Liver cancer: symptoms, treatment and prevention

ndex

• What is liver cancer
• Primary and secondary liver tumors (metastases)
• Causes and risk factors of liver cancer (alcohol and hepatitis)
• Symptoms of liver cancer
• Liver tumors in children
• Diagnosis of liver cancer
• How liver cancer is treated
• Liver transplant

Questions and answers

What is liver cancer

The liver tumors are divided into 5 categories :

• Hepatocellular carcinoma : is the most common liver cancer, which originates directly from the liver cells, called hepatocytes . In most patients it develops as a result of chronic liver disease or cirrhosis, which predisposes to this type of disease;
• Cholangiocarcinoma : Rarer than hepatocellular carcinoma, cholangiocarcinoma originates from bile duct cells (cholangiocytes) inside the liver (peripheral cholangiocarcinoma) or outside the liver ( extrahepatic cholangiocarcinoma ). Its origin is related to some risk factors that have in common a process of chronic inflammation of the biliary tract;
• Carcinoma of the gallbladder : originates from the gallbladder (or gallbladder ) and has a behavior similar to extrahepatic cholangiocarcinoma;
• Liver metastases : they represent the most common tumors of the liver, often affected by the proliferation of cells from other organs (secondary disease);
• Benign tumors ( angioma , focal nodular hyperplasia and  hepatocellular adenoma ). They usually do not risk any therapy or intervention.

See the best facilities for malignant liver cancer:

The best hospitals for malignant liver cancer

Primary and secondary liver tumors (metastases)

We speak of primary cancer (of the liver or any other organ) when cancer originates from the organ in question. The secondary tumors are those that originate in an organ such as metastasis of existing tumors in other organs.

Primary liver tumors generally do not migrate to other organs , but spread early in the liver itself with so-called multifocal tumors, i.e. multiple locations within the organ. Most liver cancers are secondary, which means they are metastases that colonize the liver. This is because this important organ acts as a filter of our organism, receiving the bloodfrom almost all body districts. An example is pancreatic cancer, which tends to metastasize with lesions to the liver , lymph nodes, and bile ducts. For this reason AIRC advises people who have other cases of pancreatic cancer in the family to undergo periodic checks on the functionality of the pancreas, liver and intestine, especially after the age of 50 .
The primary tumor is rarer. In Italy, the 2017 Italian Cancer Registry estimated about 8,900 new primary liver tumors in men and 4,000 in women .

Causes and risk factors of liver cancer (alcohol and hepatitis)

More than 70 percent of cases of primary liver cancer are estimated to be attributable to known risk factors , such as hepatitis B and C virus infection, and long-term alcohol abuse. Furthermore, it is good to keep in mind that the abuse of alcoholic substances is a risk factor for the onset of hepatitis because the liver, processing alcohol, produces toxic substances that trigger an inflammatory process. Hepatopathy in particular is a progressive inflammatory process that damages the liver characterized by three linked diseases: steatosis (fatty liver), alcoholic hepatitis, liver cirrhosis. Alcoholic hepatitis (steatohepatitis) affects 10 to 35% of heavy drinkers. Severely damaged hepatocytes can become necrotic.

This means that unlike other cancers it is possible to reduce the risk of contracting this primary cancer by implementing a healthy lifestyle and protecting ourselves from hepatitis, even if it does not mean that all liver tumors originate from cirrhosis or degeneration of hepatitis. chronic.
Let’s look at the liver cancer risk factors one by one:

• Cirrhosis . Cirrhosis of the liver is the main risk factor for this cancer: more than 90% of hepatocellular carcinomas arise in livers with this disease;
• Chronic hepatitis B or C virus infections . If hepatitis is not intercepted and treated, it becomes chronic over the years, and can cause tumor degeneration of the hepatocytes. Hepatitis infection in highly endemic countries is responsible for up to 90% of liver cancers . In addition, chronic hepatitis can progress to liver cirrhosis in about 5 years in 20% of cases. The good news is that there is a vaccine for hepatitis B, which is one of the mandatory vaccinations in Italy for children within one year of age, and can also be requested by adults. However, there is no vaccine against hepatitis C, but once diagnosed there are drugs to eradicate the virus;
• Hereditary diseases of the liver . For example hemochromatosis and the alpha1 antitrypsin defect ;
• Diabetes . Uncontrolled diabetes is also considered a risk factor for liver cancer;
• Obesity . Obesity is considered a risk factor for the development of this cancer, especially among younger people (there are cases of liver cancer even at 30 years of age). According to data from the Global Burden of Disease 2017, in the last 35 years the cases of liver cancer in the world have increased by 114 percent , with a trend more pronounced in Western countries due to an increase in tumors caused by the accumulation of fat in the liver (fatty liver, the so-called fatty liver). L ‘ diet is so important: from a healthy diet low in fat .

Symptoms of liver cancer

The problem is that liver cancer has no symptoms in the early stages , which is why it has also been called silent cancer .
As the disease progresses, the first symptoms appear such as pain in the upper abdomen , which can also radiate to the back and shoulders , enlargement of the abdomen , loss of weight and appetite , nausea , the vomiting , the feeling of satiety , the exhaustion , the ‘ jaundice (ie the yellow skin color),dark coloration of urine and fever. Jaundice is due to the fact that significant concentrations of bilirubin accumulate in the blood , when a large portion of the liver is affected by the tumor or when the bile duct is blocked.
Sometimes there is an enlarged spleen , especially if the liver cancer is secondary to a tumor originating in the pancreas.

Many people complain of localized swelling in the abdominal cavity or lower limbs , for example swollen feet , but these are general symptoms of liver disease, not necessarily cancer. Another symptom is ascites , the presence offree fluid in the abdomen , caused by the liver having reduced production of a particular protein called ‘ albumin ‘. When the albumin in the blood is too low, some of the water that makes up the blood leaks into the abdomen .
In general, the initial symptoms mentioned are quite common, which can also indicate other diseases. If in doubt, it is therefore advisable to ask your doctor, who will recommend the most appropriate tests.

Liver tumors in children

Even the children may have liver cancer, although in one in three cases they are benign tumors : Hemangiomas , ie clusters of blood vessels, which usually occur in the first 6 months of life; hamartomas, which mostly appear within the first 2 years; l ‘ nodular hyperplasia focal and the’ hepatic adenoma . The malignant tumors found are hepatoblastoma and hepatocellular carcinoma .

The most frequent malignant tumor in children is hepatoblastoma , which accounts for almost one fifth of all cancers in children, mainly between 6 months and 4 years of life, with an incidence peak at 18 months of life. In most cases, the tumor is sporadic but can also be associated with constitutional genetic anomalies , malformations and familial tumor syndromes ( Beckwith-Wiedemann syndrome , familial polyposis adenomatosis ). Treatment for malignant tumors consists of surgery and post-operative chemotherapy . In recent years – explain the experts of the “Bambino Gesù” Pediatric Hospital in Rome – the advances in multidisciplinary treatment have contributed to considerably improving the prognosis, with a high survival rate.

Liver cancer diagnosis

Since the symptoms are not very indicative , the doctor has several diagnostic tools:

• Abdominal ultrasound . Using an ultrasound probe, the doctor obtains images of the liver and surrounding organs that can help in the diagnosis . It is a safe, effective and fast exam;
• Computed tomography . It is a radiological examination that uses X-rays and allows you to study all the organs of the abdomen in detail;
• Nuclear Magnetic Resonance (NMR) . It is a radiological examination that uses magnetic fields and radiofrequency electromagnetic waves and allows to obtain very precise and accurate images to study the different liver diseases;
• Percutaneous transhepatic cholangiography (PTC) . It is a radiological examination which, by means of direct puncture of the liver through the wall of the abdomen, allows to visualize in detail the biliary tracts inside and outside the liver;
• Liver biopsy . It consists of an ultrasound-guided puncture of the liver in order to obtain a sample of cells to be analyzed by the pathologist .

How liver cancer is treated

First of all, surgery is proposed to the patient. Depending on the situation we proceed with Radio-Chemotherapy , depending on the extent of the tumor, which can be performed before (neo-adjuvant) or after (adjuvant) surgery, with the aim of improving the results obtainable with surgery alone. When surgery is not possible, chemotherapy and radiotherapy can be used alone or in combination as a definitive treatment for the patient.

In patients not susceptible to these treatments, chemoembolization and arterial embolization of the liver can be proposed, which are locoregional therapies through which it is possible to administer some drugs in order to obtain local control of the disease.
Then there are the percutaneous ablative therapies, including radiofrequency, which consist of an ultrasound-guided puncture of the liver tumor with dedicated needles , then connected to energy sources that destroy the tumor cells.

A new perspective for inoperable liver tumors is given by immunotherapy . Recent data showed that the combination of atezolizumab and bevacizumab(a molecule that inhibits the formation of blood vessels) increases the duration of survival and improves the quality of life in these patients compared to those treated with standard radiotherapy and chemotherapy .

Liver transplant

An increasingly considered alternative to treat liver cancer is transplantation . In particular, in June 2020 an article published by the prestigious journal The Lancet Oncology shows that the 5-year survival rate of patients with liver transplantation after cancer is enormously higher than that of patients treated without surgery.

Questions and answers

HOW LONG DO YOU LIVE WITH LIVER CANCER?

It depends on many factors: what tumor it is, when the diagnosis is made, what type of therapy is followed, if there are concomitant diseases. For this reason it is never recommended to refer to the statistics found online, because they are mathematical averages that do not take these factors into account. The differences in survival are very different depending on the situation. 5-year survival can reach 80% in the case of transplant patients.

WHAT ARE THE SYMPTOMS OF LIVER CANCER?

The problem is that liver cancer has no symptoms in the early stages, which is why it has also been called silent cancer. As the disease progresses, the first symptoms appear such as pain in the upper abdomen, which can also radiate to the back and shoulders, belly enlargement, loss of weight and appetite, nausea, vomiting, feeling full, tired, jaundice (yellowing of the skin), dark urine and fever. Many people complain of localized swelling in the abdominal cavity or lower limbs, for example swollen feet, which are general symptoms of liver disease, not necessarily cancer. Another symptom is ascites, the presence of free fluid in the abdomen, caused by reduced production,

HOW IS LIVER CANCER TREATED?

First of all, surgery is proposed to the patient. Depending on the situation we proceed with Radio-Chemotherapy, depending on the extent of the tumor, which can be performed before (neo-adjuvant) or after (adjuvant) surgery, with the aim of improving the results obtainable with surgery alone. When surgery is not possible, chemotherapy and radiotherapy can be used alone or in combination as a definitive treatment for the patient. In some cases, liver transplantation is proposed, which at the moment is the solution that has shown the best results in terms of survival.
A new perspective for inoperable liver tumors is given by immunotherapy. Recent data has shown that the combination of atezolizumab and bevacizumab, a molecule that inhibits blood vessel formation, increases the duration of survival and improves the quality of life in these patients compared to those treated with standard radiotherapy and chemotherapy.

WHAT HAPPENS WHEN THE LIVER IS NOT FUNCTIONING WELL?

The liver is a fundamental gland for human metabolism, the largest in our body, and central in the elimination of toxic substances. If it is not healthy, many functions of our body can be compromised. Liver diseases are serious diseases that need to be treated immediately.
Being part of the endocrine system, it oversees the production of hormones, and produces bile, which is essential for the digestion of fats. The organ plays a role in the metabolism of proteins and in the reduction of their toxic waste, in the management and storage of sugars. The liver cells then are the “chemical powerhouse” essential for the disposal of fats, triglycerides and cholesterol.

WHAT DOES IT MEAN TO HAVE FATTY LIVER?

Fatty liver is an organ with excessive accumulation of fat in the liver cells, that is, with a percentage of fat that exceeds 5-10% of the weight of the liver.