The Liver Cancer Recap – The New Indian Express

Through Express press service

CHENNAI: Liver cancer is the third leading cause of death globally. It can occur silently and can only be discovered when it has spread and cannot be treated. Therefore, caution is warranted and the liver should be checked regularly. But if detected early, a complete cure can be offered. How can cancer affect the liver? Cancer can affect the liver in two ways. It can originate in the liver itself (primary liver cancer) or it can spread to the liver from a primary tumor at another site (secondary or metastatic cancer).

Primary liver cancer

Primary liver cancer can arise from the liver cells themselves (hepatocellular carcinoma) or from the system of tubes that drain bile from the liver (cholangiocarcinoma, gallbladder cancer). Most patients with primary liver cancer have already suffered from liver disease such as chronic hepatitis, cirrhosis or, in less developed countries, have been exposed to plant poisons (aflatoxins). Vaccination against hepatitis B could, particularly in developing countries, prevent many cases of primary liver cancer.


People with chronic liver disease can develop liver cancer without noticing any new symptoms. Typical symptoms are discomfort or pain in the right side of the upper abdomen, jaundice, weight loss, and fatigue.


Primary liver cancer can be diagnosed using blood tests that include liver function tests and a tumor marker called Alpha-fetoprotein. They can be clearly seen on ultrasound, but a good quality CT scan is still needed to get more information. A tumor biopsy is never recommended if surgery has been planned.


For patients with limited tumor in a normal liver setting, surgical removal may be possible. Liver transplantation is the best option if the tumor is of a certain size and has not spread outside the liver. Surgery and transplantation are the only curative options; the rest of the described methods are cancer control measures. They can control the disease, but only for a certain period of time. Some tumors can be treated by injecting them with alcohol (PEI or percutaneous ethanol injection) or by heating them with electrodes (RFA or radiofrequency ablation). This can be done using needles through the skin or using keyhole surgery.

A technique called TACE (transarterial chemoembolization) can be used for more advanced tumors. An interventional radiologist can place a catheter into the artery feeding the tumor and this can be used to deliver chemotherapy drugs mixed in a syrupy liquid directly to the tumor. This approach both delivers the cell-killing drug directly to the tumor and cuts off its blood supply. Standard intravenous chemotherapy is sometimes used for inoperable tumors, but any benefit is usually short-lived.

Experimental treatments include biological agents such as cetuximab (like Erbitux) and sorafenib or using catheters to deliver tiny radioactive pellets to the tumor (SIRT or Selective Internal Radiation Therapy). Survival for primary liver cancers, if detected early, is good and can be as high as 50% with five-year survival in patients undergoing resection or 75% with five-year survival if transplantation is carried out.

Secondary liver cancer

Secondary (metastatic) cancer reaches the liver by spreading through the bloodstream from a primary tumor at a separate site. In about 50% of patients with metastatic liver cancer, the primary tumor is in the intestine (colon, rectum) or stomach. Other common primary sites are the breasts and the lungs.


Symptoms may include fatigue, loss of appetite, nausea, a feeling of drag or heaviness felt under the lower ribs on the right side, and body aches in the upper part of the belly, especially when bending down. the front. In later stages, the skin may develop a yellowish tint (jaundice), as well as fever and profuse sweating, especially
the night.


Diagnosis is usually based on a combination of imaging tests (ultrasound, scanner, MRI). Sometimes blood tests (tumor markers), for example a CEA, CA 19-9 can also be useful.


Treatment for secondary (metastatic) liver cancer is determined by where the primary tumor originated. It is important to realize that the tumor – although spread to the liver – will still behave according to its origin – breast cancer involving the liver behaves like breast cancer, not like primary liver cancer. Therefore, the outlook may be rather better for patients with secondary liver cancer as opposed to primary liver cancer.

Surgery is increasingly being used for patients with secondary liver cancer. This may sometimes involve removing a segment of liver.

Alternatively, keyhole techniques can be used to apply extreme heat to localized areas of the liver. Selective Internal Radiation Therapy (SIRT) is an experimental technique that involves delivering microscopic radioactive spheres directly to tumors via their blood supply.

The presence of a secondary cancer in the liver implies that the primary tumor has spread via the bloodstream and therefore other organs may be at risk.

It is therefore wise to consider using a treatment such as chemotherapy, which acts on the whole body. The type of chemotherapy used will depend on the type of primary cancer. Chemotherapy and radiotherapy are used in addition to surgery because they complement each other.

Constant monitoring is essential when dealing with patients with end-stage liver disease or in whom primary cancer has been diagnosed elsewhere. Indeed, early detection of tumors in the liver can be effectively treated. In other healthy people, annual liver function tests and ultrasound are essential.

This article is written by Dr. Vivekanandan MBBS, MRCS, FRCS., Managing Director, Chennai Liver Foundation

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