Liver Cancer

Around 50% of cases of liver cancer are caused by hepatitis B virus (HBV) and hepatitis C virus (HCV) infection which can be prevented through immunisation. Liver cancer usually originates from cancer of other regions in the body, and is present as a result of the cancer spreading. In the case of colon cancer, spreading to the liver is the major cause of death, but in some cases is curable.

Primary liver cancer in the form of hepatocellular cancer is the fourth most common cancer in the world and usually occurs where there is underlying chronic liver damage.

Classification of liver cancer tumors include:

Hepatocellular Carcinoma
This begins in the hepatocytes, the main type of liver cell. Approximately 75% of primary liver cancers are of this type. This type of cancer can have different growth patterns. Multiple HCC is most often seen in people with liver cirrhosis.

Intrahepatic Cholangiocarcinomas
These tumours account for approximately 10-20% of cases of liver cancer. These cancers start in the small tubes that carry bile within the liver.

Angiosarcomas and Hermangiosarcomas
These tumours are rare forms of cancer that begin in the blood vessels of the liver and grow quickly.

Metastatic Liver Cancer
Results from the spread (metastasis) of cancer from other areas of the body. The most common cancers treated when spread to the liver are colorectal cancer, and neuroendocrine tumors. Less commonly liver surgery is performed with the aim of cure for melanoma, breast cancer, uterine cancer, renal cell carcinoma (kidney) and lung cancer

Statistics

  • Diagnoses of primary liver cancer in Australia are relatively low, although it is growing faster than that of any other cancer.
  • In 2016 there will be approximately 1,840 people diagnosed with primary liver cancer.
  • Early detection rates of liver cancer are extremely low and as a consequence of this the mortality rate is high.
  • Secondary liver cancer is a lot more common occurring 20 times more often than primary liver cancer. In Australia on average 28,000 people are diagnosed with secondary liver cancer.

Causes

Some risk factors associated with liver cancer include;

  • Smoking: people who smoke are at a higher risk of developing liver cancer.
  • Chronic liver infection: Liver cancer can develop after years of chronic infection with the hepatitis B or C virus.
  • Cirrhosis: Cirrhosis develops when liver cells are damaged and replaced with scar tissue. This can be caused by alcohol abuse, certain drugs and other chemicals or certain viruses or parasites.
  • Gender: males are nearly three times more likely to get liver cancer than females. Males have a higher risk of contracting viral hepatitis and alcoholic cirrhosis.
  • Obesity: high fat diet and being overweight has been linked to increased prevalence of liver cancer.
  • Family history: people with a family history of liver cancer may be more likely to develop the disease.
  • Age: Liver cancer tends to be detected in people over the age of 60.
  • Alcohol: drinking alcohol over a long period of time can cause increased risk of developing liver cancer.

Symptoms

In its early stages, liver cancer is difficult to detect which is why it is known as a ‘silent killer’ of cancers. Primary liver cancer does not tend to cause many prevalent symptoms until the cancer is more advanced.

liver-cancer-symptoms_for_web

Primary and secondary liver cancer symptoms may include:

  • Unexpected weight loss or loss of appetite
  • Jaundice (yellow skin, eyes and dark urine)
  • Fever
  • Pain in the right side of the upper abdomen
  • Excessive fatigue or weakness

Having one or more of the symptoms listed above does not necessarily mean you have liver cancer. It is important to discuss any symptoms with your doctor.

Tests

There are a number of tests that can be done to diagnose liver cancer including:

  • Physical examination
  • Blood test
  • Imaging tests CT scan, PET scan, ultrasound and MRI
  • Biopsy (tissue sample) from the liver for examination

Treatment

Currently, the best chance for potentially curing liver cancer is through surgery or complete destruction of the tumor by using heat methods such as microwave or radiofrequency. Surgery can be done in attempt to remove the tumour or to do a liver transplant in cases of some primary liver tumours, such as hepatocellular cancer in suitable patients. If the surgeon is able to remove most of the tumour, this improves the chance of a positive outlook for survival.

liver-cancer

The success of a liver tumour removal depends on the following factors:

  • Location of the tumour
  • Number of tumours
  • Distribution of the tumours
  • Amount of liver left after tumour removal

Resection of a large portion of the liver is possible because the remaining liver grows to compensate for the part that was removed. This determination can only be made by a surgeon experienced in liver surgery. In a healthy liver, up to 80% of the liver can be removed with patients able to function on two segments of liver only.

In combination with other members of the multi-disciplinary team, your surgeon will assess if it is possible to remove the entire tumour or all of the disease while leaving enough liver behind.

In some instances it may appear that the disease involves a large majority of your liver, and it may be determined that surgery is impossible. However, sometimes with the combination of chemotherapy to shrink the tumor and portal vein embolization to help the liver “grow” before the surgery, all the cancer can be removed. Sometimes staged liver surgery may be needed, with one surgery followed by a period to allow the liver to grow, and then surgery to remove more liver.

In suitable patients, laparoscopic liver tumor removal may be possible, which involves removing part of the liver with minimally invasive techniques, requiring a smaller incision and providing a quicker recovery.

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