Liver Cancer Treatment
Primary liver cancer is a disease in which malignant (cancerous) cells form in the tissues of the liver. Cancer that forms in other parts of the body and spreads to the liver is called secondary liver cancer. Worldwide, liver cancer is the sixth most common type of cancer and the third leading cause of cancer-related death.
The liver is one of the largest organs in the body, consisting of a right lobe and a left lobe. Each lobe is divided into 2 sections and fills the upper right side of the abdomen within the ribcage, located near the stomach, intestines, gallbladder, and pancreas. The main functions of the liver include:
• Producing bile to help digest fats from food.
• Storing sugar that the body uses for energy.
• Filtering harmful substances from the blood so they can be excreted from the body through stool and urine.
Types of liver tumors:
Hepatocellular carcinoma and bile duct cancer are the two main types of primary liver cancer in adults. Hepatocellular carcinoma develops in the cells that make up the liver and it is the most common type of liver cancer. Rare types of liver cancer, such as vascular cancers, develop in the cells lining the blood vessels of the liver. These rare types often multiply rapidly.So, does liver cancer spread quickly? Liver cancer can spread quickly depending on the type of cancer. Vascular cancers tend to spread rapidly, while hepatocellular carcinoma often spreads later.
Symptoms of liver cancer:
The symptoms of malignant liver tumors vary depending on the stage of the disease, leading to a range of complications associated with liver cancer. In its early stages, liver cancer may not cause any symptoms. However, some early symptoms of liver cancer include:• Pain: Liver cancer pain is more commonly felt in the upper right abdomen and may radiate to the right shoulder or back.
• Hepatomegaly: Sometimes, a liver mass can be felt on the right side of the abdomen, referred to as hepatomegaly.
• Swelling: Abdominal swelling may occur due to fluid accumulation (ascites).
• Jaundice: Yellowing of the skin and the whitening of the eyes.
Late symptoms of liver cancer occur during the final stages:
• Unusual fatigue or weakness.• Nausea or vomiting.
• Vomiting blood in cases of liver cancer with liver cirrhosis.
• Changes in stool color.
• Unexplained weight loss.
• Loss of appetite or feeling full after a small meal.
• Easy bruising or bleeding.
• Enlargement of the liver and spleen.
• Fever may result from an immune response to the tumor, infection, or deep vein thrombosis.
The most common symptoms of liver cancer in children include a noticeable mass or swelling in the abdomen, which may be painful, as well as weight loss, loss of appetite, vomiting, and nausea.
Symptoms of benign liver tumors are rare, especially when the cancer is small. In rare cases, it can become large enough to press on nearby organs, causing abdominal pain.
Causes and risk factors of liver cancer:
The most common type of liver cancer in adults is hepatocellular carcinoma (HCC), which usually develops in individuals with chronic liver disease due to hepatitis virus infection or cirrhosis. The risk factors for liver cancer are more pronounced in men than in women, making men more susceptible to liver cancer due to gender differences. Individuals with multiple risk factors have a higher risk.Many risk factors have been associated with liver cancer. However, not everyone with one or more of these risk factors will develop the disease. It may also occur in some individuals without any known risk factors. Risk factors include:
• Hepatitis B virus infection: Hepatitis B can be transmitted through blood, semen, or other body fluids. Infection can occur from mother to child during childbirth, through sexual contact, or by sharing needles used for drug injection. Hepatitis can lead to cancer. Routine vaccination against hepatitis B in childhood reduces the incidence of hepatitis B infections.
• Hepatitis C virus infection: Hepatitis C is primarily transmitted through blood. It spreads through sharing needles used for drug injection or, less commonly, through sexual contact. In the past, infections also spread during blood transfusions or organ transplants. Currently, blood banks test all donated blood for hepatitis C, significantly reducing the risk of infection from transfusions. The virus can cause cirrhosis, which may lead to liver cancer.
• Cirrhosis: The risk of liver cancer increases in individuals with cirrhosis, a condition where healthy liver tissue is replaced by scar tissue. The scar tissue obstructs blood flow through the liver, impairing its function. Chronic alcohol abuse and chronic hepatitis infections are common causes of cirrhosis. Individuals with cirrhosis related to hepatitis C are at a higher risk of developing liver cancer compared to those with cirrhosis related to hepatitis B or alcohol use.
• Excessive alcohol consumption: Heavy alcohol consumption can lead to cirrhosis, which is a risk factor for liver cancer. Liver cancer can also occur in heavy drinkers who do not have cirrhosis. Heavy drinkers with cirrhosis are ten times more likely to develop liver cancer compared to heavy drinkers without cirrhosis. Studies have also shown an increased risk of liver cancer in individuals with hepatitis B or hepatitis C who also consume alcohol excessively.
• Aflatoxin B1: The risk of liver cancer may increase by consuming foods contaminated with aflatoxin B1, a toxin produced by fungi that can grow on foods like corn and nuts if stored in hot, humid conditions.
• Non-alcoholic fatty liver disease: Non-alcoholic fatty liver disease can cause cirrhosis, which may lead to liver cancer. This cirrhosis is the most severe form of non-alcoholic fatty liver disease, characterized by an abnormal amount of fat in the liver. In some individuals, this can cause inflammation and damage to liver cells. The presence of cirrhosis associated with fatty liver disease increases the risk of liver cancer. Liver cancer can also occur in individuals with fatty liver disease who do not have cirrhosis.
• Cigarette smoking: Smoking is associated with an increased risk of liver cancer. The risk increases with the number of cigarettes a person smokes daily and the number of years a person has smoked.
• Other conditions: Some rare medical and genetic conditions may increase the risk of liver cancer.
Liver cancer prevention:
Preventing liver cancer involves actions taken to reduce the risk of developing the disease. By preventing cancer, the number of new cancer cases is reduced, thereby decreasing the number of cancer-related deaths.Prevention includes avoiding risk factors and increasing protective factors. Here are some protective measures against liver cancer:
• Vaccination against hepatitis B: Vaccination against hepatitis B in newborns has been shown to reduce the risk of liver cancer in children.
• Treatment for chronic hepatitis B infection: Treatment options for individuals with chronic hepatitis B infection include interferon therapy and Nucleos(t)ide analogues (NUCs). These treatments may lower the risk of developing liver cancer.
• Reducing exposure to aflatoxin B1: Replacing foods containing high levels of aflatoxin B1 with foods of significantly lower levels can reduce the risk of liver cancer.
Early detection of liver cancer:
Early detection of liver cancer involves searching for cancer before any symptoms appear, which helps in identifying the disease at an earlier stage. When abnormal tissues or cancer are detected early, it may be easier to treat.Screening tests are conducted when no cancer symptoms are present. If a screening test result is abnormal, further diagnostic tests may be needed to determine if cancer is present. Here are some screening tests:
• Ultrasound: An ultrasound is a procedure that uses high-energy sound to create echoes from the liver, forming an image known as an echogram.
• Computed tomography (CT) scan: A CT scan captures detailed images of the liver from different angles using a computer connected to an X-ray machine, often with contrast dye injected into a vein or swallowed to enhance visibility. Spiral CT scans produce highly detailed images by scanning the body in a spiral path.
• Alpha-fetoprotein (AFP) tumor marker test: Tumor markers are substances produced by tumors, found in the blood, other body fluids, or tissues. A high level of a specific tumor marker may indicate a certain type of cancer in the body. Alpha-fetoprotein (AFP) is the most commonly used tumor marker for detecting liver cancer. However, other cancers and certain conditions, including pregnancy, hepatitis, cirrhosis, and other cancers, may also increase AFP levels.
How is liver cancer diagnosed?
Tests that examine the liver and blood are used to diagnose liver cancer. Not everyone will undergo all the tests; the best oncologists in Iraq will determine the most appropriate tests based on the previous evaluations, including:• Physical examination and medical history: A physical exam is performed to check the individual's health, including looking for signs of disease, such as lumps or anything unusual. The medical history, previous treatments, and health habits of the patient are also recorded.
• Liver function tests: Blood tests measure the levels of certain substances released by the liver. An elevated level of a substance may indicate liver cancer.
• Magnetic resonance imaging (MRI): This procedure uses magnets, radio waves, and a computer to create detailed liver images. Detailed pictures of the blood vessels within and near the liver can also be produced by injecting contrast dye into a vein, known as magnetic resonance angiography.
• Biopsy: During a biopsy, cells or tissues are removed so that a pathologist can examine them under a microscope for signs of cancer.
• Positron emission tomography (PET) scan: This procedure is used after the primary liver cancer diagnosis to see if cancer cells have spread within the liver or to other parts of the body by injecting a small amount of radioactive glucose into a vein. The PET scanner rotates around the body and captures images of where glucose is used. Malignant liver cells appear brighter in the pictures because they are more active and consume more glucose than normal cells.
What affects recovery from liver cancer?
Once liver cancer is diagnosed, the rates of recovery and treatment options depend on the following factors:• Stage of cancer (size of the tumor, whether it has affected the liver or part of it, or if it has spread to other parts of the body).
• Functionality of the liver (how well the liver is functioning).
• The overall health of the patient, including whether there is liver cirrhosis.
• Symptoms caused by liver cancer.
The stages of liver cancer consist of five stages:
• Stage 0: Very early.• Stage A: Early.
• Stage B: Intermediate.
• Stage C: Advanced.
• Stage D: Late-stage of liver cancer.
For liver cancer in adults, the stages are also evaluated based on how the liver tumor can be treated:
• The cancer has not spread outside the liver and can be surgically removed. This includes stages 0, A, and B.• The cancer has not spread to distant parts but cannot be safely removed by surgery. This includes stage C.
• Metastatic liver cancer is cancer that has spread from the liver to distant parts. Metastatic liver cancer cannot be completely removed by surgery. This includes stage D, which represents the most severe stage of liver cancer.
• Recurrent liver cancer is cancer that returns after treatment, which may come back either in the liver or in other parts of the body.
Treatment of Malignant Liver Tumors in Iraq:
1- Surgical treatment for liver cancer:
Partial hepatectomy (surgery to remove a part of the liver containing cancer) can be performed. This involves removing the diseased tissue, an entire lobe, or a larger section of the liver, along with some surrounding healthy tissue. The remaining liver tissue takes over the liver functions and can regenerate.2- Radiotherapy for liver cancer:
Radiation therapy for liver cancer is administered through an external machine that sends high-energy X-rays or other types of radiation toward the cancerous area of the liver. Radiation is given in a series of treatments to allow healthy cells to recover and enhance the effectiveness of the radiation. The number of treatments depends on specific details about the cancer, such as the size and location of the tumor. Certain methods of delivering external radiation therapy can help prevent damage to nearby healthy tissues, such as stereotactic radiotherapy.Stereotactic radiosurgery (SRS) is a non-surgical treatment that uses precise radiation to target liver tumors. This technique is not a traditional surgical procedure where no incision is made. Instead, SRS employs 3D imaging to deliver high doses of radiation to the affected area while minimizing the impact on surrounding healthy tissues.
SRS is used to treat high-risk tumors and is characterized by delivering a single dose of radiation in one session, instead of multiple doses required by other radiation therapy methods. This results in fewer treatment sessions (usually three to five), with each session duration being short.
Warith International Cancer Institute (WICI) offers SRS technology in its radiation therapy department as one of the latest methods for treating liver cancer.
3- Liver transplantation:
In a liver transplantation procedure, the diseased liver is completely removed and replaced with a healthy donor liver. A liver transplant can be performed when the disease is restricted to the liver and a suitable donor liver is available. If the patient must wait for a donated liver, alternative treatments will be provided as needed.4- Ablation therapy:
Ablation therapy involves removing or destroying tissue. Various types of ablation treatments are used for liver cancer:• Radiofrequency ablation: Special needles are inserted directly through the skin or through an abdominal incision to reach the tumor. High-energy radio waves heat the needles and the tumor, killing the cancerous liver cells.
• Microwave ablation: The malignant liver tumor is exposed to high temperatures produced by microwaves, which can damage and kill cancer cells or make them more sensitive to radiation effects and certain anticancer drugs.
• Percutaneous ethanol injection: This method utilizes the ability of ethanol to kill cancer cells after being injected directly into the liver tumor with a small needle.
• Cryoablation: A device is used to freeze and destroy the cancerous cells in the liver.
My experience with liver cancer:
Watch what liver cancer looks like in the following video:5- Liver cancer treatment via catheterization:
Catheterization is used for patients who cannot undergo surgery to remove the tumor and whose tumor has not spread outside the liver. This treatment involves using materials to block or reduce blood flow through the hepatic artery to the tumor. When the cancerous tissue does not receive the oxygen and nutrients it needs, it cannot continue to grow.The liver receives blood from both the hepatic portal vein and the hepatic artery. Typically, blood coming to the liver from the portal vein goes to healthy liver tissues, while blood from the hepatic artery usually supplies the tumor. By blocking the hepatic artery during catheterization treatment, healthy liver tissues continue to receive blood from the portal vein.
There are two main types of catheterization treatment:
• Transarterial embolization (TAE): A small surgical incision is made in the inner thigh, and a catheter (a thin, flexible tube) is inserted and guided to the hepatic artery. Once the catheter is in place, a substance is injected to block the hepatic artery and stop blood flow to the tumor.
• Transarterial chemoembolization (TACE): This procedure is similar to TAE, except that a chemotherapy drug is also administered, allowing most of the chemotherapy to remain near the tumor, with only a small amount reaching other parts of the body.