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Liver Cancer

Liver Cancer – Overview, Types, Symptoms, Causes, and Treatment

Liver cancer refers to the development of malignant (cancerous) tumors in the liver. The liver is the largest organ in the human body, located in the upper right portion of the abdomen beneath the diaphragm and above the stomach. It plays a vital role in metabolism, detoxification, and digestion.
Cancer can either start in the liver (primary liver cancer) or spread to it from other parts of the body (secondary/metastatic liver cancer).

Types of Liver Cancer

A. Primary Liver Cancer

This originates in the cells of the liver and can occur in both adults and children. The main types include:

Hepatocellular carcinoma (HCC):

  • The most common type of primary liver cancer.

  • Arises from hepatocytes (main liver cells).

  • Third leading cause of cancer-related deaths worldwide.

Intrahepatic cholangiocarcinoma (bile duct cancer):

  • Develops in the small bile ducts within the liver.

Hepatoblastoma:

  • A rare type, usually affecting children.

B. Secondary (Metastatic) Liver Cancer

  • Originates from another organ such as the colon, lungs, or breasts and spreads to the liver.

  • Classified according to its primary site (e.g., metastatic colon cancer).

Causes and Risk Factors

Liver cancer occurs when mutations in cell DNA cause uncontrolled growth, forming tumors. Known causes include:

  • Chronic hepatitis B or C infections.

  • Cirrhosis (scarring of the liver).

  • Certain metabolic diseases.

  • Sometimes, the exact cause is unknown.

Signs and Symptoms

Early stages often present no symptoms. As the tumor grows, symptoms may include:

General Symptoms

  • Unintended weight loss
  • Fatigue or weakness
  • Loss of appetite
  • Nausea or vomiting

Pain and Swelling

  • Pain in the upper right abdomen or near the right shoulder blade
  • Abdominal bloating or swelling
  • A hard lump under the right rib cage

Digestive and Biliary Changes

  • Feeling full after small meals
  • Pale stools
  • Dark urine

Jaundice and Skin Changes

  • Yellowing of the skin and eyes (due to high bilirubin levels)
  • Itchy skin

Hormonal Effects (in some cases)

  • High calcium levels → constipation, nausea, confusion
  • Low blood sugar → tiredness, dizziness
  • Enlarged breasts or shrinking testicles in men
  • High red blood cell count → facial redness

Diagnosis and Surveillance

  • Surveillance is recommended for small liver lesions (<1 cm), typically with follow-up every 3 months.

  • Imaging and laboratory tests are used to monitor changes.

Treatment Options

Treatment depends on the stage of cancer, liver function, overall health, and patient preference.

Treatment depends on the stage of cancer, liver function, overall health, and patient preference.

A. Surgical Options

  • Partial Hepatectomy: Removal of the cancerous part of the liver along with some healthy tissue.

  • Total Hepatectomy and Liver Transplant: Diseased liver is replaced with a donor liver. Suitable for certain early-stage cases.

B. Localized Treatments

These target cancer directly within the liver:

Ablation Therapy:

  • Radiofrequency ablation (RFA): Uses high-energy radio waves to destroy tumors.

  • Microwave therapy: Heats tumors to damage cancer cells.

  • Percutaneous ethanol injection: Injects pure alcohol to kill tumor cells.

  • Cryoablation: Freezes and destroys cancer cells.

  • Electroporation therapy: Uses electric pulses to kill tumor cells (under study).

Embolization Therapy: Blocks blood flow to tumors:

  • Transarterial embolization (TAE): Blocks hepatic artery supply.

  • Transarterial chemoembolization (TACE): Combines embolization with localized chemotherapy.

C. Radiation Therapy

  • External Beam Radiation Therapy (EBRT): Directs high-energy rays at tumors.

  • Stereotactic Body Radiation Therapy (SBRT): Delivers high doses with precision.

  • Proton Beam Therapy: Minimizes damage to surrounding healthy tissue.

D. Systemic Treatments

Targeted Drug Therapy:

  • Examples: bevacizumab, cabozantinib, lenvatinib, ramucirumab, regorafenib, sorafenib.

  • Works by attacking specific cancer cell abnormalities.

Immunotherapy:

  • Stimulates the immune system to fight cancer.

  • Drugs include:

    • atezolizumab + bevacizumab/cabozantinib

    • durvalumab + tremelimumab

    • nivolumab + ipilimumab

    • pembrolizumab

Chemotherapy:

  • Less commonly used for liver cancer.

  • Delivered intravenously or orally.

E. Palliative (Supportive) Care

  • Focuses on symptom relief and improving quality of life.

  • Can be combined with curative treatments.

 

Treatment by Stage

Localized Liver Cancer:

  • Surveillance (for lesions <1 cm)

  • Partial hepatectomy

  • Liver transplant

  • Ablation therapy

  • Radiation therapy

Locally Advanced or Metastatic Liver Cancer:

  • TAE or TACE

  • Targeted drugs

  • Immunotherapy

  • Radiation therapy

Recurrent Liver Cancer:

  • Surgical removal (partial or total hepatectomy with transplant)

  • Ablation therapy

  • Radiation therapy

  • TACE and sorafenib as palliative care

Clinical Trials

Patients may join clinical trials to access experimental treatments or new combinations of existing therapies. Trials may focus on:

  • New drugs

  • Advanced radiation methods

  • Quality-of-life improvements