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Primary Liver Cancer

liver cancer


The liver is in the upper right part of the abdomen. It has many functions which include:

  • Storing glycogen (fuel for the body) which is made from sugars.
  • Helping to process fats and proteins from digested food.
  • Making proteins that are essential for blood to clot (clotting factors).
  • Helping to process and/or remove alcohol, many types of medicines, toxins and poisons from the body.
  • Making bile which passes from the liver to the gut down the bile duct.

Cancer of the liver can be divided into primary liver cancer and secondary liver cancer:

Primary liver cancer means that the cancer started (originated) in the liver. Worldwide, it is one of the most common cancers.

Secondary (metastatic) liver cancer means that a cancer which started in another part of the body has spread to the liver. Most commonly, cancers of the bowel, pancreas, stomach, lung or breast.

There are different types of primary liver cancer which include:

  • Hepatoma. This is the most common type (about 9 in 10 cases). It is sometimes called hepatocellular carcinoma (HCC). This type of cancer originates from a liver cell (hepatocyte) which becomes cancerous. A hepatoma most commonly develops as a complication of liver diseases such as cirrhosis (scarring of the liver) or types of hepatitis (liver inflammation).
  • Fibrolamellar hepatoma is a rare subtype of hepatoma. It typically develops in a liver which was previously healthy.
  • Cholangiocarcinoma. It develops from cells which line the bile duct.
  • Hepatoblastoma. This is a rare cancer which occurs in some young children.
  • Angiosarcoma. This is rare. It develops from blood vessel cells within the liver.

What causes primary liver cancer?

A cancerous tumour starts from one abnormal cell. The exact reason why a cell becomes cancerous is unclear. Most people who develop a primary liver cancer have one or more of the following risk factors which seem to make liver cells more prone to becoming cancerous:

  • Cirrhosis.
  • Long-term infection with the hepatitis B or hepatitis C virus. It typically takes 20-30 years after first becoming infected to develop primary liver cancer.
  • Ingesting some poisons or toxins. For example, a known risk factor is a poison called aflatoxin which contaminates some foods.
  • Some conditions which cause persistent inflammation of the gut increase the risk slightly of developing a cholangiocarcinoma - ulcerative colitis.
  • There is some evidence that smoking can increase the risk.
  • A parasitic infection (liver fluke) which mainly occurs in Africa and Asia increases the risk of developing a cholangiocarcinoma.

What are the symptoms of primary liver cancer?

There may be no symptoms in the early stage of the disease. As the cancer develops further, more specific symptoms which may also develop include:

  • Abdominal pain over the liver area.
  • Jaundice.
  • Itch.
  • Swelling of the abdomen.

How is cancer of the liver diagnosed and assessed?

Screening

Screening using ultrasound, and sometimes also a blood test for alpha-fetoprotein (AFP), at 6- to 12-month intervals, has been recommended for people at high risk of liver cancer. This includes people with liver cirrhosis associated with infection with hepatitis B or hepatitis C virus.

Initial assessment

Scans such as ultrasound scan, CT scan or MRI scan.
A liver biopsy. This is usually done to confirm the type of cancer.
Blood tests help to assess the liver function and your general health.
Other tests may be done like a laparoscopy is sometimes done.

What are the treatment options for primary liver cancer?

  • The main treatments used for primary liver cancer are surgery and chemotherapy. Other techniques are sometimes used. The treatment advised in each case depends on various factors such as:
  • The exact site of the primary tumour in the liver.
  • The stage of the cancer.
  • Your general health.

Surgery

Surgery which aims to cure the cancer is an option in some cases. If the cancer is small, has not spread outside the liver, and the rest of the liver is healthy, then it may be possible to cut out the part of the liver which contains the cancer. Healthy liver tissue will regrow to its full size within a few weeks if a section of liver is cut out. However, this operation is not suitable if your liver is damaged with severe cirrhosis.

A liver transplant is another option, but again only suitable for a small number of cases.
Surgery also has a role in palliative care. For example, if jaundice is severe, it may be possible to relieve the blockage of the bile by inserting a stent.

Chemotherapy

Chemotherapy is a treatment which uses anti-cancer medicines to kill cancer cells, or to stop them from multiplying. It is not likely to be curative for primary liver cancer, but may shrink the tumor down to slow the progression of the disease.

There are new medicines being developed for the treatment of liver cancer. For example, sorafenib is a type of medicine called a multi-targeted kinase inhibitor. It interferes with the growth of cancer cells.

Other treatments

  • Alcohol ablation. Ablation means to destroy. For this treatment, alcohol is injected into the tumour. The alcohol kills cancer cells.
  • Radiofrequency ablation. For this treatment, a needle is inserted into the tumour. High-intensity radio waves or laser light are then passed through the needle. This heats the cancer cells and kills them.
  • Cryotherapy. For this treatment, a small metal object filled with liquid nitrogen is placed into the tumour. The liquid nitrogen makes it very cold which destroys cancer cells.
  • Chemoembolisation. For this treatment, medicines used for chemotherapy are mixed with another oily chemical. The mixture is then injected into branches of the liver artery (hepatic artery) which are supplying the tumour with blood..
  • Radiotherapy. This is a treatment which uses high-energy beams of radiation which are focused on cancerous tissue. This kills cancer cells, or stops cancer cells from multiplying. Radiotherapy is not often used for primary liver cancers apart form the uncommon cholangiocarcinoma type of cancer.

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