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The liver continuously filters blood that circulates through the body, converting nutrients and drugs absorbed from the digestive tract into ready-to-use chemicals. The liver performs many other important functions, such as removing toxins and other chemical waste products from the blood and readying them for excretion. Because all the blood in the body must pass through it, the liver is unusually accessible to cancer cells traveling in the bloodstream.
What is Liver cancer?
Liver cancer or hepatic cancer is a cancer that originates in the liver. Liver cancers are malignant tumors that grow on the surface or inside the liver.
Liver cancer or hepatic cancer is a cancer that originates in the liver. Liver cancers are malignant tumors that grow on the surface or inside the liver.
Types of Liver Cancer
Staging of Liver Cancer
Diagnosis of Liver Cancer
There are two broad categories of liver cancer: Primary and Secondary
Primary Liver Cancer
Primary liver cancer starts in the cells, bile ducts, blood vessels or connective tissue of the liver. There are different types of primary liver cancer that include:
Hepatoma :This is the most common type. It is sometimes called hepatocellular carcinoma (HCC). This type of cancer originates from a liver cell (hepatocyte) which becomes cancerous. The bulk of the liver is made up from hepatocytes. A hepatoma most commonly develops as a complication of liver diseases such as cirrhosis or types of hepatitis (liver inflammation).
Fibrolamellar : This hepatoma is a rare sub-type of hepatoma. It typically develops in a liver that was previously healthy.
Cholangiocarcinoma : This is uncommon. It develops from cells which line the bile duct.
Hepatoblastoma : This is a very rare cancer that occurs in some young children.
Angiosarcoma : This is very rare. It develops from cells of blood vessels within the liver.
Secondary Liver Cancer
Secondary liver cancer is a cancer that first develops elsewhere in the body and then spreads (metastasizes) to the liver. It is sometimes called metastatic cancer.
When a cancer forms in a part of the body, a few cancer cells may break off and find their way into the bloodstream. Because your liver filters your blood, any cancer cells in the bloodstream have a high chance of settling in the liver to form a cancer nodule (metastasis).
People who are most at risk of secondary liver cancer are those with cancers of the large bowel (colon), pancreas, stomach, lung or breast. It is important to know where the cancer started as this will determine the type of cells which are causing the cancer and affect which treatment is best suited for you. Secondary cancer diagnosed in the liver may be a sign of cancer in other organs. Sometimes, secondary cancer is found in the liver and yet, even with thorough medical tests, it’s not possible to find out where the cancer started. This is sometimes known as cancer of unknown primary.
There are a number of different systems that can be used to stage liver cancer. Many liver cancer specialists use combination-staging systems that include features of both the cancer and liver function to stage a person’s condition.
One combination system for staging liver cancer is known as the Barcelona Clinic Liver Cancer (BCLC) staging system that consists of the following five stages.
Stage 0 – The tumour is less than 2cm (20mm) in diameter and the person is very well and has normal liver function.
Stage A – A single tumour has grown but is less than 5cm (50mm) in diameter, or there are three or fewer smaller tumours that are less than 3cm (30mm) in diameter and the person is very well with normal liver function.
Stage B – There are multiple tumours in the liver, but the person is well and their liver function is unaffected.
Stage C – Any of the above circumstances, but the person is not so well and their liver function is not so good; or where the cancer has started to spread into the main blood vessel of the liver, into nearby lymph nodes or into other parts of the body.
Stage D – Where the liver has lost most of its functioning abilities and the person begins to have symptoms of end-stage liver disease, such as a build-up of fluid inside their abdomen.
Physical examination helps in determining symptoms or lumps that may suspect the presence of liver cancer. Some of the other tests that are performed for diagnosing liver cancer include –
Laparoscopy : A thin tube is used for observing liver and other organs within the abdominal cavity. A laparoscope can also be used along with a biopsy.
Blood Tests : The blood tests also include liver enzymes and a serum marker test. The measurement of some substances associated to cancer can be done by performing serum marker test. An underlying liver problem is indicated with the help of liver enzymes.
Angiogram : The injection of a dye is done into an artery that shows tumors and liver tissues.
Ultrasound : High-frequency sound waves from the body are transmitted by this procedure.
Magnetic Resonance Imaging (MRI): A computer, large magnet and radio waves are produced in this test that provides clear images of the human body.
Computed Tomography (CT scan) : This test also provides detailed images of the organs.
Liver Cancer Treatment at World Best Cancer Hospitals in India
Nonsurgical Treatments for Liver Cancer in India
The treatment options are dictated by the stage of Liver Cancer and the overall condition of the patient. The treatment to be given depends mainly on the size, number, and site of tumors in the liver. Before planning the appropriate treatment the functioning of the Liver is checked as also the spread of the cancer within and outside the liver is to be tested. The Various treatment options available are as follows:
Surgery : Surgery is the removal of the tumor and surrounding tissue during an operation. It is likely to be the most successful disease-directed treatment, particularly for patients with small tumors (smaller than 5 cm). A surgical oncologist is a doctor who specializes in treating cancer using surgery.
Liver Transplant : When it is available, a liver transplant may be the best option for some people with small liver cancers. At this time, liver transplants are reserved for those with small tumors (either 1 tumor smaller than 5 cm across or 2 to 3 tumors no larger than 3 cm) that have not invaded nearby blood vessels. In most cases, transplant is used for tumors that cannot be totally removed, either because of the location of the tumors or because the liver is too diseased for the patient to withstand removing part of it.
Radiation therapy : Another potential method of treating liver cancer is radiation therapy . The radiation comes in the form of high energy x-rays that are delivered to the patient only in the areas at highest risk for cancer. These x-rays are similar to those used for diagnostic x-rays, only of a much high energy. The high energy of x-rays in radiation therapy results in damage to the DNA of cells. Because cancer cells are not as good as normal, healthy cell at repairing DNA damage, radiation results in relatively more damage to the cancer cells than to normal cells.consists of a specific number of treatments given over a set period of time.
External-beam radiation therapy is radiation given from a machine outside the body.External-beam radiation therapy is not often used for HCC.
Targeted Therapy : Targeted therapy is a treatment that targets the cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. This type of treatment blocks the growth and spread of cancer cells while limiting damage to normal cells. Recent studies show that not all tumors have the same targets. To find the most effective treatment, your doctor may run tests to identify the genes, proteins, and other factors in your tumor.
Chemoembolization : Before Insertion of the tiny particles that block the blood flow an anticancer drug is injected into the artery. The drug stays in the liver for longer without blood flow, and thus the impact is more.
Radiofrequency Ablation : For inoperable liver tumors, radiofrequency ablation (RFA) offers a nonsurgical, localized treatment that kills the tumor cells with heat, while sparing the healthy liver tissue. Thus, this treatment is much easier on the patient than systemic therapy.
Cryosurgery : It is a treatment that uses an instrument to freeze and destroy abnormal tissue, such as cancerous cells. This type of treatment is also called Cryotherapy. The doctor may use ultrasound to guide the instrument.
Percutaneous Ethanol Injection : Percutaneous ethanol injection is a cancer treatment in which a small needle is used to inject ethanol (alcohol) directly into a tumor to kill cancer cells. The procedure may be done once or twice a week. Usually local anesthesia is used, but if the patient has many tumors in the liver, general anesthesia may be needed.
Hyperthermia Therapy : Hyperthermia therapy is a type of treatment in which body tissue is exposed to high temperatures to damage and kill cancer cells or to make cancer cells more sensitive to the effects of radiation and certain anticancer drugs. Because some cancer cells are more sensitive to heat than normal cells are, the cancer cells die and the tumor shrinks.
Biologic Therapy : Biologic therapy is a treatment that uses the patient’s immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body’s natural defenses against cancer. This type of cancer treatment is also called biotherapy or immunotherapy.
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