Signs and symptoms of liver cancer are most often the result of liver damage and may include yellowing of the skin (jaundice), pain in the shoulder blade or abdomen on the right side, or lumps on the upper right side. of the abdomen. However, many of the warning signs are not decisive in diagnosing it, such as weight loss and fatigue.
What is the liver?
The liver is the body’s largest internal organ , and its main functions include the production and secretion of bile that is used for digestion (especially fatty foods), energy storage, and the synthesis of plasma proteins , including clotting factors, as well as chemicals and the metabolism of alcohol, drugs, and other toxic substances before they are eliminated from the body through feces and urine.
The liver is made up of several cell types with different embryological origins, such as hepatocytes (liver cells), hepatic endothelial cells, and bile epithelial cells . Bile epithelial cells expand outside the liver to form bile duct tubules that connect the liver to the intestine and gallbladder to drain bile secreted by hepatocytes.
When liver cells develop changes (mutations) in their DNA , they can start to grow out of control and eventually form a tumor . Different types of liver cells can form various types of benign (non-cancerous) and malignant (cancerous) tumors . Malignant liver tumors can start only in the liver or spread to other organs in the body. However, these tumors with different types and causes have a wide variation in disease prognosis and are treated differently.
Types of liver cancer
Liver cancer is a disease that begins in the cells of the liver and is called primary liver cancer. While liver cancer caused by other cancers is called secondary liver cancer (metastatic liver cancer) . Secondary liver cancer is more common in the West than in Asia.
Several types of cancer can form in the liver. The two most common are:
Cholangiocarcinoma
Cholangiocarcinoma or cancer of the bile ducts is a cancer that forms in the bile ducts that connect the liver with the gallbladder and the small intestine. This type of cancer usually begins in the cells that line the bile ducts within the liver.
Cholangiocarcinoma is a very difficult type of tumor to treat, so treatments are often complicated with unsatisfactory results and a poor prognosis. The best possible way to reduce the risk of cholangiocarcinoma is to avoid eating raw freshwater fish and foods with nitrosamine contamination.
Hepatocellular carcinoma
Hepatocellular carcinoma is the most common type of primary liver cancer . It develops in people with chronic liver diseases, such as hepatitis B and hepatitis C infection , which can be passed from mother to child during childbirth and the sexual tract. When hepatitis viruses pass into the bloodstream and liver cells, they cause liver infection and inflammation that can turn into chronic hepatitis or hepatitis carriers who can keep the viruses and pass them on to others without showing symptoms. The most common causes for this type of cancer to develop are:
- Drinking large amounts of alcohol and developing cirrhosis .
- Having a buildup of fat in the liver (fatty liver).
- Eating grains contaminated with aflatoxin , which is a hepatitis B accelerator.
To reduce the risks of developing hepatocellular carcinoma, it is advisable to get vaccinated against hepatitis and avoid exposure to the hepatitis B and C viruses , such as sexual contact and sharing needles and syringes.
Signs and symptoms of liver cancer
Most people may not have signs and symptoms of liver cancer in its early stages . When they appear, the most common are usually:
- General weakness and fatigue .
- Loss of appetite
- Involuntary weight loss
- Flatulence.
- Abdominal pain in the upper right part .
- Abdominal discomfort or a tight stomach .
- The pain can radiate to the right shoulder or below the right shoulder blade .
If liver cancer progresses and liver function deteriorates significantly or the bile duct becomes blocked , patients may experience the following signs and symptoms:
- Yellow discoloration of the skin.
- Yellow discoloration of the whites of the eyes.
- Darker urine.
- Swelling or fluid buildup in the abdomen.
- Leg swelling.
- Mild fever of unknown cause.
If liver cancer progresses to its late stage , cancerous tumors can spread (metastasize) to other parts of the body , such as bones.
Screening and early detection
Since the symptoms of liver cancer do not usually appear in the early stages, the chances of successful treatment results are limited , especially when the disease progresses to an advanced stage. Screening and early detection of liver cancer is considered the most effective measure to look for liver cancer, even if no signs appear. Early detection of cancer greatly increases the chances of successful treatment by focusing on detecting asymptomatic patients as early as possible.
Prevention and risk reduction
- Cholangiocarcinoma prevention: Avoid liver fluke infection and consumption of food with nitrosamine.
- Prevention of hepatocellular carcinoma: Get vaccinated against hepatitis B and avoid all routes of transmission of hepatitis B and C (direct contact with the blood and sexual route). People who are at higher risk of developing hepatocellular carcinoma are hepatitis B carriers, patients with chronic hepatitis B or C, and patients with cirrhosis. These groups of people are strongly advised to have an abdominal ultrasound and an AFP (alpha-fetoprotein) test regularly every 6 months.
The risk of liver cancer is substantially reduced if early detection is done on time . To achieve the best possible result, a multidisciplinary team in a specialized cancer hospital is the key. In addition, with greater chances of successful treatment, the quality of life of the patient improves greatly.
Liver cancer treatment
Once the signs and symptoms of liver cancer are diagnosed, the multidisciplinary team is vitally important in determining the most appropriate treatment plan for each individual patient, based primarily on the size, location and stage of the cancer, or whether it has spread to other organs. The main treatment options are generally surgery, chemotherapy, and radiation .
Since patients with liver cancer usually have tissue fibrosis or cirrhosis , surgery can only be performed in 20% of all cases . If patients have a small liver with a large area of cirrhosis, the alternative treatment that might be considered is liver transplantation .
In cases where liver cancer cannot be removed by surgery for certain reasons, such as the mass being considerably large or multiple masses are detected, personalized treatment through targeted therapy is presented as the most effective treatment, especially for hepatocellular carcinoma. .
Targeted therapy and personalized treatment
Targeted therapy targets specific abnormalities present only within cancer cells . By acting to block these abnormalities, the drug can cause liver cancer cells to die. There are many medications available to treat advanced liver cancer. However, some targeted therapies only work in people whose cancer cells have certain genetic mutations .
Precision Medicine
Recently, some clinical trials have focused on advances in “precision medicine” to determine specific genes and related therapeutic mechanisms to fight cancer cells. In addition, immunotherapy , the use of drugs that help the patient’s own immune system find and destroy cancer cells, has been developed and used in advanced liver cancer.
Radiofrequency ablation
With advances in technology, radiofrequency (RF) ablation is one of the most common methods of treating small liver cancer, less than 3 cm in size. During this procedure, the doctor inserts a thin, needle-shaped tube into the cancerous mass of the liver through the skin. Then, a high-frequency current is passed through the tip of the probe, which heats up and kills the cancer cells.
TACE or chemoembolization
In some cases, if there are too many tumors or if the tumor is too large to surgically remove, a procedure called TACE may be done. This minimally invasive procedure uses a catheter to deliver both chemotherapy drug and embolization material (embolic agent) to kill cancer cells.
During TACE, the doctor places a thin tube (a catheter) into the large blood vessel in the groin or arm . The doctor then moves the catheter up through the artery until it reaches the hepatic artery in the liver . A radiopaque fluid is injected into the catheter and an X-ray machine looks for the branches of the artery that feed the liver tumors.
The chemotherapy drug and embolization material are then injected into the arteries that feed the tumors , causing the cancer cells to die.
OCD or transarterial chemoembolization
In some cases, TOCE or transarterial chemoembolization may be used instead of TACE. This method uses a chemotherapy drug and an oily liquid called lipiodol that provides a powerful embolic effect to the vessels that feed cancer cells . However, multiple treatments are needed to completely block the vessels.
Selective internal radiation therapy
To avoid multiple injections, selective internal radiation therapy (SIRT) could be an alternative option. During SIRT treatment, small radioactive beads are delivered directly to the liver tumor through the arteries of the liver . The beads emit radiation, which are high-energy rays that damage cancer cells within the liver . This method is recommended for patients who have liver cancer that spreads to the hepatic veins.
