Liver Cancer

Liver Cancer: Understanding the Risks, Diagnosis, and Treatment

Liver cancer is a serious illness that starts in the cells of your liver, a vital organ located in your upper abdomen. It's often linked to pre-existing liver problems, but sometimes it appears without any apparent cause.

Who is at Risk?

Most liver cancers develop in people who already have liver disease. Problems like chronic hepatitis B or C infections, cirrhosis (scarring of the liver), certain inherited liver conditions (like hemochromatosis and Wilson's disease), diabetes, non-alcoholic fatty liver disease (NAFLD), and exposure to aflatoxins increase the risk. Long-term heavy alcohol use can also significantly damage the liver and increase the risk of liver cancer. Importantly, many people with these conditions don't realize they have a problem until the liver is severely damaged or cancer develops. This is why early detection is so crucial.

What are the Symptoms?

In the early stages, liver cancer often has no noticeable symptoms. If symptoms do appear, they can include:

• Unexplained weight loss
• Loss of appetite
• Pain in the upper abdomen
• Nausea and vomiting
• Fatigue and weakness
• Swelling in the abdomen
• Jaundice (yellowing of the skin and eyes)
• Pale, chalky-looking stools
• Fever
• Visible enlarged veins in the abdomen
• Easy bruising or bleeding

Regular checkups and screenings, especially for those with liver problems, are important for early detection.

How is Liver Cancer Diagnosed?

Doctors use various methods to diagnose liver cancer:

• Blood tests: These can reveal abnormalities in liver function.
• Imaging tests: Ultrasound, CT scans, and MRIs create detailed images of the liver, helping to identify any abnormalities.
• Staging tests: Once cancer is diagnosed, additional tests like CT scans, MRIs, and bone scans help determine the size, location, and spread of the cancer. This "staging" process helps doctors understand the extent of the disease and the best treatment options. Different staging systems, such as Roman numerals (I-IV) or letters (A-D), are used to categorize the cancer's progression.

How is Liver Cancer Treated?

Treatment options for liver cancer depend on the stage and severity of the disease. Options include:

• Surgery: Removing the tumor or even the entire liver (liver transplant) can be a treatment option.
• Radiation therapy: High-powered energy beams, like X-rays or protons, are used to destroy cancer cells and shrink tumors. The treatment is precisely targeted to minimize damage to healthy tissue.
• Chemotherapy: Powerful drugs are used to kill cancer cells.
• Targeted therapy: These drugs focus on specific weaknesses within the cancer cells, causing them to die without harming healthy cells.

Different Types of Liver Cancer:

The most common type of liver cancer is hepatocellular carcinoma (HCC), which begins in the main type of liver cells (hepatocytes). Other less common types include intrahepatic cholangiocarcinoma and hepatoblastoma. It's important to understand that cancer can spread to the liver from other parts of the body (metastatic cancer). For example, cancer that starts in the colon and spreads to the liver is called metastatic colon cancer, not liver cancer.

The liver is the largest internal organ in your body, roughly the size of a football. It's located mainly in the upper right part of your abdomen, above your stomach.

Unfortunately, many people don't notice any problems with their liver in the early stages of primary liver cancer. But as the cancer progresses, some signs and symptoms might appear. These can include:

• Unexpected weight loss: Losing weight without trying to lose it is a common early symptom.
• Loss of appetite: A decreased desire to eat is another possible sign.
• Upper abdominal pain: Pain in the upper part of your belly can be a symptom.
• Nausea and vomiting: Feeling sick to your stomach and throwing up are potential symptoms.
• Feeling generally weak and tired: A lack of energy and feeling constantly fatigued are important signals to watch out for.
• Swelling in your abdomen: Your belly might start to swell or feel bloated.
• Yellowing of your skin and eyes (jaundice): This is a noticeable change where your skin and the whites of your eyes turn yellow.
• White, clay-colored stools: Your bowel movements might become a pale, chalky white color.

If you experience any of these symptoms, it's important to see a doctor for a proper diagnosis. These symptoms could be related to liver cancer or other health issues. Early detection is key to effective treatment.

If you're feeling unwell or have any concerns about your health, it's important to schedule a visit with your doctor. Don't hesitate to make an appointment if you notice any unusual symptoms or changes in your body. Your doctor can help you understand what's happening and provide the best possible care.

Liver cancer happens when the instructions inside liver cells (DNA) get messed up. DNA is like a recipe book for all the body's processes. When these instructions are changed (mutated), it can lead to problems. One problem is that liver cells start growing too quickly and form a tumor – a clump of abnormal cells.

Sometimes, we know what causes this problem, like if a person has a long-term hepatitis infection. But other times, liver cancer appears in people who don't have any other health issues, and the reason why isn't fully understood.

Several factors can increase your chances of getting liver cancer. Understanding these risks can help you make healthier choices.

Infections: Chronic infections with the hepatitis B virus (HBV) or hepatitis C virus (HCV) significantly raise your risk of liver cancer. These viruses damage the liver over time, making it more susceptible to developing cancerous cells.

Liver Scarring (Cirrhosis): Cirrhosis is a serious liver condition. It's like the liver getting progressively filled with scar tissue, much like a wound that never heals properly. This scar tissue makes the liver less able to function and greatly increases the risk of liver cancer.

Inherited Liver Diseases: Some inherited conditions can harm your liver and raise your risk of cancer. For example, hemochromatosis causes your body to absorb too much iron, damaging the liver. Wilson's disease is another example, where your body can't properly process copper, leading to liver problems.

Diabetes: People with diabetes have a higher chance of developing liver cancer than those without diabetes. High blood sugar levels can damage the liver over time.

Fatty Liver Disease: Nonalcoholic fatty liver disease (NAFLD) occurs when too much fat builds up in the liver. This can lead to inflammation and liver damage, increasing the risk of liver cancer. This is different from fatty liver disease caused by alcohol use.

Mold Toxins (Aflatoxins): Aflatoxins are harmful substances produced by certain molds. These molds can grow on improperly stored crops like grains and nuts. If you eat foods containing these contaminated crops, you can be exposed to aflatoxins, which can increase your liver cancer risk.

Excessive Alcohol Use: Drinking significantly more alcohol than recommended over a long period can lead to serious liver damage. This damage can make your liver more vulnerable to becoming cancerous. It's important to remember that moderate alcohol consumption is different from excessive alcohol use.

Liver Disease Prevention and Risk Reduction

Liver cirrhosis is scarring of the liver, which can increase the risk of liver cancer. You can lower your chances of getting cirrhosis by making some healthy choices:

1. Alcohol Consumption: If you drink alcohol, do so in moderation. This means limiting your intake significantly. For women, this means no more than one drink per day. Men should limit themselves to no more than two drinks daily. Consider cutting back or quitting altogether.

2. Healthy Weight Management: Maintaining a healthy weight is crucial. If you're already at a healthy weight, keep it up by eating nutritious foods and exercising most days of the week. If you need to lose weight, do so gradually. Aim for losing 1 to 2 pounds (0.5 to 1 kilogram) per week by adjusting your diet and increasing physical activity.

Preventing Hepatitis B and C Infections:

Hepatitis B is preventable through vaccination. This vaccine is safe and effective for almost everyone, including infants, older adults, and people with weakened immune systems. Getting vaccinated is a good way to protect yourself.

Unfortunately, there's no vaccine for hepatitis C. However, you can still lower your risk:

3. Safe Sexual Practices: Know the health status of your sexual partners. If you're unsure about your partner's health, always use condoms during sexual activity. This helps protect you from hepatitis B, hepatitis C, and other sexually transmitted infections (STIs).

4. Drug Use and Injection Practices: Using intravenous (IV) drugs significantly increases your risk of hepatitis C. If you choose to use IV drugs, always use a sterile needle and never share needles. Contaminated needles are a major source of hepatitis C infection. If you struggle with drug use, consider participating in needle exchange programs in your community and seeking professional help.

5. Safe Piercings and Tattoos: Always choose reputable shops for piercings and tattoos. Ensure the needles used are sterile and that the shop follows proper safety procedures. If a shop is reluctant to answer questions about safety or doesn't seem concerned about hygiene, it's best to find a different place.

Treatment and Screening for Liver Cancer:

Treatments are available for hepatitis B and C infections. Studies show that these treatments can lower the risk of liver cancer developing.

Liver Cancer Screening:

Routine screening for liver cancer in the general population isn't usually recommended because it hasn't been proven to reduce the risk of death from liver cancer. However, people with certain conditions that increase their risk of liver cancer, such as hepatitis B, hepatitis C, or cirrhosis, might consider screening.

Talk to your doctor about the pros and cons of screening for liver cancer. Together, you can decide if screening is right for you based on your individual risk factors. If screening is recommended, it typically involves a blood test and an ultrasound scan of the abdomen every six months.

Frequently Asked Questions about Liver Cancer

Liver surgeon Dr. Sean Cleary answers common questions about liver cancer.

Choosing the Right Care Team

When you're diagnosed with liver cancer, it's important to find a medical center with a team experienced in treating this type of cancer. This team should include specialists like liver doctors (hepatologists), liver surgeons, transplant surgeons, and doctors who specialize in chemotherapy and radiation therapy (oncologists). Look for a center that has a lot of experience treating liver cancer patients.

Working with Your Medical Team

To get the best care, be an active partner with your medical team. Ask questions about all treatment options, including the benefits and drawbacks of each one. Discuss your concerns and preferences, and together, make the best decisions for you. Knowing the details of your treatment plan is crucial.

Diet and Lifestyle Changes After Diagnosis

After a liver cancer diagnosis, it's important to avoid things that can further harm your liver, such as alcohol and smoking. Maintaining a healthy diet and regular exercise are also important for overall health and well-being.

Do I Need a Biopsy?

Sometimes, a liver biopsy isn't necessary for diagnosing liver cancer. Doctors can often diagnose it accurately with imaging tests like CT scans or MRIs. However, your doctor will determine if a biopsy is needed as part of your overall care plan. A biopsy is a procedure where a small piece of liver tissue is removed for testing.

Chemotherapy and Immunotherapy

There are exciting new developments in chemotherapy and immunotherapy for liver cancer. Talk to your doctor about whether these treatments might be part of your plan.

Diagnosing Liver Cancer: Tests and Procedures

Several tests and procedures can help diagnose liver cancer:

• Blood Tests: These tests can identify abnormalities in liver function.
• Imaging Tests: Ultrasound, CT scans, and MRI scans create images of the liver and can help detect liver cancer.

Liver Biopsy (When Necessary)

In some cases, a liver biopsy is needed to confirm a liver cancer diagnosis. A thin needle is used to remove a small sample of liver tissue for examination under a microscope. While a biopsy can provide a definitive diagnosis, it does carry a risk of complications like bleeding, bruising, or infection.

Staging Liver Cancer

After a diagnosis, doctors determine the stage of the cancer (how widespread it is) to guide treatment decisions. Tests like CT scans, MRIs, and bone scans are used to assess the size, location, and spread of the cancer. Different staging systems exist, such as using Roman numerals (I-IV) or letters (A-D). The stage helps determine the best treatment approach and the likely outcome (prognosis).