Cancers that start in the liver are called liver cancer. The liver is the largest organ of the body and is located beneath the right lung, under the right ribs.
Types of Liver Cancer
- Hepatic Adenoma: This is a type of benign liver tumor, which may cause abdominal pain or blood loss. Surgical removal is usually recommended.
- Focal Nodular Hyperplasia (FNH): This tumor is made up of several different types of cells
- Hepatic Angiosarcoma and Hemangiosarcoma: These are rare.
- Hepatocellular Carcinoma (Hepatocellular Cancer): This is the most common form of primary liver cancer in adults. It can occur as a single tumor or as many small cancer nodules throughout the liver. This is seen most often in people with cirrhosis (chronic liver damage)
- Intrahepatic cholangiocarcinoma (bile duct cancer): 10%-15% liver cancers are of this type. It commonly spreads to the lymph nodes, lung, and bone marrow.
- Hepatoblastoma: This is rare cancer found in children, usually under age 4.
- Secondary liver cancer: This is cancer that starts elsewhere in the body such as the pancreas, colon, stomach, breast, or lung and spreads (metastasis) to the liver.
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Causes of Liver Cancer
The exact cause of liver cancer is not known, however, there are many risk factors for liver cancer:
- Liver Cirrhosis: Here liver cells become damaged and are replaced by scar tissue. People with cirrhosis have an increased risk of liver cancer. Chronic alcohol abuse or chronic HBV or HCV infections usually leads to cirrhosis.
- Gender: More common in male
- Age: Usually seen in ages 55 years or older
- Ethnicity: Asian or Hispanic ethnicity
- Genetic: Family history or a first-degree relative
- Obesity: Increases the risk of developing liver cancer as obesity leads to fatty liver disease and cirrhosis.
- Chronic Viral Hepatitis: Hepatitis B or C, (HBV or HCV) is a most common risk factor for liver cancer. These infections lead to cirrhosis of the liver.
- Alcohol Abuse: It is the main cause of cirrhosis which in turn is linked with an increased risk of liver cancer.
- Elevated iron content in the blood due to hemochromatosis.
- Primary Biliary cirrhosis: People with advanced PBC have a high risk of liver cancer.
- Non-alcoholic fatty liver disease: Commonly seen in obese people can be a predisposing factor.
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Signs and Symptoms of Liver Cancer
Liver Cancer causes no symptoms of its own. As the tumor grows, it may cause symptoms of pain. Some patients may have symptoms of chronic liver disease or cirrhosis:
- Unexplained weight loss
- Decreased appetite
- Nausea or vomiting
- Enlarged liver and spleen
- Pain in the abdomen or near the right shoulder blade,
- Fluid in the abdomen
Diagnosis and Tests for Liver Cancer
- Medical history and Examination: The consultant takes complete medical history to check for risk factors and symptoms. Performs clinical examination with special attention to abdomen and checks for jaundice.
- Imaging tests
- Ultrasound is often the first test used to look at the liver.
- CT scan: It can help to identify many types of liver tumors. It can provide precise information about the size, shape, and position of any tumors.
- MRI scan can be very helpful in looking at liver tumors- from a malignant one to a benign tumor. They can also be used to look at blood vessels in and around the liver and can help show if the liver cancer has spread to other parts of the body.
- A bone scan can help look for cancer that has spread to the bone.
- Blood tests
- Alpha-fetoprotein (AFP): Elevated in 70% of patients with liver cancer. A rising level of AFP is suspicious for liver cancer.
- Liver Function Tests (LFTs): Blood tests to access the liver functioning
- Blood Clotting Tests: Blood tests such as a prothrombin time (PT) to help assess the risk of the bleeding disorder.
- Tests for viral hepatitis: Blood tests to check for hepatitis B and C.
- Kidney function tests: Often done to assess kidney functionality.
- Biopsy: Sample tissue from the lesion in the liver is taken, which is analyzed by a pathologist to confirm the suspected diagnosis of liver cancer.
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Treatment of Liver Cancer
It’s important to discuss treatment options, including goals and possible side effects with a consultant. Treatment is planned to take into consideration:
- Patients age
- Other comorbid health conditions
- The stage of cancer
- Whether or not surgery can remove the cancer
Treatment of Liver Cancer
- Partial Hepatectomy: Surgery to remove part of the liver is called partial hepatectomy. This operation is considered for a single tumor that has not grown into blood vessels. Bleeding after surgery is a major concern. Others are infections, complications from anesthesia, blood clots, and pneumonia
- Liver Transplant: It is a major operation. People who get a liver transplant are given drugs to help suppress their immune systems. Some of the drugs used to prevent rejection can also cause high blood pressure, high cholesterol, and diabetes; can weaken the bones and kidneys, and can even lead to new cancer, or faster spread of old cancer.
- Tumour ablation: It is a treatment that destroys liver tumors without removing them and is followed for patients with a few small tumors when surgery is not an option. As it often destroys some of the normal tissue around the tumor, so ablation is not suitable for treating tumors near major blood vessels.
- Tumour Embolization: It is a procedure that injects substances to try to block or reduce the blood flow to cancer cells in the liver. It can be used for tumors that are too large to be treated with ablation (usually larger than 5 cm across).
- Radiation Therapy: Radiation therapy uses high-energy rays to kill cancer cells. Most often, radiation treatments are given 5 days a week for several weeks
- Targeted therapy: Uses newer drugs that specifically target the changes in cells that cause cancer. These drugs enter the bloodstream and reach all areas of the body.
- Immunotherapy: Immunotherapy is the use of medicines that help a person’s own immune system find and destroy cancer cells.
- Chemotherapy(chemo): It is a treatment with drugs to destroy cancer cells. The side effects of chemo depend on the type and dose of drugs given and the length of time they are taken. They usually don’t last long and go away after treatment is finished.
Liver cancer is difficult to cure. Even when successfully treated, Liver cancer may never go away completely, so follow-up is very important. Blood tests and imaging tests on a regular basis are important.
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Factors affecting the Cost of Treatment of Liver Cancer
The cost to the patient depends on a variety of factors like:
- The hospital patient chooses
- The type of room
- Fees for the team of doctors
- Medicine cost
- Cost of Tests and diagnostic procedure
- Type of treatment - Cost of surgery, cost of radiotherapy, cost of chemotherapy
- Cost of follow-up care required