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Liver cancer

Overview

Liver cancer, also known as hepatic cancer, occurs when malignant cells form in the tissues of the liver. The liver is a vital organ responsible for functions such as detoxifying the body, producing bile, and synthesising proteins, making liver cancer particularly concerning. Hepatocellular carcinoma (HCC) is the most common type of liver cancer, but there are also other forms like cholangiocarcinoma (bile duct cancer) and rare types like hepatoblastoma (found mainly in children).

  • Hepatocellular carcinoma (HCC):
    • The most common type of liver cancer, making up around 75-85% of cases. It originates in the liver cells (hepatocytes).
  • Cholangiocarcinoma (bile duct cancer):
    • Cancer that starts in the bile ducts inside or outside the liver. It’s less common than HCC.
  • Hepatoblastoma:
    • A rare and aggressive form of liver cancer, primarily affecting children.
  • Angiosarcoma and hemangiosarcoma:
    • Rare cancers that originate in the blood vessels of the liver.

  • Chronic liver disease:
    • Long-term conditions like cirrhosis (scarring of the liver) or chronic hepatitis B or C infections are primary causes. The damage to liver cells can lead to cancer over time.
  • Cirrhosis:
    • This is often caused by alcohol abuse, hepatitis, fatty liver disease, or other liver conditions.
  • Hepatitis B and C:
    • Both viral infections can increase the risk of liver cancer by causing chronic liver inflammation and damage.
  • Fatty liver disease:
    • Non-alcoholic fatty liver disease (NAFLD) is associated with obesity, diabetes, and high cholesterol, which increase cancer risk.
  • Aflatoxin exposure:
    • A toxin produced by mold in certain grains and nuts, which can increase liver cancer risk.
  • Inherited liver diseases:
    • Conditions like hemochromatosis (excess iron accumulation) or Wilson’s disease (copper buildup) can increase risk.
  • Tobacco and alcohol use:
    • Smoking and heavy drinking damage the liver and increase the likelihood of developing liver cancer.

  • Chronic viral infections:
    • Hepatitis B or C.
  • Alcohol consumption:
    • Long-term alcohol abuse is a major risk factor for cirrhosis, leading to liver cancer.
  • Obesity and diabetes:
    • Both conditions contribute to the development of non-alcoholic fatty liver disease (NAFLD), which raises cancer risk.
  • Gender and age:
    • Men are more likely to develop liver cancer, and the risk increases with age, typically occurring in people over 50.
  • Family history:
    • A family history of liver cancer or chronic liver disease can increase risk.
  • Exposure to chemicals:
    • Chemicals such as vinyl chloride and arsenic have been linked to a higher risk of liver cancer.

  • Unexplained weight loss:
    • One of the most common symptoms of liver cancer.
  • Loss of appetite:
    • Feeling full after eating only a small amount or a loss of interest in food.
  • Abdominal pain:
    • Pain or a feeling of fullness in the upper right side of the abdomen, where the liver is located.
  • Jaundice:
    • Caused by a buildup of bilirubin.
  • Fatigue and weakness:
    • Chronic tiredness or a feeling of weakness.
  • Abdominal swelling (ascites):
    • Legs and feet may swell due to fluid retention.
  • Nausea and vomiting:
    • Digestive issues often accompany liver cancer.
  • Itchy skin:
    • An uncommon but possible symptom.

  • Physical examination:
    • A doctor will check for signs of liver enlargement or tenderness.
  • Blood tests:
    • Alpha-fetoprotein (AFP): Elevated levels of AFP may indicate liver cancer, although it can also be high in other liver conditions.
  • Imaging tests:
    • Ultrasound: Often the first imaging test to identify liver tumours.
    • CT: Helps provide detailed images of the liver.
    • MRI (Magnetic Resonance Imaging): Used for a more detailed assessment of liver cancer and surrounding structures.
  • Biopsy:
    • A biopsy may be done to confirm the diagnosis. A small sample of liver tissue is removed for examination.
  • Liver function tests:
    • To assess how well the liver is working.

The treatment depends on the stage, type, and overall health of the patient.

  • Surgical options:
    • Liver resection: Removal of part of the liver if the cancer is localized.
    • Liver transplant: In cases where the liver is severely damaged or cancer has spread to the entire liver.
  • Ablation therapy:
    • Radiofrequency ablation (RFA): Uses heat to destroy cancer cells.
    • Microwave ablation: Similar to RFA but uses microwave energy.
    • Ethanol injection: Injecting alcohol directly into the tumour to destroy it.
  • Chemotherapy:
    • Traditional chemotherapy: Drugs used to target and kill cancer cells, although liver cancer is often resistant to chemotherapy.
    • Transarterial chemoembolization (TACE): Delivers chemotherapy directly to the tumour and cuts off its blood supply.
  • Immunotherapy:
    • Checkpoint Inhibitors: Drugs like pembrolizumab (Keytruda) or nivolumab (Opdivo) stimulate the immune system to recognize and attack cancer cells.
    • Cytokine Therapy: Uses substances like interleukin-2 (IL-2) to help the immune system fight cancer.
  • Targeted therapy:
    • Sorafenib (Nexavar) or Lenvatinib (Lenvima) target specific pathways that allow liver cancer cells to grow.
  • Radiation therapy:
    • Used in certain situations to target specific tumours, though it’s not commonly used for liver cancer.
  • Palliative care:
    • For patients with advanced liver cancer, palliative care focuses on relieving
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