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What is liver cancer?
Cancer in the liver can arise from the liver itself or originate from another organ and then spread to the liver. Liver cancer that forms directly in the liver is known as primary liver cancer. There are 2 main types of primary liver cancer: hepatocellular carcinoma (HCC) and cholangiocarcinoma.
The most common form of liver cancer in adults is known as hepatocellular cancer (HCC) which arises from hepatocytes (liver cells) while cells forming the ducts leading to the gall bladder and intestine can mutate into the cancerous cholangiocarcinoma.
Most cases of HCC develop due to viral infection (hepatitis B or C) or cirrhosis. Cirrhosis is scarring of the liver with resulting poor liver function as a result of chronic liver disease. Causes can also include alcohol abuse over a long period of time. HCC may be difficult to detect in its early stages as symptoms do not appear until the cancer has progressed to a more advanced stage.
Another type of liver cancer is metastatic liver disease (cancer) or secondary liver cancer. This kind of liver cancer arises when the main cancer, which originates in other parts of the body, spreads to the liver.
Causes / Risk Factors Some of the risk factors for Hepatocellular Carcinoma are:
Some of the symptoms that may be experienced are:
You may have one or more of the following carried out:
There are a couple of treatment options for liver cancer.
Surgery remains the best effective means of treating liver cancer. It involves removing all the cancer that the surgeon can find, guided by the investigation results and imaging studies. However as symptoms do usually not appear until the cancer has progressed to an advanced stage resulting in late diagnosis, most patients with HCC have tumours that make them unsuitable for surgery.
Complete removal may not be possible if the tumour is too big or if the tumours can be found in multiple sites in the liver. Moreover, patients with cirrhosis are considered eligible for surgery only if their liver function is adequate. Liver transplant can also be useful for selected patients with cancer that is small but with liver function too poor to allow safe resection. The patient must also fulfil other strict criteria that ascertain that transplantation is useful for prolonging the life of the patient. Access to this alternative is limited by donor availability.
In chemotherapy, anticancer drugs reach all parts of the body. This makes the treatment potentially useful for cancers that have spread to other organs. Currently the only drug proven to make liver cancer patients survive longer is the drug sorafenib. (see small molecular targeted therapy below).
The use of radiation therapy is an option for patients who are unable to have surgery. Radiation is usually delivered as selective internal radiation therapy (SIRT). In this procedure, tiny radioactive spheres are injected into the hepatic artery where the radioactive spheres travel to the tumours and kill the cancer cells with its radiation emission. One such example is Sir-Spheres, which has shown to be well tolerated and effective for selected patients with unresectable HCC.
In embolization/ chemoembolization, the doctor injects particles or anticancer drugs into the hepatic artery to block the flow of blood to the tumour cells and at the same time, kills the tumour cells. It is a widely used therapy when surgery is not possible. An example would be Trans-catheter Arterial Chemo-Embolisation. Clinical trials have demonstrated encouraging rates of tumour shrinkage and the therapy is usually well tolerated if cirrhosis is not severe.
New treatment options, such as small molecule targeted therapy, have been developed to treat liver cancer. Small molecules are designed to block certain key functions of the cancer cells, thus stopping them from growing. An example of such a drug is Sorafenib. It has been established as the standard treatment for metastatic advanced HCC. Currently, Sorafenib offers the best option for patients whose cancer is no longer responding satisfactorily to other forms of therapy.