It is Liver Cancer Awareness Month this October and we would like to bring your attention to this cancer that does not show any specific symptoms in the early stages. Primary liver cancer occurs when the cancer originates from the liver cells. Hepatocellular carcinoma (HCC), the most common primary liver cancer, originates from the main cells of the liver, called hepatocytes.
Liver cancer is the 3rd most common cause of cancer-death and the 4th most frequent cancers diagnosed for males in Asia. According to the Cancer Journal for Clinicians, men are 2-3 times more likely to suffer from this cancer than women. Join us as we walk through an overview of liver cancer and its treatment.
What are the symptoms of liver cancer?
Liver cancer in its early stages may not produce any signs. In the advanced stages, patients may experience symptoms such as:
- Jaundice (yellow skin and eyes)
- Swelling of the abdomen with fluid (ascites)
- Upper abdominal pain (upper right portion of abdomen)
- Encephalopathy (altered mental state or delusions)
- Bleeding in the stomach and intestinal tract indicating severe liver damage
- Unexplained weight loss
- Nausea and vomiting
- Sleepiness despite regular sleeping hours
- Loss of appetite
- White, chalky stools
- Lump in upper abdomen
However, these symptoms are often also associated with many common diseases affecting the liver and nearby organs like the stomach and intestines, making it difficult for patients to identify symptoms early.
Screening and diagnosis for liver cancer
The top few causes of primary liver cancer include chronic hepatitis B infection, chronic hepatitis C infection, and liver cirrhosis caused by excessive alcohol consumption. Some other causes of liver cancer include non-alcoholic fatty liver disease, inherited liver conditions or exposure to certain toxins. Any patients with these conditions are at increased risk and should be screened for liver cancer regularly.
Screening involves a blood test for alpha-fetoprotein (AFP), a liver cancer tumour marker, every 3-6 months, and an ultrasound scan of the liver every 6-12 months. Diagnosis and assessment is done through performing the following tests and procedures:
The doctor will examine your abdomen to check for hard lumps in the liver and abdominal swelling.
Blood tests are used to check for any liver function abnormalities and the amount of alpha-fetoprotein (AFP) present. The level of AFP is usually higher in people with primary liver cancer (HCC).
Liver ultrasound scan
An ultrasound scan uses high-frequency sound waves to produce a picture of the liver and reveal any existing tumours. The test is painless and can be performed in a matter of minutes.
Computed tomography (CT) or magnetic resonance imaging (MRI) scan of the abdomen
This scan creates a 3-dimensional picture of the liver, producing a detailed picture showing the size and position of any liver tumours, and whether it has spread.
An additional liver biopsy may be required to confirm the diagnosis. During the biopsy, a part of the abnormal liver tissue will be removed and sent for examination.
Liver cancer treatment options
Treatment for patients with liver cancer depends on its stage (size of tumour and whether it has spread) and the patient’s general health. The 5 main categories of treatments are surgery, tumour ablation (removal), targeted cancer therapy, chemotherapy, and radiotherapy.
Surgery is the preferred treatment for people with early stage liver cancer as it has the chance of treating the cancer. If only some sections of the liver are affected by cancer and the remainder is healthy, surgery to remove the affected part or parts may be possible. This type of surgery is called a liver resection.
Another option is to do a liver transplant. This entails removing the whole liver and replacing it with a healthy, donated liver. This is a major procedure which is considered only when the liver cancer tumour meets certain criteria, the cancer resides solely in the liver, a donor liver is available, and the medical team believes that the cancer will likely be removed by surgery. Because a healthy liver may regenerate, a living donor liver transplant can be conducted, in which a portion of a living donor’s liver is removed and transferred to the patient. If the procedure is successful, both the living donor’s remaining liver and the transplanted liver can grow back fully. Anti-rejection medications (immunosuppressants) will be required to prevent organ rejection after a liver transplant.
Tumour ablation (removal) uses either heat (radiofrequency ablation – RFA) or alcohol (percutaneous ethanol injection – PEI) to eliminate primary liver cancer cells. This treatment is typically performed using ultrasound or computed tomography (CT) to assist the doctor in guiding a needle into the liver tumour.
At the start of the procedure, a local anaesthetic will be administered. RFA treatment involves passing laser light or radio waves through the needle to eliminate cancer cells by heating them to extremely high temperatures. On the other hand, PEI treatment employs alcohol injected through the needle into the tumour to kill the cancer cells. Tumour ablation may sometimes be repeated if the cancer cells return.
Chemotherapy is the use of anti-cancer medications to either kill or prevent cancer cells from proliferating and growing further. It can help with symptom control by reducing the size of the tumour and slowing its growth. Chemotherapy medications are often administered intravenously (as injections into the vein), or ingested orally as tablets. Chemotherapy may also be administered as part of a procedure known as chemoembolisation. The chemotherapy medications are injected directly into the liver tumour, along with a gel or tiny plastic beads to prevent blood supply to the tumour (embolisation). Chemotherapy is not for everyone because it can only be administered if the liver is functioning normally.
Targeted cancer therapy
Targeted cancer therapy are medications that work by interfering with specific genes or proteins that are involved in cancer growth and development, thus blocking the spread and growth of the tumours. One example of targeted cancer therapy is a medication that stops the tumour from growing its own blood vessels. Because cancer cells require a blood supply in order to get nutrition and oxygen, this may impede the tumour’s capacity to grow.
Radiotherapy employs high-energy rays to either kill or inhibit the growth of cancer cells. External radiotherapy directs radiation to the cancer using a machine outside the body. Because the liver cannot tolerate large doses of radiation, this type of treatment is rarely utilised to treat liver cancer. It may, however, be used to relieve pain in patients whose cancer has spread to the bone. Internal radiation involves a radioactive chemical implanted selectively to the tumour via the hepatic artery, a major blood vessel which transports blood to the liver.
Can liver cancer be prevented?
Yes, liver cancer may be prevented by reducing your exposure to risk factors and taking the following steps:
- Vaccinate against the hepatitis B virus.
- Prevent Hepatitis C by not engaging in unprotected sex
- Try to avoid drinking too much alcohol as it may cause alcoholic fatty liver disease – a disease that may develop into liver cancer.
- Maintain a healthy body weight, keeping cholesterol and blood sugar levels under control
- Avoid eating heavy meat and animal fat
- Go for regular screenings if you are considered part of the high-risk group.
We celebrate the resilience of all patients and caregivers, and encourage everyone to take the necessary steps to stay safe and healthy.
This educational article is supported by IPSEN, in conjunction with Liver Cancer Awareness Month.