsy uses a thicker needle. These biopsies are guided by ultrasound. Biopsies are typically done by a radiologist.
6. Biomarker Testing: Laboratory tests on the tumor sample can identify specific genes, proteins, and other factors unique to the tumor. This information may be used to determine if targeted therapy is a suitable treatment option. It’s important to note that, in certain situations, a biopsy may not be needed if other diagnostic tests, such as the AFP blood test, CT scan, or MRI, strongly indicate HCC and other results are consistent with HCC. Some very small masses may require a “watch and wait” approach, where the patient is monitored closely with repeated scans. If the mass remains stable, surveillance continues, but if it grows, a biopsy may be recommended
After the diagnostic tests are completed, your doctor will discuss the results with you. If the diagnosis is HCC, the results will also help determine the stage of the cancer, which is crucial for treatment planning. Staging is a process of categorizing the extent and severity of the cancer.
STAGES OF LIVER CANCER
The TNM system for staging liver cancer classifies it into four main stages with various sub-stages
STAGE 1 :
In the initial stage of liver cancer, a tumor forms within the liver. However, its impact is limited because it has not yet come into contact with any blood vessels.
STAGE 2 :
The tumor grows in size, reaching a diameter of up to 5 cm. There is also a possibility of developing multiple small tumors. Although the tumor has expanded into blood vessels, its spread remains localized.
STAGE 3A :
This stage is characterized by further tumor growth. The average tumor size is 5 cm in diameter, and nearby lymph nodes are still free from cancer.
STAGE 3B :
One or more tumors invade the portal or hepatic vein of the liver. At this point, nearby lymph nodes and distant organs are still unaffected by the malignancy.
STAGE 3C :
The tumor has either encased the outer surface of the liver or penetrated nearby organs, but distant sites are still unharmed by the cancer.
STAGE 4A :
In this stage, the size and number of liver tumors grow significantly. Tumors have also spread to lymph nodes, blood vessels, or neighboring organs. However, distant sites are still unaffected.
STAGE 4B :
Malignant cells have spread throughout the entire body.