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| What is liver cancer? |
| Liver cancer refers to the growth of malignant tumors in liver tissue. Cancer that starts in the liver is called primary liver cancer and cancer that spreads to the liver from another organ is called metastatic liver cancer. |
The most common form of primary liver cancer (cancer that starts in the liver) in adults is called hepatocellular carcinoma (HCC). It is a cancer of liver cells. This type of cancer can have different growth patterns. Some begin as a single tumour that grows larger. It may spread to other parts of the liver in later stages of the disease. Liver cancer may also develop in more than one site in the liver and may grow into multiple tumours. This pattern is most often seen in people with liver cirrhosis.
Another liver cancer is called cholangiocarcinoma. It originates in the small bile ducts which are tubes that carry bile to the gall bladder.
Most often, however, when cancer occurs in the liver, it did not start there, but spread to the liver from a cancer that began somewhere else in the body. These types of cancers are named after the place where they began (primary site) and are considered secondary liver cancers or cancer metastases. For example, cancer that started in the lung and spread to the liver is called metastatic lung cancer with spread to the liver. Secondary liver cancers are 30 times more prevalent than primary liver cancers. |
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| What are the symptoms of liver cancer? |
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| Often there are no symptoms of liver cancer until the later stages. This is why early detection is difficult. When symptoms do occur, they may include fatigue, pain on the right side of the upper abdomen or around the right shoulder blade, nausea, loss of appetite, feeling full after a small meal, unexplained weight loss and jaundice (yellowing of the eyes and the skin). If you have one or more risk factors for liver cancer and any of these symptoms, you should see your doctor immediately. |
What causes liver cancer? |
| There are several risk factors that increase the likelihood someone will get liver cancer. |
- Cirrhosis, or scarring, can lead to liver cancer. Over 80 percent of liver cancer cases are linked to cirrhosis.
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- Long-term infection with hepatitis B and C are linked to liver cancer because they often lead to cirrhosis. Hepatitis B can lead to liver cancer without cirrhosis.
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- Smoking is another probable risk factor, especially among people who abuse alcohol and have cirrhosis.
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- Obesity also appears to be linked to primary liver cancer.
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- Less common risk factors include abuse of anabolic steroids, or male hormones, for strength conditioning; exposure to arsenic in drinking water; and exposure to certain chemicals in the plastics industry.
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| How is liver cancer diagnosed? |
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Liver cancer may be discovered in a routine checkup if the doctor feels hard lumps in the abdomen, or incidentally by imaging studies. To confirm a diagnosis of liver cancer, doctors would use blood tests; ultrasound; computer tomography (CT) scans; and magnetic resonance imaging, or MRI. Doctors may find it necessary to do a biopsy, where a small sample of liver tissue is removed with a needle and then examined for cancer cells.
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How is liver cancer treated? |
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Transplant: For some patients a liver transplant may be an option, but only if the cancer has not spread to other organs and a suitable liver can be found.
Surgery:In cases where the cancer has been found early and the liver is otherwise healthy, or has only early-stage cirrhosis, doctors will remove the portion of the liver where the tumor is located, a process called surgical resection.
Cryosurgery (also called cryotherapy): This is the use of extreme cold produced by liquid nitrogen (or argon gas) to destroy abnormal tissue.
Ablation: Some liver tumors can be destroyed by processes called ablation. Radio frequency ablation (RFA) kills liver tumors by heating them to high temperatures with microwave probes. Another ablation technique destroys tumors by injecting them with ethanol, a form of alcohol.
Chemotherapy: Although chemotherapy cannot cure liver cancer, a new technique called transarterial chemoembolization (TACE) may help prolong life for liver cancer patients. In this procedure, chemotherapy drugs are injected into the blood vessels that feed the tumors. This delivers a high dose of chemotherapy to the tumor while decreasing the flow of blood that feeds the tumor.
Radiation therapy: In some cases, doctors may try to reduce the size or slow the growth of liver cancer with radiation, or high-energy x-rays. Traditional radiation therapy also destroys healthy liver tissue, so doctors are experimenting with new techniques that deliver the radiation with higher precision. |
What is the outlook for patients with liver cancer? |
| A successful liver transplant will effectively cure liver cancer, but it is an option for a small percentage of patients. Surgical resections are successful in only about one out of three cases. However, scientists are experimenting with several promising new drugs and therapies that could help prolong the lives of people with liver cancer. |
What is the best way to prevent liver cancer? |
| There are steps that you can take to reduce the risk of getting liver cancer or to discover it at an early stage, through screening. These steps are especially important if you already have liver disease.
If you have been diagnosed with cirrhosis or chronic liver disease, you should be under the care of a doctor who specializes in liver disease. See your doctor regularly and follow all recommendations for treatment, vaccinations and cancer screenings.
If someone close to you has hepatitis, talk to your doctor about prevention, including vaccination options. Take steps to prevent exposure to hepatitis B and C.
Talk to your doctor about liver health, hepatitis vaccinations and liver cancer screening. This is especially important if you are also a former or current drinker or smoker, or if you are significantly overweight. |
Liver Resection
What is liver resection and why is it done?
Liver resection is the surgical removal of a portion of the liver. This operation is usually done to remove various types of liver tumors that are located in the resected portion of the liver. The goal of liver resection is to completely remove the tumor and the appropriate surrounding liver tissue without leaving any tumor behind.
Which patients will undergo liver resection?
The most typical indication for liver resection is a malignant tumor. Tumors can be primary (developed in the liver) or metastatic (developed in another organ, then migrated to the liver). The majority of liver metastases come from the colon. The single tumor or more than one tumor confined to either left or right side of the liver can be successfully resected with 5-year survival as high as 60%.
Benign tumors of the liver (cyst, adenoma, hemangioma) can be successfully managed by liver resection as well. If the location of a benign tumor is superficial and small in size, the operation can be performed laparoscopically (by making small punctures in the abdomen while viewing through a video camera).
Liver resections are also performed on people willing to donate part of their liver to a loved one (live donor liver transplant).
Liver resection patients are carefully evaluated by a multidisciplinary team to ensure the absence of the extrahepatic (outside the liver) tumor. Liver resections performed on patients with extrahepatic disease may relieve the symptoms caused by the tumor, but offer little improvement in survival.
What is the duration of the surgery and hospital stay?
A minor liver resection (removal of 1 to 3 segments) takes approximately 3-5 hours and can be performed without the need for blood transfusion. A major liver resection (removal of more than 4 segments) may take 8-10 hours. The hospital stay is about 5-10 days and complete recovery occurs in 5-6 weeks. Excellent results from liver resections are usually achieved.
Does the resected liver grow back?
When a portion of a normal liver is removed, the remaining liver can grow back (regenerate) to the original size within four to eight weeks. Therefore Up to 75% of the liver tissue can be safely removed, provided the remaining liver is normal. A grossly cirrhotic liver, however, cannot grow back.
What are the results (survival and recurrence) of liver resection?
For HCC patients whose tumors are successfully resected, the five-year survival is about 40% to 60% depends on the etiology and pathology of the tumor. This means that 40% to 60% of patients who actually undergo liver resection for Cancer are expected to live five years. Many of these patients, however, will have a recurrence of Cancer elsewhere in the liver. Moreover, it should be noted that the survival rate of untreated patients with similar sized tumors and similar liver function is probably negligible. |
