Jane DoeWhat is Liver cancer?
Liver cancer is a cancer that starts in the liver. To understand liver cancer, it helps to know about the normal structure and function of the liver.
The liver is the largest internal organ. It lies under your right ribs just beneath your right lung. It is shaped like a pyramid and divided into right and left lobes. The lobes are further divided into segments.
Unlike most other organs, the liver gets blood from 2 sources: the hepatic artery supplies the liver with blood rich in oxygen from the heart, and the portal vein brings nutrient-rich blood from the intestines.
You cannot live without your liver. It has several important functions:
- It breaks down and stores many of the nutrients absorbed from the intestine that your body needs to function. Some nutrients must be changed (metabolized) in the liver before they can be used by the rest of the body for energy or to build and repair body tissues.
- It makes most of the clotting factors that keep the body from bleeding too much when you are cut or injured.
- It secretes bile into the intestines to help absorb nutrients (especially fats).
- It filters out and breaks down toxic wastes in the blood, which are then removed from the body.
These different types of cells in the liver can form several types of malignant (cancerous) and benign (non-cancerous) tumors. These tumors have different causes, are treated differently, and have a different prognosis (outlook).
Symptoms of Liver Cancer
Signs and symptoms of liver cancer tend not to be felt or noticed until the cancer is well advanced.
Hepatocellular carcinoma (HCC) signs and symptoms may include:
- Jaundice - skin, tongue and whites of the eyes become yellow.
- Abdominal pain - often on the right side, may reach as high up as the shoulder.
- Unexplained weight loss
- Hepatomegaly - enlarged liver, the abdomen may seem swollen.
- Fatigue
- Nausea
- Emesis (vomiting)
- Back pain
- General itching
- Fever
Causes of Liver Cancer
Ababolic steroids
Used by athletes and weight lifters. These male hormones, if used regularly and for long enough can raise the risk of developing liver cancer, as well as some other cancers.
Aflatoxins
This is a substance that is made by a fungus and may be found in mouldy wheat, groundnuts, corn, nuts, soybeans and peanuts. For liver cancer risk to increase there needs to be long-term exposure. This is more of a problem in some poor countries than in industrialized nations.
Cirrhosis
When liver cells are damaged and replaced with scar tissue. People with cirrhosis of the liver have a higher risk of developing liver cancer.
Diabetes
Patients with diabetes, especially if they also have hepatitis, or regularly consume a lot of alcohol, are more likely to develop liver cancer.
Family histor
People whose mother, father, brother, or sister with liver cancer have a higher risk of developing it themselves, compared to others.
L-carnitine deficiency
Studies suggest that an l-carnitine deficiency increases the risk of developing liver cancer.
Liver disease and inherited liver disease
People with hepatitis B or C have a significantly higher risk of developing liver cancer, compared to other healthy individuals. According to the American Cancer Society, hepatitis C is the most common cause of liver cancer in the USA. The Society mentions that some inherited liver diseases also increase the risk of liver cancer.
Low immunity
People with weakened immune systems, such as those with HIV/AIDS have a risk of liver cancer that is five times greater than other healthy individuals.
Obesity
Obesity raises the risk of developing many cancers, including liver cancer.
Gender
A higher percentage of males get liver cancer compared to females. Some experts believe this is not due to gender, but to lifestyle characteristics - on average, males tend to smoke and abuse alcohol more than females.
Smoking
Individuals with hepatitis B or C have a higher risk of liver cancer if they smoke.
Water wells with arsenic
People who rely on water wells that have arsenic may eventually have a significantly higher risk of developing several conditions or diseases, including liver cancer.
Treatment for Liver Cancer
In creating your treatment plan, important factors to consider include the stage (extent) of the cancer and the health of the rest of your liver. But you and your cancer care team will also want to take into account the possible side effects of treatment, your overall health, and the chances of curing the disease, extending life, or relieving symptoms. Based on these factors, your treatment options may include:
- Surgery (partial hepatectomy or liver transplant)
- Other local treatments, such as ablation or embolization
- Radiation therapy
- Chemotherapy
Surgery
Surgical options are limited to individuals whose tumors are less than 5 cm and confined to the liver, with no invasion of the blood vessels
The goal of liver resection is to completely remove the tumor and the appropriate surrounding liver tissue without leaving any tumor behind. This option is limited to patients with one or two small (3 cm or less) tumors and excellent liver function, ideally without associated cirrhosis. As a result of these strict guidelines, in practice, very few patients with liver cancer can undergo liver resection. The biggest concern about resection is that following the operation, the patient can develop liver failure. The liver failure can occur if the remaining portion of the liver is inadequate to provide the necessary support for life. Even in carefully selected patients, about 10% of them are expected to die shortly after surgery, usually as a result of liver failure.
Liver transplantation has become an accepted treatment for patients with end-stage (advanced) liver disease of various types (for example, chronic hepatitis B and C, alcoholic cirrhosis, primary biliary cirrhosis, and sclerosing cholangitis). Survival rates for these patients without liver cancer are 90% at one year, 80% at three years, and 75% at five years. Moreover, liver transplantation is the best option for patients with tumors that are less than 5 cm in size who also have signs of liver failure. In fact, as one would expect, patients with small cancers (less than 3 cm) and no involvement of the blood vessels do very well. These patients have a less than 10% risk of recurrent liver cancer after transplant. On the other hand, there is a very high risk of recurrence in patients with tumors greater than 5 cm or with involvement of blood vessels. For these reasons, when patients are being evaluated for treatment of liver cancer, every effort should be made to characterize the tumor and look for signs of spread beyond the liver.
There is a severe shortage of organ donors in the U.S. Currently, there are about 18,000 patients on the waiting list for liver transplantation. About 4,000 donated cadaver livers (taken at the time of death) are available per year for patients with the highest priority. This priority goes to patients on the transplant waiting list who have the most severe liver failure. A recent change in distribution rules made liver cancer of under 5 cm a priority, so these people can spend less time on the waiting list. A newer, growing option is live donor transplantation.
In summary, liver resection should be reserved for patients with small tumors and normal liver function (no evidence of cirrhosis). Patients with multiple or large tumors should receive palliative therapy with systemic chemotherapy or TACE, provided they do not have signs of severe liver failure. Patients with an early stage of cancer and signs of chronic liver disease should receive palliative treatment with RFA, cryoablation, or TACE and undergo evaluation for liver transplantation.
Ablation techniques
Ablation refers to any method that physically destroys a tumor, and is generally only applicable to situations in which there is only one, two, or sometimes three individual cancers in a liver. When there are more than that, it is not possible to reach every one on its own, so a different method such as systemic chemotherapy or TACE must be used.
Radiation therapy
This type of radiation therapy focuses radiation delivered from outside the body on the cancer. This can sometimes be used to shrink liver tumors to relieve symptoms such as pain, but it is not used as often as other local treatments such as ablation or embolization. Although liver cancer cells are sensitive to radiation, this treatment can't be used at very high doses because normal liver tissue is also easily damaged by radiation.
Before your treatments start, the radiation team will take careful measurements to determine the correct angles for aiming the radiation beams and the proper dose of radiation. Radiation therapy is much like getting an x-ray, but the radiation is stronger. The procedure itself is painless. Each treatment lasts only a few minutes, although the setup time – getting you into place for treatment – usually takes longer. Most often, radiation treatments are given 5 days a week for several weeks.
With newer radiation techniques, doctors can better target liver tumors while reducing the radiation to nearby healthy tissues. This may make it more effective and reduce side effects.
Chemotherapy
Chemotherapy (chemo) is treatment with drugs to destroy cancer cells. Systemic (whole body) chemotherapy uses anti-cancer drugs that are injected into a vein or given by mouth. These drugs enter the bloodstream and reach all areas of the body, making this treatment potentially useful for cancers that have spread to distant organs.
Unfortunately, liver cancer resists most chemo drugs. The drugs that have been most effective in shrinking the tumors are doxorubicin (Adriamycin), 5-fluorouracil, and cisplatin. But even these drugs shrink only a small portion of tumors, and the responses often do not last long. Even with combinations of drugs, in most studies systemic chemotherapy has not helped patients live longer.
Lifestyle changes after Liver Cancer
You can't change the fact that you have had cancer. What you can change is how you live the rest of your life -- making choices to help you stay healthy and feel as well as you can. This can be a time to look at your life in new ways. Maybe you are thinking about how to improve your health over the long term. Some people even start during cancer treatment.
Making healthier choices
For many people, a diagnosis of cancer helps them focus on their health in ways they may not have thought much about in the past. Are there things you could do that might make you healthier? Maybe you could try to eat better or get more exercise. Maybe you could cut down on the alcohol, or give up tobacco. Even things like keeping your stress level under control may help. Now is a good time to think about making changes that can have positive effects for the rest of your life. You will feel better and you will also be healthier.
Eating better
If treatment caused weight changes or eating or taste problems, do the best you can and keep in mind that these problems usually get better over time. You may find it helps to eat small portions every 2 to 3 hours until you feel better. You may also want to ask your cancer team about seeing a dietitian, an expert in nutrition who can give you ideas on how to deal with these treatment side effects.
One of the best things you can do after cancer treatment is put healthy eating habits into place. You may be surprised at the long-term benefits of some simple changes, like increasing the variety of healthy foods you eat. Getting to and staying at a healthy weight, eating a healthy diet, and limiting your alcohol intake may lower your risk for a number of types of cancer, as well as having many other health benefits.
Rest, fatigue, and exercise
If you were sick and not very active during treatment, it is normal for your fitness, endurance, and muscle strength to decline. Any plan for physical activity should fit your own situation. An older person who has never exercised will not be able to take on the same amount of exercise as a 20-year-old who plays tennis twice a week. If you haven't exercised in a few years, you will have to start slowly – maybe just by taking short walks.
If you are very tired, you will need to balance activity with rest. It is OK to rest when you need to. Sometimes it's really hard for people to allow themselves to rest when they are used to working all day or taking care of a household, but this is not the time to push yourself too hard. Listen to your body and rest when you need to. (For more information on dealing with fatigue, please see Fatigue in People With Cancer and Anemia in People With Cancer.)
Keep in mind exercise can improve your physical and emotional health.
- It improves your cardiovascular (heart and circulation) fitness.
- Along with a good diet, it will help you get to and stay at a healthy weight.
- It makes your muscles stronger.
- It reduces fatigue and helps you have more energy.
- It can help lower anxiety and depression.
- It can make you feel happier.
- It helps you feel better about yourself.
