Liver Cancer

What is liver cancer?

Liver cancer is a form of cancer that starts in the cells of the liver. There are many different types of cancer that can develop, but the most common form is hepatocellular carcinoma (HCC). This type of liver cancer involves liver cells known as hepatocytes.

Liver cancer is different from metastatic forms of cancer that have spread from other parts of the body. For example, breast cancer that has spread to the liver is called metastatic breast cancer and not liver cancer.

What are the symptoms of liver cancer?

Early stages of liver cancer generally do not produce symptoms. However, some patients may experience them sooner than others. These symptoms are often not specific and may be caused by other conditions. These symptoms include:

• Unexplained weight loss
• Anorexia, or loss of appetite
• Pain in the upper abdomen
• Nausea or vomiting
• Fatigue or generalized weakness
• Itching
• Enlargement of the abdomen
• Yellow discoloration of the eyes and/or skin (jaundice)

The non-specific nature of these symptoms highlights the need for medical consultation in order to determine the exact cause and rule out or confirm the presence of liver cancer.

What are the risk factors for liver cancer?

There have been some factors identified with the development of liver cancer. These are:

• Gender – males are more likely to develop HCC than women
• Weight – obesity may be linked to the development of HCC
• Hepatis B or C infection
• Non-alcoholic fatty liver disease (NAFLD)
• Cirrhosis
• Diabetes
• Inherited metabolic diseases such as hemochromatosis and Wilson’s disease
• Exposure to aflatoxins – molds in grains and nuts

What tests are available for liver cancer?

Diagnosis of liver cancer starts out by obtaining a thorough medical history about the symptoms, risk factors, and dietary habits of the patient. This is followed by a physical examination to identify any abnormal findings such as an enlarged abdomen, jaundice, the presence of fluid in the abdomen, or in some cases, the presence of a palpably enlarged liver.

Imaging tests are also performed to detect abnormal lesions in the liver and to determine how far it may have spread. Imaging tests are also useful in guiding a biopsy needle, wherein a sample of the abnormal tissue is obtained and checked whether it is cancerous or not. These tests include:

• Ultrasound – sound waves are emitted to create visual images of the liver
• Computed tomography (CT) scan – x-rays are used to create detailed images that can give precise information on the location, size, and shape of the tumor
• Magnetic resonance imaging (MRI) – uses magnetic waves instead of x-rays that are very useful in visualizing the soft tissues of the body
• Angiography – this technique gives a detailed view of the blood vessels that feed the tumor. Oftentimes, a dye called contrast medium is used for better visualization
• Bone scan – is a method used to detect whether the primary cancer has spread to the bones and is usually done only in advanced stages of the disease or if bone pain is present

Biopsy is the definitive way to diagnose liver cancer. In this test, a sample of the tumor is taken and examined under a microscope. There are several ways to obtain a sample – either through a needle, laparoscope, or surgical incision. Blood tests are also used to detect certain substances in the blood that will indicate whether a cancer is present or not. In liver cancer, a tumor marker called alpha-fetoprotein (AFP) is significantly elevated in the blood. Other blood tests are used to check the status of the liver function by measuring the liver enzymes: alanine transaminase (ALT) or serum glutamic-pyruvic transaminase (SGPT), aspartate transaminase (AST) or serum glutamic-oxaloacetic transaminase (SGOT), alkaline phosphatase (ALP), and gamma-glutamyl transpeptidase (GGT).

Once all these tests are done and liver cancer is confirmed, the doctor will determine the extent of the disease in a process called staging.

How is liver cancer treated?

There are many treatment options for liver cancer and the method used will depend on the stage of the disease. For early stages wherein the tumor is small and is localized to only a small area, surgery can be performed to remove the tumor. Liver transplant may also be performed in a few cases of early liver cancer.

Other localized treatments include ablation techniques, wherein a substance is injected in the tumor to kill the cancer cells. These include:

• Radiofrequency ablation – uses electric currents to heat and destroy the cancer cells
• Cryotherapy ablation – uses liquid nitrogen to freeze the tumor
• Alcohol ablation – alcohol is injected to the tumor and kills the cancer cells
• Chemoembolization – chemotherapy drugs are directly injected into the tumor

Radiation therapy involves directing a focused beam of radiation into the area of the liver to shrink or even eliminate the tumor.

For cases where the liver cancer has spread beyond the liver and localized treatment such as surgery is no longer feasible, targeted therapies and chemotherapy may be the only options left. Targeted therapies work by interfering with the metabolic processes needed by the cancer cells to survive. For example, a drug called lenvatinib interferes with an enzyme called kinase needed by the cancer cells to grow and multiply. By inhibiting this enzyme, the cancer cells have no more access to certain essential substances and they eventually die. Some chemotherapy drugs are directly toxic to the cancer cells. Immunotherapy, drugs to boost the patient’s immune system to fight the cancer cells, may also be a treatment option in advanced cases.

What can I do to avoid the risk of liver cancer?

There are several ways to reduce the risks for liver cancer.

• Reduce the risk for cirrhosis by moderating your alcohol intake and maintaining proper weight
• Get vaccination against hepatitis B since this disease increases the risk for liver cancer
• Have a healthy diet and get regular exercise to ward off diabetes, one risk factor for liver cancer
• Practice safe sex, do not share items contaminated with blood (e.g., razors, needles, etc.) to minimize the risk for hepatitis B and C
• Ensure needles for acupuncture, tattoo, and body piercing are sterilized before use to prevent hepatitis infection
• Do not take medications without the advice of a doctor and do not take more than what is prescribed to avoid liver damage

For more information on liver cancer, consult your physician.