Beginner’s Guide to Liver Cancer: Symptoms, Causes, Treatments

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Survival rates have steadily increased for many cancers, and the outlook for people diagnosed with liver cancer has also improved in recent decades.

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The second largest organ after the skin, the liver is about the size of a soccer ball and is hidden behind the ribs. The liver performs up to 500 functions. It is a cleansing plant to filter and store many nutrients the body needs like sugar for energy and bile (digestive fluid) to help digest fat derived from food. The liver also identifies and breaks down toxins like alcohol and drugs, and passes them through the body through urine or stool.

Cancer is more likely to spread to the liver than to grow in liver cells. This is because all of the blood has to pass through it, making the liver exceptionally accessible to cancer cells circulating in the bloodstream.

Liver cancer is still one of the deadliest cancers because the organ itself is often damaged by cirrhosis and this makes treatment more difficult, says Dr. Jennifer Guy, director of the liver cancer program in California Pacific Medical Center, a nonprofit hospital in San Francisco. it’s part of the Sutter Health network. “There is still a lot of work to be done in trying to figure out how to diagnose people at an early stage, and then how to apply liver cancer therapies to the right people at the right time to improve their outcomes.”

Types of liver cancer

There are two main types of liver cancer, in addition to the rare forms of the disease which represent less than 1% of cases.

  • Hepatocellular carcinoma.The most common form of liver cancer is hepatocellular carcinoma, or HCC, which accounts for 75% of all cases. This cancer starts in the cells of the liver and is mainly caused by hepatitis or various risks associated with cirrhosis of the liver.
  • Cholangiocarcinoma.These liver cancers form in the bile ducts which carry bile for storage in the gallbladder. Cholangiocarcinoma, a type of cancer of the biliary tract, accounts for about 10-20% of all liver cancers.
  • Fibrolamellar carcinoma. This rare type of liver cancer is more common in adolescent girls and adult women under the age of 40 without cirrhosis of the liver. This form still lacks effective treatment.

Who has liver cancer?

There are a number of factors that can cause a person to develop liver cancer. “The main causes of liver cancer are hepatitis B and hepatitis C,” says Dr. Ghassan Abou-Alfa, a certified medical oncologist specializing in the treatment of gastrointestinal cancers at Memorial Sloan Kettering Cancer Center in New York. “Hepatitis C and sometimes hepatitis B cause cirrhosis and seriously damage a healthy liver,” he adds.

The following factors increase the risk of developing liver cancer:

  • Cirrhosis. This liver disease is mainly caused by hepatitis, fatty liver disease, or heavy alcohol consumption in which healthy liver cells are replaced by scar tissue which prevents the liver from functioning properly. People with cirrhosis have a higher risk of developing liver cancer.
  • Hepatitis. A small percentage of people with chronic hepatitis C or chronic hepatitis B, two serious conditions that prevent the liver from working properly, could develop liver cancer. More than 3 million Americans have hepatitis C and less than 5% will be diagnosed with liver cancer. Chronic hepatitis C, which is more common in the United States than hepatitis B, is contagious and is spread when body fluids are exchanged during unprotected sex, by sharing injection drugs and needles, and by getting tattoo or pierce with impure material.
  • Ethnic origin. Ethnicity does not play a role as an independent risk factor for developing liver cancer, the researchers say. But certain ethnicities are more likely to develop liver cancer due to their exposure to hepatitis B. Historically, Asian American men have had higher incidence rates of liver cancer than Hispanic men. non-Hispanic whites or Asian / Pacific Islanders. Between 2013 and 2030, rates among Asians / Pacific Islanders are expected to decline with better access to hepatitis B vaccination. By 2030, Asian men are expected to have the lowest incidence rate, while that Hispanic men should have the highest rate and black women should have the highest rate among women.
  • Kind. Men develop liver cancer more often than women at an average age of 67 years, not because of the increased incidence of risk factors in men, but because of a certain biology of the disease that favors the male sex. In 2021, about 29,890 men are expected to be newly diagnosed, compared to 12,340 women, according to the American Cancer Society.
  • Non-alcoholic fatty liver disease. This condition is caused by the accumulation of extra fat in liver cells unrelated to alcohol consumption, but rather by morbid obesity and diabetes. Researchers have identified a strong link between type 2 diabetes and liver cancer, particularly in people with increased alcohol consumption and / or chronic viral hepatitis. According to the National Cancer Institute, people who are overweight or obese are up to twice as likely as people of normal weight to be diagnosed with liver cancer. Non-alcoholic fatty liver disease progresses slowly and can lead to cirrhosis and liver cancer.

Signs and symptoms

Most people don’t have signs and symptoms in the early stages of liver cancer. When the first signs of liver cancer appear, they can include:

  • General weakness and fatigue.
  • Jaundice (yellow discoloration of the skin).
  • Lose weight without trying.
  • Loss of appetite.
  • Nausea and vomiting.
  • Swelling of the stomach.
  • Upper abdominal pain.
  • White, chalky stools.

Liver cancer screening and diagnosis

There are several ways to screen for and detect liver cancer. Current research is aimed at identifying improved tests to find liver cancer earlier and catch it when it’s most treatable.

The most common tests include:

  • Biopsy. During a biopsy procedure, your doctor will take a small sample of liver tissue by inserting a thin needle into the liver. An expert, called a pathologist, will study the cells in the sample under a microscope to determine the type of tumor.
  • computed tomography. A CT scan is a type of x-ray that is often used to diagnose liver cancer. A CT scan provides images of the region of the liver and can detect the shape, size, and location of liver tumors in the nearby organ or blood vessels.
  • Serum tumor marker test. A blood sample is taken to detect certain tumor markers – which are at increased levels in the blood when cancer exists. When alpha-fetoprotein (AFP) is detected, it can be a sign of liver cancer.
  • Ultrasound. Using sound waves to develop a computerized image, ultrasound is the most common test used to identify liver cancer.

Treatment and care

Over the past decade, new techniques and treatments have emerged to improve outcomes for patients diagnosed with liver cancer. “This is an exciting time for research as there are many studies looking at new and different ways to target liver cancer,” said Abou-Alfa. “Surgery, removal and transplant of the liver are the only options that can offer a cure, although they are not widely used except for a limited number of patients.”

  • Ablation. This procedure attacks liver cancer by precisely inserting the tumors with a thin probe rather than surgically removing the cells. Heated electromagnetic waves, concentrated alcohol, cold gases, or high-energy radio waves can pass through the probes to destroy tumors. The different types of ablation include: cryoablation / cryotherapy (cold gas); ethanol (concentrated alcohol); microwave ablation (heated electromagnetic waves); and radiofrequency ablation (high energy radio waves).
  • Embolization. This technique blocks part of the hepatic artery (a short blood vessel that supplies oxygenated blood to the liver) to damage cancer cells. Healthy cells are intact and remain supplied by the portal vein of the liver.
  • Immunotherapy. These drugs activate the body’s natural immune system to find and destroy cancer cells. Various types of immunotherapies include monoclonal antibodies, viral oncolytic therapy, T cell therapy, and cancer vaccines. A particular example of immunotherapy called checkpoint inhibitors includes pembrozlimab (Keytruda), which is used as the sole agent for second-line treatment. Most of the activities of checkpoint inhibitor immunotherapy have been demonstrated when combined with other targeted therapies. This includes atezolizumab (Tecentriq) plus bevacizumab (Avastin) and ipilimumab (Yervoy) plus nivolumab (Opdivo).
  • Radiotherapy. Using highly energized rays, radiation therapy destroys cancer cells when surgical removal, ablation, or embolization is not possible because the tumors have spread to other areas of the liver or other organs. .
  • Surgery. When the tumor is small enough and the liver is still healthy, surgical removal of cancer cells is the recommended option.
  • Targeted therapies. Working differently from chemotherapy, targeted therapies are designed to interfere with cancer cells by targeting specific molecules involved in the growth and spread of cancer. Several targeted therapies have been approved by the Food and Drug Administration, including sorafenib (Nexvar) and lenvatinib (Lenvima), as first-line therapy; and cabozantinib (Cabometyx / Cometriq), regorafenib (Stivarga) and ramucirumab (Cyramza) as second-line therapy.
  • Transplantation. For patients with limited liver cancer but severe cirrhosis, doctors may recommend a liver transplant if the cancer is a certain size, does not extend into the blood vessels, and is contained in the liver. organ.

Survival and prognosis

Over the past four decades, the prognosis has steadily increased for those diagnosed with liver cancer. Five-year survival is around 20% compared to just 3% in the early 1990s, according to the American Society of Clinical Oncology. When a patient is diagnosed early, the five-year survival rate improves to 34%.

There has been a tremendous amount of research into liver cancer since Abu-Alfa started in the field in the 1990s, he explains. “The most recent studies show that new drugs can now extend survival for up to 19 months, compared to six months just ten years ago.


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