Liver Cancer Guide

18/04/2022
20/01/2023
Facts

Your liver cancer risk doubles if you have a first-degree relative diagnosed with the tumor.

Fungi in grains like maize and nuts produce aflatoxins, which cause 28.2% of liver cancer.

About 61% of people with early-stage cancer who get a liver transplant live for ten years.

Only 10% of patients with liver cancer can get a biopsy to confirm the diagnosis.

Icon overviewWhat does the liver make, and why is it important?

To know what liver cancer is, one needs to remember how the liver is supposed to look and what it is supposed to do.

Let us introduce the largest organ in the body: the liver. It consists of cells called hepatocytes and is located under the right lung. It also has other cells, like those that line its blood vessels and makes up the bile ducts. Bile goes first from the liver to the gallbladder or straight to the intestines.

Without your liver, you can't live. It serves many vital purposes:

  • It dissolves and stores a lot of the substances your body needs. The intestine takes them in. The liver has to change some of them for use for energy or to build and repair.
  • It makes most things that help you stop bleeding when you cut or get hurt.
  • It sends bile to the intestines to help you absorb nutrients (especially fats).
  • It breaks down toxins like alcohol, drugs, and toxic wastes in the blood, leaving the body through urine and feces.

Icon editWhat kinds of cancer can develop in the liver and why?

The cells in the liver can form both cancerous and noncancerous tumors. Different tumors have various causes, ways to treat them, and outlooks for the future.

There are two ways: when cancer appears from the liver cells (primary) and when it grows because of cancer of the other organs (secondary).

When cancer begins in the liver – the primary tumor

What kinds of cancer can develop in the liver and why?Divide into several kinds depending on the type of cells:

  • The liver cells (hepatocellular carcinoma, HCC);
  • The bile duct cells (cholangiocarcinoma);
  • The lining of blood vessels cells (hemangiosarcoma);
  • The fetal lives cells (hepatoblastoma).

Each type has nuances.

For instance, HCC is 90% cases of liver tumors. It can grow from just one node or a lot of small ones. Fibrolamellar cancer in women under 35 is very rare and has a better outlook than other HCCs. Angiosarcoma is hard to treat and quickly gets worse. Hepatoblastoma is cancer that starts in kids under 4. It is mainly treated successfully until it spreads to other organs. Our experts help to choose the right way in every case.

Where does liver cancer come from?

Damaged liver cells die because of the specific protein. The process is called apoptosis. Cells that have been hurt die faster. To fix the damage, liver cells also divide more quickly. Over time, hurt liver cells die, and new ones take their place. Every time a cell divides, DNA doubles. And the errors double too. When mutations happen, genes become less stable, which makes it more likely that a liver cell will turn into a tumor.

When a tumor spreads from other body parts – secondary or metastatic liver cancer

When cancer hurts the liver, it usually doesn't start there. Instead, it spreads from another body part, like the pancreas, colon, stomach, breast, or lung. This type of cancer is secondary liver cancer because it has spread from its first (primary) site. The prior site of these tumors is used to name them and decide how to treat them. For example, cancer that starts in the breast and extends to the liver is called breast cancer which spreads to the liver, not liver cancer, and is treated in the same way.

In the US and Europe, secondary (metastatic) liver tumors are much more frequent than primary liver cancer (up to 40 times).

Icon searchWho is at risk of liver cancer?

Heavy drinkers with long-term hepatitis C and cirrhosis have a very high chance of getting liver cancer. On the other hand, the risk is much lower for young people who don't have chronic diseases and live healthy lives.

Some of the factors we can eliminate – stopping drinking alcohol and smoking, losing extra weight, avoiding toxins, eating healthy food, and doing annual check-ups. Some we can modify, but we can’t control other factors like age, race, gender, genetic conditions, and family history of liver cancer.

How else can we prevent the tumor?

Stay away from the things that can cause you to get viral hepatitis. And by contacting the vaccine against hepatitis B, which causes cirrhosis and liver cancer, you decrease the risk. Also, if the patient were diagnosed with chronic hepatitis B or C, they would be treated appropriately to decrease the risk of cancer.

Icon symptomsHow to suspect if someone has liver cancer?

Signs and symptoms of liver cancer usually don't show up until the disease is in its later stages, but they can sometimes appear earlier. If you go to the doctor as soon as you start to feel sick, your cancer might be found earlier, when it is most likely that treatment will help. Among the most common signs of liver cancer, we often see:

  • Lose weight (without trying);
  • Loss of hunger;
  • When a small meal makes you feel full;
  • Feeling sick;
  • A more significant liver and spleen make the fullness under the ribs;
  • Pain in the belly or near the right shoulder blade;
  • The buildup of fluid or swelling in the abdomen;
  • Itching;
  • Skin and eyes that are yellow (jaundice).

A fever, visible veins on the abdomen that are just under the skin surface, and unusual bruising or bleeding can also be signed.

People with chronic hepatitis or cirrhosis may feel worse than usual, or their liver function tests or alpha-fetoprotein (AFP) levels may change.

Even if you have one or more of the following signs, it doesn't mean you have liver cancer. In actuality, most of these signs are caused by something else. But it would help if you visited a doctor. Or book an online consultation with our expert.

Icon microscopeHow to know if it is liver cancer or not?

The diagnostic process usually includes the following:

  • Screening for high-risk patients. Screening can detect liver cancers without symptoms, although signs catch most.
  • Medical history. Doctors ask about symptoms and risk factors based on medical records. Your doctor may also check for signs of liver cancer, like jaundice in your belly, skin, and eyes (a yellowish color).

Additional testing is done if symptoms or a physical exam reveals liver cancer. Imaging, lab, and liver biopsies are examples.

X-rays, magnetic fields, and sound waves show the body's inner structure.

Diagnostic imaging examinations include:

  • Ultrasound is the initial liver test. Sound waves create images. This test can detect liver tumors that can be evaluated for malignancy.How to know if it is liver cancer or not?
  • CT scans reveal liver tumors. It can show liver cancer size, roundness, and abdominal blood vessels. CT scans also guide biopsies to tumors (called a CT-guided needle biopsy). A chest CT may be done in the case of liver cancer.
  • MRI shows soft tissue detail like CT scans using radio waves and magnets. MRIs detect liver tumors, hepatic blood arteries, and cancer spread. They know benign from malignant tumors.
  • Angiography shows blood vessels by injecting the contrast into an artery before an x-ray. It helps decide if and when to remove the tumor. After the local anesthesia, the catheter is inserted into a hepatic artery to administer dye.
  • MR or CT angiography delivers information on hepatic blood veins without a groin catheter. A contrast substance is injected via IV during the exam.
  • A bone scan detects bone-metastasized malignancy. This test is only offered to liver cancer patients with bone discomfort or who may undergo a liver transplant.

If imaging results aren't precise, your doctor may undertake more testing.

Only a biopsy and pathology study can diagnose liver cancer precisely. At the same time, CT and MRI scans are alternatives when the biopsy may be unnecessary. Doctors worry that inserting or moving a needle in a tumor could transmit cancer cells. That’s why a biopsy can mostly confirm the diagnosis after the surgery.

Biopsy methods vary:

  • Using an abdominal needle, the liver is accessed. Local anesthesia is given before the needle. Ultrasound or CT scans aid with this biopsy.
  • During laparoscopy biopsies, the doctor can then examine a liver sample.
  • During surgery, a fragment of the tumor or the entire tumor, along with healthy liver tissue, can be removed.

Many doctors order lab tests to diagnose liver cancer, determine your liver's health and other organs and see if the treatment works.

Lab tests include such:

  • AFP (Alpha-fetoprotein) in a liver tumor patient may indicate malignancy but doesn’t indicate liver cancer because many early cases have normal levels. Sometimes, this test helps liver cancer patients. AFP level determines treatment options. If the treatment is working, AFP should decrease. The test could search for cancer recurrence after therapy.
  • Hepatitis B and C tests are prescribed in persons with hepatitis or cirrhosis.
  • Liver function tests are performed before starting therapy because the doctor must know whether your liver is working well. If the part of your liver that isn't impacted by cancer isn't performing effectively, you may not be able to have cancer surgery. Unhealthy livers may prevent targeted therapy or chemotherapy.
  • Liver proteins clot blood. Damaged livers may not produce enough clotting factors, causing bleeding. Blood shows this danger.
  • Blood urea nitrogen and creatinine test shows renal function.
  • Complete blood count test. Red blood cells, white blood cells (which fight infections), and platelets are tested (which help the blood clot). It indicates bone marrow health (where new blood cells are generated).
  • Blood chemistry checks for liver cancer-linked substances. Liver cancer raises calcium and lowers glucose. Checking cholesterol for liver cancer may be needed.
How to know if it is liver cancer or not?

After liver cancer is found, tests determine how large and far it has spread. This is called the stage.

Find the right places to treat liver cancer

Icon doctorHow to treat liver cancer?

When deciding on a method and treatment plan, the type and stage of liver cancer are essential. Also, the doctor should check the patient's liver health, general health, any possible side effects, and the patient's chances to recover, live longer, or feel better.

  • Surgery. Removing the tumor with surgery or giving the patient a new liver is the best way to treat liver cancer. If all of cancer in your liver is taken out, your outlook will be the best. However, people who have a healthy liver and a single tumor that hasn't grown into a blood vessel are the only ones who can have surgery.
  • Systemic chemotherapy destroys cancer cells and may be an option for persons whose liver cancer cannot be treated with other methods. But, most liver cancer chemo treatments are not very successful. Recent advances reveal that combining chemo medicines may be more effective. But even these drug combinations decrease only a few tumors, and the effects are short-lived. In addition, chemotherapy medications destroy rapidly developing cancer cells. Bone marrow, mouth and gut lining, and hair follicle cells grow swiftly. Chemotherapy can harm these cells, causing adverse effects.
  • Immunotherapy is administering drugs to patients to stimulate their immune system to hunt down and kill cancer cells. Certain patients with liver cancer can be treated with it. The newer drugs aim at molecules in immune cells that must be turned on (or turned off) for an immune response to start and have many possibilities to be used as treatments for liver cancer.
  • Target therapy – are new drugs that directly target cell modifications that cause cancer. Like chemotherapy, these drugs get into the bloodstream and are transported to almost all body parts. But targeted drugs work differently. For example, monoclonal antibodies are made from antibodies, which are proteins produced by the immune system to connect to a specific target.
  • Radiation with high-energy rays is used in therapy to kill cancer cells (or particles). Some people may not get better from this treatment, especially if they have a severely damaged liver from cirrhosis or hepatitis.

Where to treat liver cancer the best?

Icon plusWhat about newer treatment options for liver cancer?

Compared to the last ten years, the number of people who got better and returned to their everyday lives after oncology went up by 20% in 2021. This is only possible because of the new technologies and research that have been added to modern treatment methods. The last words on how to treat liver cancer are the following:

  • Transarterial chemoembolization (TACE) is a minimally invasive technique in which chemo drugs are injected directly into the tumor(through vessels. It stops the blood supply to the cancerous tumor by blocking the blood vessels that bring blood to it. It also keeps the chemo inside cancer.
  • Transarterial chemoperfusion, or TACP, is a minimally invasive way to treat a liver tumor locally. Chemotherapy drugs are put directly into the artery that feeds the tumor through a catheter.
  • Radioembolization, also called selective internal radiation therapy with microspheres (SIRT), uses the blood vessels to send radioactive particles to the tumor. They kill cancerous cells by giving off radiation after they have settled in tumors.
  • Radiosurgery, also known as CyberKnife and GammaKnife, is a one-of-a-kind radiosurgical technique that eliminates the immediate focus of targeted radiation. It is non-invasive and works without surgery, giving good results for tumors that can't be cut. Most people can keep doing everyday things during treatment.
  • HIFU, high-frequency focused ultrasound, is a novel cancer treatment known as waves of varying intensities are applied to the affected area. The machine's sound waves direct a focused energy beam toward a particular tumor region. The cancer cells are killed as a result of the increased temperature.
  • Ablation therapy, also called radiofrequency ablation, microwave thermal ablation, and ethanol ablation, is a minimally invasive treatment that destroys a liver tumor instead of removing it.
  • Proton therapy is a type of radiation treatment. A radiation beam made of protons that gives off a set amount of radiation is focused on the affected area while avoiding the tissues around it.
  • Dendritic cell-based vaccines as part of immunotherapy in recent years have shown promising results. It made HCC patients more resistant to tumors, increased their chances of survival and length of life, and was safe.

What experts work in liver cancer diagnosis and treatment?

Prof. Dr. med. Helmut Friess image
general, abdominal, thoracic, oncosurgery, endocrine surgery, and transplantology
Prof. Dr. med. Wolf O. Bechstein image
general and visceral surgery, transplant and thoracic surgery
Prof. Dr. med Harald-Robert Bruch, MSc, PhD image
gastroenterology, hepatology, infectious diseases, oncology, hematology, pain therapy and nutritionology

Icon chartWhat about statistics and prognosis?

The Cancer Net editorial board says that more than 950,000 new liver cancer cases are found worldwide annually. It is the seventh most common type of cancer. The number of people who get liver cancer has almost doubled in the last ten years, and this tendency is still going on.

Liver cancer is the third leading cause of death from cancer around the world. In 2021, this disease killed more than 800 thousand individuals.

How long someone with liver cancer is likely to live depends on how early the cancer was found and how far it has spread. Cancer patients are thought to have a five-year chance of living.

What about statistics and prognosis?

Liver cancer commonly has a 20% chance of being alive after five years.

When caught early, 78% of people with cancer will live.

In the second stage, 35% of people still live five years after diagnosis.

But only 3% of people who have liver cancer that has spread to other organs will live.

How long a person with liver cancer lives depends greatly on how old they are. The best chance of living is between 15 and 39 years old.

References:

  1. American Cancer Society: Liver Cancer
  2. NHS: Tests and next steps Liver cancer
  3. Stanford Medicine: Hepatoblastoma in Children
  4. National Library of Medicine: Diagnosis and management of hepatic focal nodular hyperplasia
  5. National Library of Medicine: Surgical treatment for liver cancer
  6. Medscape: Liver Transplantation Treatment & Management
  7. Interventional News: Transarterial chemoperfusion is safe and feasible in advanced mesothelioma
  8. Cancer Net: Liver Cancer: Statistics
  9. National Library of Medicine: Effect of dendritic cell-based immunotherapy on hepatocellular carcinoma: A systematic review and meta-analysis
  10. National Library of Medicine: Global Burden of Aflatoxin-Induced Hepatocellular Carcinoma: A Risk Assessment
  11. Khan Academy: Cancer and the cell cycle