Liver Cancer 101: Causes, Symptoms, and Treatment Options

Liver cancer, also known as hepatic cancer, is a condition characterized by the abnormal growth of cells in the liver, leading to the formation of tumors. This cancer can manifest itself in various forms. Understanding the basics of liver cancer, including its definition, types of liver tumors, and the progression of liver carcinoma, is crucial for early detection and effective management of this potentially serious disease. Let’s delve deeper into the intricate world of liver cancer and explore the key concepts that define this complex condition.

Types of liver cancer

• Hepatocellular carcinoma (HCC): This is the most common type of liver cancer, accounting for 75% of cases. HCC starts in the main liver cells called hepatocytes.
• Cholangiocarcinoma: This type starts in the bile ducts of the liver. There are intrahepatic cholangiocarcinoma that start inside the liver and extrahepatic cholangiocarcinoma that start outside the liver.
• Angiosarcoma and hemangiosarcoma: These are rare cancers that start in the liver’s blood vessels.
• Hepatoblastoma: This type of liver cancer usually affects children under the age of 3 and starts in the immature cells of the liver.

Liver cancer usually starts in liver cells. However, it can also start from cancer elsewhere in the body that has spread or metastasized to the liver via the bloodstream or lymphatic system. This is called secondary liver cancer. Compared to secondary liver cancer, primary liver cancer is more prevalent.

How does liver cancer affect the body?

Liver cancer can affect the body in different ways depending on the stage and extent of the cancer. Common symptoms include:

• Unexplained weight loss
• Loss of appetite
• Abdominal pain
• Yellowing of the skin and eyes (jaundice)
• Fatigue and abdominal swelling
• Blood clotting

Causes and Risk Factors:

• Cirrhosis: Cirrhosis refers to scarring of the liver, often due to hepatitis infections or alcohol abuse. It results in abnormal liver cell regeneration, which can lead to tumor development. It is present in 80-90% of liver cancer cases.
• Hepatitis B/C infections: Chronic infection with the hepatitis B or C virus is a major risk factor. The immune system’s response to these viruses causes inflammation and damage that can lead to cancer. Hepatitis B is more common in developing countries, while Hepatitis C is more common in developed nations.
• Alcohol abuse: Drinking excessive amounts of alcohol for many years can lead to liver damage and inflammation that promotes cancer growth. Alcohol abuse also often leads to cirrhosis.
• Obesity: Being obese or overweight increases the risk of liver cancer. The exact reason is unclear but may relate to fatty liver disease.
• Diabetes: People with type 2 diabetes have a higher risk of liver cancer, likely related to the development of non-alcoholic fatty liver disease. High blood sugar levels may also play a role.
• Aflatoxins: These toxic substances produced by mold are a risk factor, particularly in parts of Africa and Asia where food contamination occurs. The toxins damage liver cells.

Symptoms:

The most common symptoms of liver cancer include:

• Abdominal pain or swelling
• Unexplained weight loss
• Loss of appetite
• Fatigue
• Jaundice
• nausea

Diagnosis:

Diagnosing liver cancer typically involves blood tests, imaging tests, and a biopsy.

• Blood tests: The most common blood test is to check for alpha-fetoprotein (AFP). AFP is a tumor marker that can be high in people with liver cancer. However, AFP levels alone are not enough to diagnose liver cancer since levels can also be raised in people with cirrhosis or hepatitis.
• Imaging tests: Imaging tests are important for the diagnosis and staging of hepatic tumors. Often, it begins with an abdominal ultrasound, which can spot masses in the liver. Consequently, it is not possible to tell between the cancer and non-cancer by using only ultrasound. To obtain this, cross-sectional imaging is required. As CT and MR scans allow for a good look into the liver, one can see the size, shape, and characteristics of any masses. They assist in discovering whether or not the tumor has spread to other organs.
• Biopsy: The cellular visualization of the resection of a tumor through a microscope is needed to correct the diagnosis of liver cancer. To that end, an aspiration core or swelling biopsy using a needle guided by CT, ultrasound and other techniques can be done in the first stage. Reviewing the tissue sample, the clinicians obtain information on whether the tumor is primary liver cancer or is secondary, i.e. cancer spread from another tumor. Lastly, technology is involved in diagnosing a few types of liver tumors.

Stages:

Liver cancer is classified into stages based on how far the cancer has spread. The stages help determine prognosis and guide treatment options.

• Localized – In the localized stage, the cancer is confined to the liver and has not spread to nearby lymph nodes or other organs. This is considered an early stage.
• Regional Spread – In the regional spread stage, the cancer has grown larger in the liver and/or has spread to nearby structures or lymph nodes.
• Distant Metastasis – In the advanced stage of cancer, it spreads to distant parts of the body such as the lungs, bones, or brain.

Treatment:

Liver cancer treatment depends on the stage of the cancer, the condition of the liver, and the patient’s health and preferences. Options may include:

• Surgery – If where the cancer is localized and it has not spread out of the liver, surgery to remove the tumor itself usually will be the physician’s choice for their treatment. One of the available options to be listed here is removing the entire liver (liver transplant) or many liver areas (partial hepatectomy). A liver transplant is the only one in use that can guarantee the full cure, yet there are few donors for livers.
• Ablation and Embolization – If surgery is not an option, ablation techniques can be used to destroy liver tumors without having to remove them. This can be achieved through freezing (cryoablation) or heating (radiofrequency ablation) the tumors. Embolization blocks the blood supply to the liver tumor, leading to its shrinkage.
• Chemotherapy – Chemotherapy is a treatment that uses anti-cancer drugs, typically given intravenously or orally to kill cancer cells. It is administered before surgery or transplant to shrink tumors and is usually used if the cancer has spread beyond the liver.
• Radiation Therapy – Radiation therapy is not a primary treatment option for liver cancer but can be used to alleviate symptoms and pain by directing high-energy beams at the tumor to destroy cancer cells.
• Immunotherapy – Immunotherapy boosts the body’s immune system to help it attack cancer cells. The drugs pembrolizumab and nivolumab have been approved for advanced liver cancer.
• Targeted Therapy – Monoclonal antibodies have the potential to block cancer cells from multiplying, thus, halting the cancer progression. In the case of advanced liver cancer the medications sorafenib, lenvasatinib, regorafenib, and cabozatintin are approved.

Prevention:

There are several ways to lower your risk of developing liver cancer:

• Get yourself vaccinated against hepatitis B and hepatitis C – These viruses are one of the two main risk factors for liver cancer, therefore vaccination reduces your risk of contracting the disease. The Hepatitis B vaccine is usually administered early to children, while the hepatitis C vaccine is still in a developing stage.
• Limit alcohol consumption – Chronic heavy drinking is associated with cirrhosis which leads to liver cancer Furthermore; If you are having alcohol then do it in moderation. For individuals in good health, it means one drink a day for women and up to two drinks a day per day for men.
• Maintain a healthy weight –  Compared with nonalcoholic fatty liver disease, the situation with obesity is characterized by the development of liver cancer. Eat healthy and exercise regularly to keep weight from getting high.
• Avoid aflatoxins – These harmful substances are generated by molds and they threaten nuts, grains, and beans. With the right food storage and handling practices, exposure can be reduced. Some geographical regions have a higher frequency of events.

If you are at high risk of developing liver cancer, it is advisable to undergo screening. Additionally, avoiding smoking and other environmental carcinogens is also helpful in preventing cancer. It’s best to discuss your risk profile with your doctor, who can guide you on the best prevention strategies. By implementing these strategies, you can reduce your chances of developing liver cancer.