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Liver cancer symptoms, causes, treatment – Liver Cancer

Liver cancer symptoms appear in the late disease stages. This article tells all you need to know about liver cancer and its symptoms.

Cancer is a group of pathologies or diseases. A cluster of cells begins to replicate without control or regulation, eventually invading complete organs and other tissues far away from the initial tumor.

Liver cancer is a type of cancer that starts in the liver. Liver cancer can be either primary or secondary. Primary liver cancer arises directly from the liver. In contrast, secondary liver cancer occurs when another primary cancer expands to the liver. Several different types of primary liver cancer exist, such as hepatocellular carcinoma, intrahepatic cholangiocarcinoma (bile duct cancer), angiosarcoma, and hepatoblastoma.

Liver cancer is the most rapidly increasing form of cancer in the developing world. The appearance of new liver cancer cases has more than tripled since the 1980s. According to the American Cancer Society statistics, there are more than 42.000 new liver cancer cases every year.

The same organization estimates that there will be more than 30.000 deaths due to liver cancer in the United States during 2021. Worldwide, there are over 900.000 new cases each year and over 800.000 deaths. Although it only accounts for 2,5% of cancer cases in the United States, liver cancer is particularly deadly, causing approximately 5% of cancer deaths in the same country.

Hepatocellular cancer represents more than 70% of liver cancer cases. The disease typically affects patients over the age of 64; cases under 50 are rare. It is more frequent in men than in women. Recognizing liver cancer symptoms is of paramount importance in certain high-risk people for diagnosing and treating the disease. Take a look at all you need to know about liver cancer in this article.

What is the liver, and what does it do?

The liver is a vital organ located in the upper right side of the abdomen. It is involved in several critical functions that include:

  • Breaking down and storing the nutrients necessary for other organs to work.
  • Producing clotting factors essential to stop bleeding from cuts and injuries.
  • Creates and delivers bile required for nutrient absorption.
  • It breaks down toxins, alcohol and metabolizes drugs like acetaminophen and morphine.

The liver has many different kinds of cells. The most common cell type in the liver is the hepatocyte. Hepatocellular carcinoma, the most common type of liver cancer, arises from hepatocytes.

What are the types of liver cancer and liver tumors?

There are many different ways to classify liver tumors. The first big differentiation doctors have to make when facing a liver tumor is to tell whether it is a malignant tumor (cancer) or a benign tumor. The difference between them is that, unlike malignant tumors, benign tumors grow slowly and do to spread to other tissues; benign tumors are usually harmless. 

Liver cancer can be further classified into secondary liver cancer and primary liver cancer. Secondary liver cancer or metastatic liver cancer arises from a different tissue (like the lungs or the brain ) and later spreads to the liver. The lesions or tumors that arise in the liver due to the spreading of another type of cancer are called liver metastases or hepatic metastases. In these cases, cancer receives the name of the primary cancer type, for example, brain cancer with liver metastasis. 

Primary liver cancers arise from the liver itself and can later produce metastases in other organs. There are several types of primary liver cancer:

  • Hepatocellular carcinoma: The most common form of liver cancer, the most recent studies show that this cancer arises from hepatocytes which are the most common liver cells. There are many ways in which hepatocellular carcinoma can appear. Sometimes it seems a single tumor that grows larger with time. In other cases, hepatocellular carcinoma starts as many different nodules or masses distributed throughout the liver. 
  • Bile duct cancer: The second most common form of liver cancer. It arises from the tubes that carry bile into the gallbladder and small intestine, known as the Biliary system.
  • Angiosarcoma: These tumors arise from the cells lining the liver’s blood vessels and are very hard to treat.
  • Hepatoblastoma: This is a rare liver cancer that constitutes the most common cause of childhood liver cancer.
Resultado de imagen de bile system
Biliary system
Source

How do you get liver cancer?

Despite several decades of research, the exact mechanisms that cause normal cells to transform into cancerous cells are, so far, only partially understood. Yet, nowadays, the medical community knows that cell DNA damage is the main cause behind many forms of cancer.

Oncogenes are genes that control how cells grow and divide; tumor suppressor genes are genes that repair mistakes in DNA production and promote healthy cell death when it is appropriate. Cancer is the result of damage towards oncogenes or tumor suppressor genes that leads to mutations. Certain toxins, viruses, and forms of radiation can cause that damage. Still, in some cases, gene mutations appear for no apparent reason. 

What are risk factors linked to liver cancer?

The medical community has discovered several risk factors that increase the chance of DNA damage in the liver, increase liver cancer risk, and therefore liver cancer symptoms emerging.

Risk factors for liver cancer include:

  • Male sex: For unknown reasons, liver cancer is more frequent in men than in women.
  • Viral hepatitis: Long-term infection with Hepatitis B or Hepatitis C virus is the most crucial risk factor for adult primary liver cancer worldwide. Patients with any of these infections can develop chronic hepatitis and liver cirrhosis. Chronic damage to liver cells increases the risk of malignant transformation. 
  • Cirrhosis: Live cirrhosis is a disease in which an essential part of liver tissue is replaced by scar tissue. There are several causes of cirrhosis. The most common ones are alcohol abuse and viral hepatitis. The great majority of liver cancer patients have some degree of cirrhosis by the time of diagnosis.
  • Non-alcoholic fatty liver disease: It is a common condition in obese patients. Numerous (but not all) of these patients will develop liver cirrhosis due to the disease. 
  • Heavy alcohol use: It is no secret that chronic and abusive alcohol consumption increases the risk of cirrhosis and liver cancer risk. 
  • Anabolic steroid use: Some athletes inject themselves with an anabolic steroid to increase their muscle mass. Although it is not as important a risk factor as viral hepatitis or alcoholism, it slightly increases the chance of getting liver cancer.
  • Toxins: Vinyl chloride is a substance used in plastic production, and thorium dioxide is used as X-ray contrast. These two substances have in common that continued exposure to them increases the chance of suffering from liver angiosarcoma.  
  • Type two diabetes: Patients that have type two diabetes have an increased risk of developing liver cancer.

What are the symptoms of liver cancer?

The liver is a big organ; most estimates suggest that the average person only needs 25% to 30% of the liver to perform normal bodily functions. This is great for transplant patients that receive half a liver, but it has a downside. The fact that the liver can work at such a low percentage of its total capacity means that a liver can be 75% destroyed before the person it belongs to notices anything is wrong. 

Liver cancer, compared to other types of cancer, is relatively easier to treat. But most people don’t go to the doctor unless they feel that there is something wrong. The result is that the majority of liver cancer diagnoses are in the late stages.  

Common liver cancer symptoms that appear in the late stages of the disease are not specific to liver cancer. They can be present in many other diseases. Nevertheless, you should seek medical assistance if you present any of the following symptoms

  • Unintentional weight loss
  • Loss of appetite (related or not to weight loss)
  • Abdominal pain (particularly in the upper right quadrant of the abdomen)
  • Itching throughout the body 
  • Fluid buildup in the abdomen may appear more bloated or distended than usual.
  • Yellowing of the skin and eyes (jaundice)
  • Dark urine and white stools 
  • Enlarged liver (felt as a fullness under the ribs on the right side)
  • Enlarged spleen (felt as a fullness under the ribs on the left side)
  • An enlarged vein in the abdomen that looks like a spider web or Medusa’s hair 
  • Abnormal bruising or bleeding 

What stage of liver cancer does jaundice occur?

Jaundice is not only the most characteristic finding of liver cancer. It is also the most characteristic finding of liver disease in general. Jaundice is a consequence of the excessive accumulation of a substance called bilirubin in the body.

Bilirubin is a product of the degradation of hemoglobin, which is metabolized and eliminated by the liver in normal conditions. When the liver stops working correctly, bilirubin levels soar.

In the liver, cancer is the result of tumor infiltration into the liver tissue. It typically appears in the very late liver cancer stages, when the tumor has already compromised more than 70% of the hepatic tissue. The prognosis or possible outcomes of liver cancer patients with jaundice are not the best and vary from case to case. 

How do you check for liver cancer symptoms?

As in most diseases, liver cancer diagnosis begins with a detailed medical history, physical examination, and clinical suspicion. Suppose you present with symptoms suggestive of liver cancer or liver disease and have essential risk factors for the disease, such as cirrhosis, a history of alcohol abuse, or viral hepatitis. The doctor might do some of the following laboratory and imaging studies.

  • Liver function tests: These are a series of blood tests that help your doctor assess your liver’s health and functionality. These include Total and partial bilirubin, Clotting tests (remember clotting factors are a liver product), Liver enzymes (AST, ALT elevated values are a marker of liver tissue destruction), and Albumin and total serum proteins (typically decreased in advanced liver disease).
  • Tumor markers: Tumor markers are substances that are not typically found in the body that are present in the blood, urine, or tissues of certain cancer patients. These substances can either be produced by the tumor itself or by other cells in response to the tumor’s presence. There are many different types of tumor markers, each one created by various tumors. Some tumors do not produce tumor markers of any kind. Alpha-fetoprotein (AFP) is a tumor marker found in the blood of approximately 75% of all liver cancer patients. An AFP of over 400 ng per deciliter indicates cellular hepatocarcinoma in 95% of cases. However, liver diseases like viral hepatitis and cirrhosis can also elevate AFP. 

What imaging studies are useful in this cancer?

Imaging studies allow doctors to see one or several liver tumors, which could be causing liver cancer symptoms. There are many modalities of imaging studies that can be of help in the context of liver cancer. These include:

  • Ultrasonography: It is the least expensive choice, but it has many limitations. The ultrasonography does not accurately detect small nodules, and it is an operator-dependent method; therefore, the study’s accuracy varies depending on who is performing it. Ultrasonography is useful for the initial screening. Notwithstanding, an ultrasonogram always requires the complement of more advanced imaging techniques. 
  • CT scanning: It is a more advanced radiographic technique that forms very detailed images of the organs inside the body. Unlike an abdominal ultrasound, CT scanning provides detailed information about the tumor’s location, size, and shape. A CT scan is also helpful in detecting metastases in other organs.
  • Magnetic resonance imaging (MRI): Magnetic resonance uses magnets and radio waves to create detailed images of the body’s inside. It is beneficial to check if the tumor has spread to the blood vessels around the liver. This is particularly important in deciding whether the tumor is eligible for surgery or not. 

What is a liver biopsy?

A liver biopsy is a procedure in which a surgeon removes a small part of the tumor for a pathologist to observe under a microscope. Depending on the characteristics the pathologist observes under the microscope through other advanced techniques called immunohistochemistry, the pathologist can distinguish which type of liver cancer the patient has. 

There are several ways a doctor can perform a liver biopsy; these include:

  • Percutaneous liver biopsy: This is the most common method. It involves placing a hollow needle in the abdomen’s upper right quadrant through the skin and liver. This biopsy is usually performed with the help of a CT scan or an ultrasound to help guide the needle into the tumor.
  • Laparoscopic biopsy: A laparoscopic procedure involves introducing small cameras and surgical instruments through tiny incisions in the abdomen (one inch or less). The main advantage over a needle biopsy is that it allows the doctor to have a clearer view of the liver, making it possible for the doctor to pick the best biopsy area.
  • Surgical biopsy: It consists of doing open abdominal surgery to take a part of the tumor (incisional biopsy) or even taking the entire tumor and a part of the healthy surrounding tissues (excisional biopsy).
  • Trans-jugular biopsy:  The procedure involves making a small incision in the neck and inserting a tube into the jugular vein, guiding it through the venous system until it reaches the liver. This technique is useful in patients with severe coagulation disorders. The other approaches represent a significant risk of hemorrhage (bleeding).
File:2133 Head and Neck Veins.jpg
Head and Neck Veins
Source

As in any other medical invasive procedure, there are certain risks involved. The most common complications, in this case, are infection and hemorrhage. 

How can you detect it early?

Early detection of liver cancer is tough because it does not produce any symptoms until it is very advanced. Most tumors are not detected in a typical physical exam because liver tumors are very hard to palpate. There is no universal screening method for liver cancer for people with low to moderate risk. However, the American Cancer Society recommends routine screening for liver cancer in high-risk individuals (alcoholic patients and people with chronic viral hepatitis). AFP testing is the preferred tool for routine screening in high-risk individuals.

What is the treatment for liver cancer?

Treatment options for liver cancer vary according to the stage of the disease. Liver cancer staging is a complex process that depends on many small details. Many liver doctors use a more practical system to classify liver cancer and decide therapeutic options.

This system divides cases into four main categories:

  • Potentially resectable: This group includes liver cancer cases that are still in the early stage and therefore are candidates for complete tumor surgical removal. This applies mostly for stage I or II tumors smaller than five cms, do not invade blood vessels, and the rest of the liver has an important degree of functionality remaining.
  • Potentially transplantable: Includes cases where the tumor is still at an early stage, but the rest of the liver is not healthy enough to function. However, not every liver cancer patient is a liver transplantation candidate. Those who are might have to wait a very long time before a new liver is available. 
  • Inoperable liver cancer (that has not spread): Many reasons can make surgical removal impossible, such as very large tumors, multiple tumors distributed through the liver, and location in an area that makes the tumor very hard to remove. The ideal objective in these cases is to make the tumor small enough for surgical removal. However, in some cases, these treatments only serve as palliative treatment to improve life quality and help a person live some months or years longer.

When doctors cannot do surgery (non-resectable tumors), the treatment can include:

  • Chemotherapy: The objective of chemotherapy is to destroy cancer cells. The problem is that chemotherapy does not distinguish between cancer cells and healthy cells. It destroys any cells that divide quickly, such as the ones in the bone marrow, the intestines, and the mouth’s lining, causing terrible side effects. Furthermore, evidence shows that liver cancer does not respond well to chemotherapy. The combination of several chemotherapy drugs only shrinks tumors in the minority of cases, and most studies show that chemo does not improve the life expectancy of liver cancer patients.
  • Transarterial chemoembolization (TACE): Given the low efficacy of chemotherapy, TACE has become the most commonly offered therapy for non-operable liver cancer. The procedure consists of cannulating the feeding artery to the tumor and delivering large doses of chemotherapy agents. The artery is later occluded to prevent flow.
  • Radiation therapy: This treatment uses high-energy particles to destroy cancer cells. The idea is focusing radiation from an outer source on cancer, pretty much like getting an x-ray but with higher radiation. Each session lasts for around 5 minutes.
  • Targeted Therapy: Targeted therapy uses drugs that reach the bloodstream and almost every part of the body (very useful in the case of metastasis). These drugs work differently from chemotherapy drugs because they target the changes in liver cells that produce cancer.
  • Tumor ablation: Tumor ablation therapy consists of destroying the tumor without removing it. There are many different ablation techniques like radiofrequency ablation, microwave ablation, cryoablation, and alcohol ablation.

What is the prognosis of liver cancer?

In general, the prognosis or possible outcomes for liver cancer patients are reserved at best, and it varies from patient to patient. The 5-year survival rate after diagnosis is only 18%. However, it depends on whether the doctors are diagnosing the disease in its early or later stages. For example, early diseases have a 5-year survival rate of approximately 30%. On the other hand, when cancer spreads to nearby and distant tissues, the 5-year survival rate falls to 10% and 2,4% percent, respectively.

Do you have Liver Cancer Symptoms?

This tool is a Liver Cancer Symptoms Checker. It gathers the most important signs, symptoms, and risk factors for the disease. Therefore, the tool will tell anybody who uses it the likelihood of their symptoms because of Liver Cancer. Using the tool is free and would only take a few minutes.

What do you think?

Written by Dr. Esteban Kosak

Doctor of Medicine - MD Recently Graduated from Medical School and inspired to aid the global population during this situation. I think that we shall no longer be waiting to see a doctor when we feel sick. Several times we feel disease searches in Google drive us to a rabbit hole and come out thinking that we may die of cancer or something very serious, given that symptoms may seem to fit a wide variety of illnesses. Since I recently graduated from medical school. I have all the medical information fresh in my mind. My thorough experience as an expert researcher allows me to very-well known the different diseases and conditions that affect human bodies. Empowered by the United Nations 17 Sustainable Development Goals (SGDs). I think that we all can provide a grain of sand to help humanity. That's why we created Symptoms.Care a place where you can come and screen your symptoms and find what different illnesses can be related to them. Armed with the right information you can instantly, discretely, secure and from the comfort of your home talk with a Doctor that can Evaluate your Symptoms and help you seek the right treatment.

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