Liver cancer is cancer that starts in the liver. Many cancers arise outside the liver and spread to the organ, but only cancer that starts in the liver is identified by doctors as liver cancer.
The liver lies under the right lung, just behind the ribcage. This is one of the human body’s largest organs, and has other important functions including removing toxins from the body.
The American Cancer Society ( ACS) reports that, in 2019, 42,030 people will be diagnosed with liver cancer. Of these, 29,480 are to be men and 12,550 are to be women. Since 1980, yearly liver cancer diagnoses have trebled.
In this article, we explain the symptoms of liver cancer, how it progresses, how it can be treated and the risk factors that may lead to the cancer. We describe the best ways to avoid the disease, too.
Symptoms
Usually the symptoms of liver cancer aren’t apparent until the disease reaches an advanced stage.
Liver cancer may cause the following:
- jaundice, where the skin and eyes become yellow
- abdominal pain
- pain close to the right shoulder blade
- unexplained weight loss
- an enlarged liver, spleen, or both
- swelling in the abdomen or fluid buildup
- fatigue
- nausea
- vomiting
- back pain
- itching
- fever
- a full feeling after a small meal
As well as swelling and bleeding, liver cancer can also cause swollen veins that are noticeable under the abdominal skin.
It may also result in high calcium and cholesterol levels, and low levels of blood sugar.
Stages
Healthcare professionals divide its development into four stages to help direct treatment and identify the outlook for liver cancer:
- Stage 1: The tumor remains in the liver and has not spread to another organ or location.
- Stage 2: Either there are several small tumors that all remain in the liver or one tumor that has reached a blood vessel.
- Stage 3: There are various large tumors or one tumor that has reached a main, large blood vessel.
- Stage 4: The cancer has metastasized, meaning it has spread to other parts of the body.
Once the cancer stage has been diagnosed and identified by a doctor, a person may begin treatment.
Treatment
The best way to increase the chances of recovery for people with treatable early stage liver cancer is through surgery that completely eliminates the tumours.
Surgical options include the following.
Partial hepatectomy
If the tumor is small and occupies a tiny portion of the liver, a surgeon may only remove that part of the organ to avoid the growth and spread of cancer.
Nevertheless, many people with hepatic cancer may have cirrhosis, or liver scarring. In this situation, following hepatectomy, a surgeon has to leave enough healthy tissue for the liver to function.
If the surgeon determines that this course is not possible during surgery and the risk is too high, they can cancel the procedure halfway through.
Hepatectomy is appropriate only for people with otherwise good liver function. However, if cancer has already spread to other parts of the liver or organs in the body, the procedure might not be a suitable treatment choice.
This size of liver surgery can cause severe bleeding and blood clotting issues, as well as infections and pneumonia.
Hepatectomy is appropriate only for people with otherwise good liver function. However, if cancer has already spread to other parts of the liver or organs in the body, the procedure might not be a suitable treatment choice.
This size of liver surgery can cause severe bleeding and blood clotting issues, as well as infections and pneumonia.
There are limited chances of performing transplants. Currently about 15,000 people are on waiting lists around the United States for a new liver.
Drugs that suppress the immune system can also leave a person vulnerable to serious infections and help the body adapt to a new liver. Such medications can also sometimes lead to the spread of tumors that have metastasized already.
Treatment for incurable tumors
Advanced liver cancer has an exceptionally poor survival rate even where it has spread to other parts of the body. A cancer care team may also take measures to treat the symptoms and delay tumor development.
Treatment options can differ according to the type of liver cancer.
- Ablative therapy: A surgeon can use radio waves, electromagnetic waves and heat, or alcohol directly on the tumor to shrink it or prevent its growth. Destroying a tumor by freezing, which is known as cryoablation, may also be possible.
- Radiation therapy: A cancer care team directs radiation at the tumor or tumors, killing a significant number of them. Side effects might include nausea, vomiting, and fatigue.
- Chemotherapy: A medical team injects drugs into the bloodstream or a main blood vessel in the liver to kill cancer cells. In chemoembolization, a doctor surgically or mechanically blocks the blood vessel in conjunction with administering anticancer drugs directly into the tumor.
A doctor may recommend that an patient participate in clinical trials for drugs and treatments which have not yet entered general use. This might relieve the symptoms and people might ask their doctor about any current clinical trials that may be suitable.
Causes
The precise causes of liver cancer are still not clear to physicians. Most liver cancers, however, are associated with cirrhosis.
Chronic hepatitis B or C virus infections are the most common causes of liver cancer in the USA, according to the ACS.
People with either type of virus have a significantly higher risk of developing hepatic cancer than other healthy individuals, as both forms can lead to cirrhosis.
Many inherited liver disorders, including hemochromatosis, cause cirrhosis, and therefore raise the risk of liver cancer.
Many contributing factors to the development of liver cancer include:
Type 2 diabetes: People with diabetes, especially if they also have hepatitis or regularly consume a lot of alcohol, are more likely to develop liver cancer.
Family history: If someone’s mother, father, brother, or sister has had liver cancer, they have a higher risk of developing the disease themselves.
Heavy alcohol use: Consuming more than six alcoholic drinks every day for an extended period can lead to cirrhosis. This, in turn, increases the risk of liver cancer.
Long term exposure to aflatoxins: A particular fungus creates a substance called aflatoxin. When mold grows on the following crops, it can lead to the presence of aflatoxins:
- wheat
- groundnuts
- corn
- nuts
- soybeans
- peanuts
The risk of hepatic cancer only rises after long-term exposure to aflatoxins. In developed nations, these compounds are less of a problem where manufacturers regularly test for aflatoxins.
Low immunity: People with weakened immune systems, such as those with HIV or AIDS have a risk of liver cancer that is five times greater than other healthy individuals.
Obesity: Being obese raises the risk of developing many cancers. In people who go on to develop liver cancer, obesity can contribute to cirrhosis and fatty liver disease.
Gender: Around three times as many males get liver cancer as females, according to the ACS.
Smoking: Both former and current smokers have a higher risk of liver cancer than people who have never smoked.
Individuals who have a high risk for liver cancer should have regular screenings for liver cancer. They include those with:
- hepatitis B or C
- alcohol related cirrhosis
- cirrhosis due to hemochromatosis, a disorder that involves deposits of iron salts in body tissue
When a doctor treat it at a later stage, liver cancer is very difficult to cure.
Screening is the most reliable way to detect liver cancer early, since early stage liver cancer signs are either mild or non-existent.
Outlook
The outlook for liver cancer is poor. People often spot late identifying liver cancer.
The 5-year survival rate is 31 per cent before liver cancer spreads from its initial source. It means 31 percent of people diagnosed with liver cancer by physicians will survive at least five years after diagnosis.
The survival rate decreases to 11 percent once the cancer spreads to nearby tissues.
As liver cancer spreads to distant organs at later stages, this decreases to 2%. That is why routine screening is so critical for people who are at high risk for liver cancer.
Liver cancer treatment often involves intensive operations with a high risk of complications. This can further affect the outlook for a person with liver cancer.
Diagnosis
Early diagnosis greatly increases survival chances for those with liver cancer.
A physician may begin by asking about the medical history of a individual to rule out any possible risk factors. They will then perform a physical examination focussing on abdominal swelling and any yellow in the eye whites. These are both reliable indicators of liver problems.
When a doctor suspects liver cancer they will call for further testing. Those may include:
- Blood tests: These include tests for blood clotting, levels of other substances in the blood, and proportions of red and white blood cells and platelets.
- Viral hepatitis tests: The doctor will check for hepatitis B and C.
- Imaging scans: An MRI or CT scan can provide a clear picture of the size and spread of the cancer.
- Biopsy: A surgeon removes a small sample of tumor tissue for analysis. The results can reveal whether the tumor is cancerous or noncancerous.
- Laparoscopy: This is an outpatient surgical procedure that takes place under general or local anesthetic. A surgeon inserts a long, flexible tube with a camera attached through a cut in the abdomen. The camera allows the doctor to see the liver and the surrounding area.
Once the doctor has assessed the stage, location, and type of liver cancer, they can decide the likelihood of safely and effectively treating it.
Prevention
Together with several other cancers, liver cancer has poor survival rate. Individuals may reduce their chance of having the disease, however. They, too, will boost their early detection chances.
There’s no way to fully avoid liver cancer, but the following steps can help reduce the risk.
Moderate alcohol intake: regular long-term alcohol consumption increases the risk of cirrhosis and liver cancer significantly.
Moderating or abstaining from consuming alcohol will significantly reduce the risk of developing hepatic cancer.
Limiting tobacco use: It can help prevent liver cancer, especially in people with hepatitis B and C.
Having a vaccine for hepatitis B: The following people should consider taking the vaccine for hepatitis:
- people with a drug dependency who share needles
- individuals who engage in unprotected sex with multiple partners
- nurses, doctors, dentists, and other medical professionals whose jobs increase their risk of hepatitis B infection
- those who frequently visit parts of the world where hepatitis B is common
There is no sure means of stopping hepatitis C and no virus vaccine. Using a condom during intercourse, however, will help to reduce the risk of infection.
Maintaining a healthy body weight: obesity is a risk factor because fatty liver disease and cirrhosis can lead to diabetes and liver cancer. Checking for good fitness and maintaining a healthy body weight will help reduce the risk of hepatic cancer.
Treatment of underlying conditions: Many other diseases, such as diabetes and hemochromatosis, will lead to liver cancer. Treating these can reduce the risk of complications before they develop into liver cancer.
If anyone thinks they may have the early signs of hepatic cancer, it is best to seek consultation with a doctor. Daily screening is important for people at high risk of contracting the disease.
