Cancer that begins in the liver is called primary liver cancer, which is relatively uncommon. However, it is common for cancer to spread to the liver from the colon, lungs, breasts, or other parts of the body. When this happens, the disease is not liver cancer. The cancer in the liver is a secondary cancer. Here we discuss only cancer that begins in the liver itself.
Most primary liver cancers begin in hepatocytes (liver cells). This type of cancer is called hepatocellular carcinoma or malignant hepatoma. When liver cancer metastasizes outside the liver, the cancer cells tend to spread to nearby lymph nodes and to the bones and lungs. When this happens, the new tumor has the same kind of abnormal cells as the primary tumor in the liver. For example, if liver cancer spreads to the bones, the cancer cells in the bones are actually liver cancer cells. The disease is metastatic liver cancer, not bone cancer. It is treated as liver cancer, not bone cancer. Doctors sometimes call the new tumor "distant" disease.
Similarly, cancer that spreads to the liver from another part of the body is different from primary liver cancer. The cancer cells in the liver are like the cells in the original tumor.
At the time of writing, no one knows its exact causes. However, people with certain risk factors have been found to be more likely than others to develop liver cancer. Studies have shown the following risk factors:
The more risk factors a person has, the greater the chance that liver cancer will develop. However, many people with known risk factors for liver cancer do not develop the disease.
Liver cancer is sometimes called a "silent disease" because in an early stage it often does not cause symptoms. But, as the cancer grows, symptoms may include:
These symptoms are not sure signs of liver cancer. Other liver diseases and other health problems can also cause these symptoms.
If a patient has symptoms that suggest liver cancer, the doctor performs one or more of the following procedures:
If liver cancer is diagnosed, the stage – or extent – of the disease needs to be determined in order to plan the best treatment. Staging is an attempt to find out the size of the tumor, whether the disease has spread, and if so, to what parts of the body. Careful staging shows whether the tumor can be removed with surgery. This is very important because most liver cancers cannot be removed with surgery.
At this time, liver cancer can be cured only when it is found at an early stage (before it has spread) and only if the patient is healthy enough to have an operation. However, treatments other than surgery may be able to control the disease and help patients live longer and feel better. When a cure or control of the disease is not possible, some patients and their doctors choose palliative therapy. Palliative therapy aims to improve the quality of a person's life by controlling pain and other problems caused by the disease.
People with liver cancer may not feel like eating, especially if they are uncomfortable or tired. Also, the side-effects of treatment can make eating difficult. Foods may smell or taste different. Nevertheless, patients should try to eat enough calories and protein to control weight loss, maintain strength, and promote healing. Also, eating well often helps people with cancer feel better and have more energy.
Careful planning and checkups are important. Liver cancer and its treatment may make it hard for patients to digest food and maintain their weight. The doctor will check the patient for weight loss, weakness, and lack of energy.
Localized resectable liver cancer is cancer that can be removed during surgery. In these cases, there is no evidence that the cancer has spread to the nearby lymph nodes or to other parts of the body. Lab tests show that the liver is working well.
Surgery to remove part of the liver is called partial hepatectomy. The extent of the surgery depends on the size, number, and location of the tumors. It also depends on how well the liver is working. The doctor may remove a wedge of tissue that contains the liver tumor, an entire lobe, or an even larger portion of the liver.
In a partial hepatectomy, the surgeon leaves a margin of normal liver tissue. This remaining healthy tissue takes over the functions of the liver.
For a few patients, liver transplantation may be an option. For this procedure, the transplant surgeon removes the patient's entire liver (total hepatectomy) and replaces it with a healthy liver from a donor. A liver transplant is an option only if the disease has not spread outside the liver and only if a suitable donated liver can be found.
Localized unresectable liver cancer cannot be removed by surgery even though it has not spread to the nearby lymph nodes or to distant parts of the body. In these cases, surgery to remove the tumor is not possible because of cirrhosis (or other conditions that cause poor liver function), the location of the tumor within the liver, or other health problems.
Patients with localized unresectable cancer may receive other treatments to control the disease and extend life:
Advanced liver cancer is cancer that is found in both lobes of the liver or that has spread to other parts of the body. Although advanced liver cancer cannot be cured, some patients receive anticancer therapy to try to slow the progress of the disease. Others discuss the possible benefits and side-effects and decide they do not want to have anticancer therapy. In either case, patients receive palliative care to reduce their pain and control other symptoms.
Recurrent cancer means the disease has come back after the initial treatment. Even when a tumor in the liver seems to have been completely removed or destroyed, the disease sometimes returns because undetected cancer cells remained somewhere in the body after treatment. Most recurrences occur within the first 2 years of treatment. The patient may have surgery or a combination of treatments for recurrent liver cancer.
A study published on November 28th, 2012 in the Journal of the National Cancer Institute showed that those who used aspirin to treat pain saw a 41% reduction in their risk of developing liver cancer. However, the incidence of liver cancer in the general population is already very low, so the risks from aspirin far outweigh the potential benefits in those who are not at increased risk of liver cancer or liver disease.
Picrorhiza has been shown to reduce formation of liver cancer due to chemical exposures in animal studies. [Jeena KJ, Joy KL, Kuttan R. Effect of Emblica officinalis, Phyllanthus amarus and Picrorrhiza [sic] kurroa on N-nitrosodiethylamine induced hepatocardinogenesis. Cancer Lett 1999;136: pp.11-6]
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