Liver Cancer

Liver cancer (hepatic cancer) is a serious malignancy that begins in the liver cells.

1. Types:

• Primary Liver Cancer: Starts in the liver.
  • Hepatocellular Carcinoma (HCC): (~75-90% of cases). Arises from hepatocytes (main liver cells). Strongly linked to chronic liver disease/cirrhosis.
  • Intrahepatic Cholangiocarcinoma (Bile Duct Cancer): (~10-15%). Starts in the bile ducts within the liver.
  • Less Common: Hepatoblastoma (rare, in children), Angiosarcoma/Hemangiosarcoma (very rare, in blood vessels).
• Secondary (Metastatic) Liver Cancer: Much more common. Cancer spreads to the liver from another organ (e.g., colon, breast, lung, pancreas). Treated based on the primary cancer.

2. Symptoms (Often appear late in the disease):

1. Unexplained weight loss
2. Loss of appetite or feeling full quickly
3. Upper abdominal pain (especially right side under ribs)
4. Nausea or vomiting
5. Weakness or fatigue
6. Abdominal swelling (ascites – fluid buildup) or bloating
7. Jaundice (yellowing of skin/eyes)
8. White, chalky stools / Dark urine
9. Itchy skin
10. Fever

11. Enlarged liver/spleen (felt by doctor)
12. Risk Factors (Primarily for HCC):

• Chronic Viral Hepatitis:
  • Hepatitis B (HBV): Major global risk factor (even without cirrhosis).
  • Hepatitis C (HCV): Leading cause in many Western countries (usually progresses to cirrhosis first).
• Cirrhosis: Scarring of the liver from any cause is the biggest risk factor for HCC.
• Causes include:
  • Chronic HBV/HCV
  • Alcohol-Related Liver Disease (ARLD): Heavy, long-term drinking.
  • Non-Alcoholic Fatty Liver Disease (NAFLD) / Non-Alcoholic Steatohepatitis (NASH): Rising cause due to obesity/diabetes epidemics.
  • Autoimmune Hepatitis
  • Genetic disorders (Hemochromatosis, Wilson’s disease, Alpha-1 antitrypsin deficiency)
• Aflatoxin Exposure: Toxin produced by mold on improperly stored grains/nuts (significant in parts of Africa/Asia).
• Other: Smoking, Type 2 Diabetes, Obesity, Certain Rare Diseases (e.g., Tyrosinemia).

4. Screening & Early Detection (For High-Risk Individuals):

• Who: People with cirrhosis (any cause), chronic HBV (even without cirrhosis), certain genetic conditions, or cured HCC.
• How:
  • Ultrasound (US): Every 6 months. Primary screening tool.
  • Blood Test: Alpha-fetoprotein (AFP) tumor marker (often with US, but less reliable alone). Other markers (AFP-L3%, DCP) may be used.

5. Diagnosis:

• Imaging: US (initial), then typically Multiphase CT scan or MRI with contrast to characterize the lesion.
• Blood Tests: Liver function tests (LFTs), AFP, HBV/HCV status, coagulation studies, kidney function.
• Biopsy: Not always needed if imaging is classic for HCC in cirrhosis (risk of bleeding/spread). Often required for atypical lesions or suspected cholangiocarcinoma.
• Staging: Uses systems like BCLC (Barcelona Clinic Liver Cancer), which incorporates tumor size/number, liver function (Child-Pugh class), performance status, and symptoms to guide treatment. Also, TNM staging.

6. Treatment (Depends heavily on Stage & Liver Function):

• Surgical:
  • Liver Resection (Surgery): Removal of the tumor + surrounding tissue. Only possible if the tumor is removable and liver function is good (usually reserved for early HCC in non-cirrhotic livers or very well-compensated cirrhosis).
  • Liver Transplant: Curative option for early-stage HCC meeting specific criteria (e.g., Milan Criteria: 1 tumor ≤5cm or ≤3 tumors each ≤3cm, no major vessel invasion). Requires a donor organ.
• Ablative Therapies (For Small Tumors):
  • Radiofrequency Ablation (RFA) / Microwave Ablation (MWA): Heat to destroy the tumor via a needle probe.
  • Ethanol Ablation (PEI): Injecting alcohol into the tumor.
  • Cryoablation: Freezing the tumor.
• Embolization (For Intermediate Stage/Multiple Tumors): Blocking the blood supply to the tumor.
  • Transarterial Chemoembolization (TACE): Chemotherapy + blocking agent injected into liver artery.
  • Transarterial Radioembolization (TARE / Y-90): Tiny radioactive beads are injected into the liver artery.
• Radiation Therapy:
  • Stereotactic Body Radiotherapy (SBRT): Precise high-dose radiation for small tumors.
  • External Beam Radiation: Sometimes used for symptom control.
• Systemic Therapies (For Advanced/Unresectable Cancer):
  • Targeted Therapy: Sorafenib, Lenvatinib (1st line); Regorafenib, Cabozantinib (2nd line). Attack cancer cell growth pathways.
  • Immunotherapy: Atezolizumab + Bevacizumab (1st line standard for advanced HCC); Nivolumab, Pembrolizumab, others. Help the immune system fight cancer.
  • Chemotherapy: Less effective for HCC than for many other cancers. More commonly used for cholangiocarcinoma.
• Supportive/Palliative Care: Crucial at all stages to manage symptoms, side effects, and quality of life.

7. Prevention:

• Vaccinate against Hepatitis B.
• Treat Chronic Hepatitis B/C: Antiviral medications can suppress HBV and cure HCV, reducing cirrhosis/HCC risk.
• Limit Alcohol Consumption.
• Maintain a Healthy Weight & Manage Diabetes: Reduce risk of NAFLD/NASH.
• Handle Food Safely: Reduce aflatoxin exposure (proper grain/nut storage).
• Regular Screening: For high-risk individuals (cirrhosis, chronic HBV).
• Use Precautions: Prevent HBV/HCV spread (safe sex, avoid sharing needles, safe tattoo/piercing practices).

8. Prognosis:

• Highly variable, depends on stage at diagnosis, liver function (Child-Pugh class), overall health, and treatment response.
• Early-stage, treatable (resection/transplant/ablation): Potential for cure; 5-year survival can be 60-70%+.
• Intermediate/Advanced Stage: Systemic therapies extend survival, but the cure is rare; median survival is often measured in months to a few years, improving with newer drugs.
• Metastatic/End-Stage: Focus shifts to palliative care; prognosis is poor.

Critical Takeaway: Liver cancer is often linked to preventable or treatable underlying conditions (like HBV, HCV, alcohol, NAFLD). Early detection in high-risk individuals through screening offers the best chance for curative treatment. If you have risk factors, discuss screening with your doctor.