Liver cancer

Symptoms Of Liver cancer 

Liver cancer may not cause symptoms in its early stages. As the cancer progresses, the following symptoms may develop:

• Pain on the upper-right side of the abdomen. The pain may be dull and persistent or sharp and intermittent.

• Yellowing of the skin and eyes (jaundice)

• Nausea and vomiting

• Loss of appetite or feeling full after eating small amounts

• Unexplained weight loss

• Tiredness or weakness

• Dark urine

• Fever

• Diarrhea

• Itchy skin

• Pale stools

• Enlarged liver or spleen

• Swelling or fluid build-up in the abdomen (ascites) 

• Easy bruising or bleeding

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Types of Liver Cancer

Liver cancer can be categorized into primary and secondary types.

1. Primary liver cancer

Primary liver cancer is the most common type of liver cancer. It originates in the cells called hepatocytes, which are responsible for carrying out various functions of the liver.

Different subtypes of primary liver cancer based on their cellular characteristics are:

• Hepatocellular Carcinoma (HCC): This subtype accounts for the majority of all primary liver cancers. HCC often develops in individuals with underlying chronic liver diseases.

• Fibrolamellar Carcinoma: This rare subtype typically affects younger individuals who do not have any underlying chronic liver disease. It has distinct features under a microscope and may have a better prognosis compared to other forms of primary liver cancer.

• Cholangiocarcinoma: Unlike HCC which starts in hepatocytes, cholangiocarcinoma arises from bile duct cells within or outside the liver. It occurs less frequently than HCC but can be more challenging to treat due to its location and tendency to spread early on.

2. Secondary liver cancer

This occurs when cancer spreads from another part of the body (such as breast, lung, colon) to the liver via blood circulation or direct invasion into adjacent organs like pancreas or stomach.

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Causes Of Liver Cancer

The development of liver cancer is a complex process involving the liver cells. Here's an overview of what happens during liver cancer:

• DNA, the genetic material, governs cell behavior, growth, division, and cell death.

• Multiple mutations in DNA that activate cell division or deactivate tumor suppressor genes, can lead to uncontrolled cell growth and abnormal mass formation in the liver.

• Over time, these abnormal cells may spread within the liver or to other organs through the bloodstream or lymphatic system.

Risk Factors For Liver Cancer

Here are some common risk factors associated with liver cancer. 

It's important to note that having one or more risk factors does not mean the development of liver cancer, but they may increase the likelihood.

1. Gender

Liver cancer is more prevalent in men, however, the fibrolamellar subtype is more common in women.

2. Age

Liver cancer is more common in older individuals, with the highest rates observed in those over 60, particularly 85 to 89-year-olds.

3. Family history

Family history also plays a crucial role in determining one's susceptibility to liver cancer. If someone has a close relative who has been diagnosed with this disease, their own risk is elevated.

4. Underlying medical conditions

• Non-alcoholic fatty liver disease(NAFLD)

• Chronic viral infections infections, particularly hepatitis B and C

• Cirrhosis

• Type 2 diabetes

• Gallstones or gallbladder removal

• HIV infection or AIDS

5. Genetic conditions

• Hemochromatosis (iron buildup in the body)

• Wilson's disease (copper accumulation in the body)

• Alpha-1 antitrypsin deficiency (a specific protein deficiency)

6. Lifestyle choices

• Obesity 

• Heavy alcohol consumption

• Smoking

• Chewing betel quid, a mixture of betel leaf, areca nut, and slaked lime

7. Long term use of certain medications without medical supervision

• Anabolic steroids like testosterone, nandrolone, etc, which are used to promote muscle growth

• Methotrexate, generally prescribed for rheumatoid arthritis and psoriasis

• Over-the-counter NSAIDs

• High-dose estrogen-containing oral contraceptives

8. Exposure to harmful chemicals

• Aflatoxin, a toxic substance produced by certain molds commonly found in crops such as peanuts and corn

• Vinyl chloride

• Arsenic

• Asbestos

Diagnosis Of Liver Cancer

To arrive at the diagnosis and chart the treatment course of cancer, it is important to understand its staging. The most common way of staging liver cancer is the TNM staging system, where:

• T: Tumor and how many layers of the liver wall the tumor has penetrated

• N: Lymph Nodes and how many lymph nodes have cancer spread to. It also looks at where the lymph nodes are affected and how close to the original tumor.

• M: Metastasis ie. spread to other parts of the body

Depending on this the cancer is divided into 4 stages. These are:

1. Stage 0: Also known as carcinoma in situ. This stage is distinguished by abnormal cells in the liver lining. The cells can become malignant in the future.

2. Stage I: Cancer is localized to the liver and has not spread to nearby blood vessels or lymph nodes.

3. Stage II: Cancer has either grown larger and/or has invaded nearby blood vessels but has not spread to distant sites or lymph nodes.

4. Stage III: Cancer has spread to nearby lymph nodes or structures beyond the liver, but it has not spread to distant organs.

5. Stage IV: Cancer has spread to distant organs or structures, indicating advanced metastatic disease.

The diagnosis consists of the following:

1. Medical history and physical examination

Your doctor will begin by taking a detailed medical history, including any risk factors for liver cancer, your medications, lifestyle habits, previous surgeries, or any other health conditions. A physical examination may reveal signs such as an enlarged liver and jaundice (yellowing of the skin and eyes)

2. Blood tests

These tests are part of a comprehensive diagnostic approach, often combined with other imaging and biopsy procedures. The doctor can assess the overall health with liver and kidney function tests and detect any abnormalities with blood cell counts. High levels of alpha-fetoprotein (AFP) and other tumor markers may also indicate liver cancer.

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3. Imaging studies

Imaging tests are crucial for evaluating the liver and identifying any tumors. Common imaging studies include:

• Ultrasound: A non-invasive test using sound waves to create an image of the liver.
  
  

• CT (Computed Tomography) scan: X-ray images taken from different angles to create detailed cross-sectional images of the liver.
  
  

• MRI (Magnetic Resonance Imaging): This imaging technique uses a powerful magnetic field, radio frequency pulses, and a computer to produce detailed pictures of the liver and surroundings.
  
  

• PET (Positron Emission Tomography) scan: Helps determine the extent of the disease and if it has spread to other parts of the body.
  
  

• Angiography: It is a method to visualize blood vessels, but isn't very effective in spotting small HCC tumors. It's mostly used for mapping the liver's structure before surgery or guiding chemoembolization treatment.

4. Liver biopsy

If a suspicious mass or tumor is detected, a liver biopsy may be performed to obtain a small tissue sample for analysis under a microscope. This helps confirm the presence of cancer cells and determine the type and stage of the cancer.

5. Laparoscopy

Also known as keyhole surgery, is a minimally invasive procedure where a small tube with a camera and light (laparoscope) is inserted through a small abdominal cut. This helps assess the liver and surrounding areas, aiding in determining if surgery to remove cancer is feasible. 

Prevention Of Liver Cancer

Preventing liver cancer involves adopting a healthy lifestyle, minimizing exposure to risk factors, and undergoing regular screenings if you're at an increased risk. 

Here are some strategies that can help reduce the risk of getting liver cancer:

1. Prevent hepatitis infections

• Avoid sharing needles, practice safe sex, and maintain proper hygiene to prevent hepatitis B (HBV) and hepatitis C (HCV) infections.

• Consider HBV vaccination.

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2. Timely screening and treatment of Hepatitis B and C

It's crucial for individuals at risk to undergo regular screenings and receive appropriate treatment if diagnosed with viral hepatitis to reduce their chances of developing liver cancer.

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3. Make healthier lifestyle choices

• Quit smoking

• Limit alcohol consumption 

• Avoid using illegal drugs and intravenous drug use that can lead to hepatitis transmission.

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4. Reduce exposure to aflatoxin

• Prevention strategies include proper storage and handling of grains and nuts, as well as regular monitoring of food products for aflatoxin levels. 

• Efforts to improve agricultural practices and promote food safety regulations can help reduce exposure to this carcinogen and lower the incidence of liver cancer associated with aflatoxin consumption.

5. Maintain optimum blood sugar levels

Manage diabetes effectively by maintaining a balanced diet, engaging in regular physical activity, and adhering to prescribed medications for blood sugar control.

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6. Always adhere to prescribed medication dosages 

Always follow prescribed medication dosages. Avoid excessive, long-term use of over-the-counter medications like NSAIDs that can potentially harm the liver.

7. Watch your weight

Manage weight through regular exercise, an active healthy lifestyle along a balanced diet rich in fruits, vegetables, and whole grains.

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8. Consume a healthy diet

A diet rich in fresh vegetables, fruits and fiber and low in saturated/trans fats significantly reduces the risk of cancer.

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Doctor To Visit

Management of liver cancer takes a comprehensive approach that involves multiple specialists. 

A general practitioner can evaluate causes of liver abnormalities and refer to the following specialists for assessment:

• Gastroenterologist
• Hepatologist
• Surgical oncologist
• Radiologist
• Medical oncologist
• Interventional radiologist

A gastroenterologist focuses on treating and managing issues related to digestive tract organs, including the liver. 

A hepatologist specializes in disorders of the liver, biliary tract, gallbladder, and pancreas. 

A surgical oncologist is a specialist surgeon focusing on treating liver cancer through surgical procedures.

A radiologist specializes in focusing on cancer treatment using radiation therapy in the treatment of liver cancer. 

A medical oncologist administers medications like chemotherapy, targeted therapy, or immunotherapy for liver cancer treatment.

An interventional radiologist is a specialized doctor proficient in performing procedures like ablations and embolizations relevant to liver cancer management.

Never take your liver health lightly. If you are experiencing any liver symptoms or have risk factors that can increase your chances of liver cancer, seek professional guidance.
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Treatment Of Liver Cancer

The treatment of liver cancer depends on size, location and extent of the cancer. Management of liver cancer include:

1. Surveillance

It involves closely monitoring small lesions (<1 cm) discovered in screenings, typically with follow-ups every 3 months. It's a watchful approach, intervening only if tests reveal worsening conditions, aiming to detect any changes and act accordingly. The process includes regular exams and tests according to a set schedule.

2. Ablation therapy

Ablation techniques are used to destroy liver tumors without removing them surgically. Common ablation techniques include:

• Radiofrequency ablation (RFA): High-energy radio waves are used to heat and kill cancer cells by inserting special needles into the tumor through the skin or abdomen.
  
  

• Microwave therapy: Microwaves generate high temperatures that can destroy cancer cells or enhance their sensitivity to radiation and specific anticancer drugs.
  
  

• Percutaneous ethanol injection: Pure alcohol (ethanol) is directly injected into the tumor using a small needle to kill cancer cells. Local or general anesthesia may be used based on the number of liver tumors.
  
  

• Cryoablation: Cancer cells are frozen and destroyed using a specialized instrument. Ultrasound may guide this process.
  
  

• Electroporation therapy: Electrical pulses are sent through an electrode placed in a tumor to kill cancer cells. This therapy is under research in clinical trials.

3. Radiation therapy

• External beam radiation: High-energy X-rays are used to destroy cancer cells or shrink tumors from outside the body.

• Radioembolization: Tiny radioactive beads are injected into the blood vessels that supply the liver tumor, delivering radiation directly to the cancer cells.

4. Chemotherapy

• Systemic chemotherapy: Drugs are administered orally or intravenously to kill cancer cells or slow their growth.

• Transarterial chemotherapy: Chemotherapy drugs are injected directly into the artery supplying the liver, delivering a higher concentration of the drug to the tumor.

5. Immunotherapy

Immunotherapeutic drugs boost the immune system's ability to recognize and attack cancer cells. This therapy is used in the treatment of advanced liver cancer. Most commonly used drugs are:

• Atezolizumab

• Nivolumab

• Ipilimumab

• Pembrolizumab

6. Embolization therapy

Embolization therapies are designed to cut off the blood supply to the tumor, reducing its growth. This may involve:

• Transarterial chemoembolization (TACE): A combination of chemotherapy drugs and tiny beads is injected into the artery supplying the tumor, blocking its blood supply.

• Radioembolization (Yttrium-90): Tiny radioactive beads are placed into the arteries supplying the liver tumor, delivering radiation directly to the cancer cells.

7. Surgery

• Hepatectomy: This involves the surgical removal of the part of the liver that contains the tumor.

• Liver transplant: In cases where the tumor is small and the liver is severely damaged, a liver transplant may be considered.

8. Targeted drug therapy

Targeted therapies involve using drugs to attack specific cancer cells with minimal harm to normal cells. It is less invasive than chemotherapy or radiation. Commonly used drugs are:

• Bevacizumab

• Cabozantinib

• Ramucirumab

Some targeted therapies for advanced liver cancer include:

• Sorafenib and Lenvatinib: These drugs block signals that promote cancer cell growth and formation of new blood vessels.

• Regorafenib: A drug used for advanced liver cancer that hasn't responded to other treatments.

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Home-care For Liver Cancer

Liver cancer requires a conventional medical treatment approach. However, some home-remedies are believed to support liver health and augment the medical treatment.

1. Milk thistle: It is a Mediterranean herb which acts as a powerful liver cleanser by rebuilding liver cells, reducing liver damage, and removing toxins from the body that are processed through the liver. However, consult your doctor before using it to ensure it is safe and appropriate for you.

Tip: It can be consumed in the form of a capsule as directed by your doctor or brew milk thistle tea from seeds with hot water under professional guidance.

2. Turmeric (Haldi): It inhibits the growth of liver cancer, reduces inflammation and oxidative stress, and demonstrates anti-tumour activity.

Tip: Add a tablespoon of turmeric in hot milk with honey and drink this once a day for about a month.
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3. Ginger (Adrak): It can suppress metastasis of liver cancer, stop the rapid increase of cancer cells and inhibit inflammation.

Tip: You can include ginger in your diet by using it in cooking, making ginger tea, or adding it to smoothies.

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4. Garlic (Lehsun): It inhibits the growth of precancerous lesions in the liver and migration of cancer cells.

Tip: It can be used by adding crushed or minced garlic to various dishes such as salads, soups, stir-fries, or as a seasoning in cooking.

5. Cinnamon (Dalchini): It increases the production of ROS (Reactive Oxygen Species) which can play a role in killing cancer cells.

Tip: Incorporate cinnamon by sprinkling it on foods like oatmeal, yogurt, smoothies, or in tea for potential flavor and health benefits.

Complications Of Liver Cancer

Hepatocellular carcinoma (HCC), a type of liver cancer, can cause significant complications that include:

1. Liver failure: Liver cancer can impair the normal functioning of the liver, leading to liver failure that can be life-threatening.

2. Hepatic encephalopathy: It is a condition where the liver's inability to remove toxins like ammonia from the blood affects brain function. It can lead to confusion, difficulty concentrating, and changes in mental status.

3. Portal vein thrombosis: This complication involves the formation of blood clots in the portal vein, a major blood vessel in the liver. 

4. Worsening ascites: Ascites is the accumulation of fluid in the abdominal cavity. In HCC, ascites can worsen, causing abdominal swelling and discomfort due to the liver's impaired ability to manage fluid levels.

5. Variceal bleeding: Liver cancer can cause increased pressure in the portal vein, a major blood vessel in the liver. This can result in portal hypertension, leading to symptoms like abdominal swelling, varices (enlarged veins), and increased risk of bleeding in the digestive tract.

6. Obstructive jaundice: Liver cancer can obstruct the bile ducts, causing a buildup of bilirubin in the body. 

7. Pyogenic liver abscess: Liver cancer can predispose individuals to infections within the liver, resulting in the formation of pus-filled pockets (abscesses). 

8. Metastasis: Liver cancer can spread (metastasize) to other organs or parts of the body, leading to additional complications associated with secondary tumors in those areas.

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Alternative Therapies For Liver Cancer

Some of the following complementary methods might help people dealing with liver cancer, when used along with standard medical treatment. It is important to consult your healthcare provider before starting any of these:

1. Acupressure and acupuncture

Acupressure involves applying pressure or massaging specific body areas to manage symptoms. Acupuncture uses thin needles in specific body points to alleviate symptoms associated with liver cancer.

2. Yoga

It can aid individuals with cancer by reducing stress, improving physical well-being, and managing symptoms like pain, nausea, and fatigue, all while offering emotional support.

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3. Aromatherapy

It utilizes plant-derived essential oils to alter mood and address symptoms like stress and nausea through inhalation or topical use.

4. Massage

Massage therapy helps to reduce stress, anxiety, pain, and enhance alertness and relaxation.

5. Meditation and mind-body techniques

Meditation and mind-body techniques can help reduce stress, improve relaxation, and enhance overall well-being.

6. Biofeedback

It utilizes monitoring devices to enhance conscious control over involuntary physical processes like heart rate, blood pressure, and muscle tension.

7. Music

Music therapy utilizes music to facilitate healing and enhance the overall quality of life.

8. Art therapy

Living With Liver Cancer

After completing liver cancer treatment, it's common to feel a mix of relief and worry about cancer recurrence. Living with persistent or potentially recurring cancer can be challenging and emotionally taxing. Things that the caregiver and the patient should take into consideration include:

1. Managing the emotional well-being

Dealing with cancer often leads to a whirlwind of emotions such as sadness, anxiety, or anger, and coping with stress can be difficult. Helpful tips include:

• Gather comprehensive information about the treatment plan

• Engage in open communication with loved ones

• Join support groups to connect with others facing similar challenges

• Start palliative care to get relief from other symptoms

• Seek help in coping with practical issues like financial burdens, childcare, and work-related concerns

• Practice relaxation techniques such as deep breathing, meditation, yoga, or guided imagery.

2. Addressing physical side effects

Physical health changes depend on various factors, including the cancer's stage, treatment duration and dosage, and the patient's overall health. Important considerations are:

• Keep a note about any new side effects or changes in existing side effects

• Inform your doctor about the side effects so that they can potentially keep any side effects from worsening

• Keep a record of side effects so it is easier to explain any changes to the healthcare team

• Seek treatment for long-term and late-developing side effects to ensure well-being post-treatment.

3. Follow-up care

Regular follow-up appointments, every 3-6 months is crucial even after treatment completion. Monitoring for signs of cancer recurrence or treatment side effects is essential during these check-ups. It's vital to communicate any new symptoms or concerns to your healthcare team.

4. Supervising the costs of cancer care

Cancer treatment can be expensive. It may be a source of stress and anxiety for people with cancer and their families. This can be managed by:

• Understanding the costs associated with the treatment.

• Discussing financial concerns with family members or the healthcare team

• Seeking support from organizations that assist with treatment, housing, travel, and other cancer-related expenses.

5. Health insurance and medical records

Maintaining health insurance and organizing copies of your medical records is essential. This ensures you have access to necessary tests and medical history, even when seeing new doctors.

Cancer can drain a person physically and mentally. Gaining knowledge and awareness about cancer and the myths that surround it is necessary to enable timely diagnosis and treatment.