LIVER CANCER
Liver cancer is one of the deadliest forms of cancer. According to a research paper published in 2018, liver cancer is the sixth most commonly reported cancer in the world and also the fourth leading cause of all cancer-related deaths. The highest number of liver cancer cases, notably hepatocellular carcinoma (HCC), occur in East Asian and African countries. However, India has reported less liver cancer when compared to most of the other cases, with male to female ratio being 4:1. Why is liver cancer considered the deadliest cancer in the world?
Read this comprehensive guide to liver cancer to get an idea.
<span data-metadata=""><span data-buffer="">What is liver cancer?
Cancer is a condition where cells in the human body undergo abnormal mitosis or cell division to form lumps of tissue called a tumour. Liver cancer is a condition where the cells in the liver undergo abnormal mitosis to form malignant or cancerous tumours. These tumours grow uncontrollably, break away and spread to other body parts.
The liver plays an important function in the human digestive system by eliminating waste, absorbing nutrients, and healing wounds. It produces bile, a physiological aqueous solution, which contains substances like bile salts, cholesterol, conjugated bilirubin, electrolytes, phospholipids, and water. Bile helps digest fats, vitamins, and other nutrients consumed by humans. The liver stores the necessary glucose to give the human body energy when a person is not eating.
The liver is also crucial in removing toxins and medications from the human body. Liver cancer affects all these normal functions by destroying the normal cells.
<span data-metadata=""><span data-buffer="">Where does liver cancer start?
The human liver is made up of cells called hepatocytes. It also has cells that line its blood vessels and cells that line small tubes called bile ducts, which carry bile to the duodenum (a part of the small intestine). Liver cancer can start in any of these regions. There are two types of liver cancers, namely primary and secondary liver cancer.
Primary liver cancer is a condition where the cancer cells form in the liver. Secondary liver cancer is a condition where abnormal cancerous cells form and spread to the liver from other body parts like the pancreas or breast.
<span data-metadata=""><span data-buffer="">Where are the different types of liver cancer?
Primary liver cancer, a type of cancer that begins in the liver cells, is divided into the following types;
1. Hepatocellular carcinoma (HCC): It is the most commonly reported liver cancer. It develops in the hepatocytes, the type of cells that make up the liver structure. There are two types of HCC growth patterns;
- The type of HCC grows as a single tumour in one region of the liver, and its metastasis only when it is significantly big.
- The type of HCC that begins as a series of tiny cancer nodules spreads throughout the liver, a condition common in individuals with liver cirrhosis.
- Fibrolamellar Carcinoma (FLC/FLHCC) is a rare type of liver cancer that occurs in younger individuals, especially women. FLC is so rare that it is only 1% of all reported liver cancer cases. It is also a subtype of HCC and is mostly seen in women younger than 35 years of age.
2. Cholangiocarcinoma: It is the type of cancer which affects the bile ducts, also known as bile duct cancer. These ducts carry bile to the gallbladder, which later releases it into the small intestine. Bile duct cancers are divided into; intrahepatic bile duct cancer and extrahepatic bile duct cancer.
3. Intrahepatic bile duct cancer: it is the type of cancer that begins in the ducts inside the liver.
4. Extrahepatic bile duct cancer: it is the type of cancer that begins in the ducts outside the liver.
5. Liver angiosarcoma: It is the type of cancer that develops in the blood vessels of the liver and is often diagnosed when it is at a very advanced stage.
6. Hepatoblastoma: It is a very rare liver cancer that is typically found in children below three years of age. However, it is extremely sensitive to chemotherapy, and almost 70% of hepatoblastoma patients survive the disease.
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<span data-metadata=""><span data-buffer="">What are the different stages of liver cancer?
Cancer staging describes the location and size of the cancerous tumour and whether it has invaded the nearby tissues, lymph nodes or distant sites. The treatment process is determined based on the staging and grading of the tumour. There are several processes of liver cancer staging, but the most common one is the AJCC’s TNM staging.
In TNM staging, T refers to the tumour’s size, N highlights how many lymph nodes have been affected, and M is whether the tumour has metastasized or not. Based on that, the tumour is staged into four;
- Stage 1 – The cancerous tumour is small and localized.
- Stage 2 – The cancerous tumour is big, but it has or has not invaded the blood vessels or lymph nodes.
- Stage 3 – The cancerous has invaded the lymph nodes.
- Stage 4 – The cancerous tumour has spread or metastasized.
Depending on the type of tumour, liver cancer is also categorised under different grades. Tumour grade determines how similar the tumour cells are when compared with the normal cells. It gives an idea about how fast a tumour divides and grows out of its point of origin. The tumour grades are divided into four;
- Grade 1 or low grade – The cancerous cells are similar to the normal cells and are growing slowly.
- Grade 2 or intermediate grade – The cancerous cells are somewhat similar to normal cells. It is growing more quickly than normal, but it is not aggressive.
- Grade 3 or high grade – The cancerous cells are completely different when compared to the normal cells and are multiplying.
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<span data-metadata=""><span data-buffer="">How is liver cancer diagnosed?
Liver cancer can be diagnosed through any of the following methods;
- Physical examination: Patients with liver cancer tend to experience lumps or bumps in their abdomen region and jaundice. So, medical experts check for these symptoms along with significant changes in the liver, pancreas, spleen, and other organs.
- Blood tests: The medical experts check for the normal functioning of the liver and pancreas. The book is tested to check for the levels of a tumour marker named alpha-fetoprotein (AFP).
- Imaging tests: Patients can undergo imaging tests such as Ultrasound or MRI to check for the presence of a tumour. An ultrasound test uses sound waves to create an image of the body’s internal structure. MRI produces detailed images of the human body using magnetic fields. MRI is beneficial to check whether the tumour has metastasized to other body parts or not.
- Angiogram: An angiogram is an X-ray image of the human body’s blood vessels. The liver’s blood vessels become visible on an X-ray because of a dye that has been injected into the human body.
- Biopsy: Biopsy is a method where a sample of the tumour is taken with the help of a needle (or surgically removed) and then checked under laboratory conditions. Biopsy confirms whether the tumour is precancerous, benign or malignant.
<span data-metadata=""><span data-buffer="">What are the various liver cancer treatment methods?
When the cancerous tumour is less than 1 centimetre, the patient undergoes surveillance, where the medical experts watch its moves. In other cases, the treatment of liver cancer depends on its size, location, and whether it has spread or invaded the nearby blood vessels or lymph nodes. Various treatment methods are as follows;
- Surgery: Based on the size and growth of the tumour, the patient can undergo either partial hepatectomy or liver transplant. Partial hepatectomy is the process where the portion of the liver with the cancerous is surgically removed. A liver transplant is a process where the cancer-affected liver is replaced with a healthy one.
- Radiation therapy: It is the process where high-energy X-rays or other types of radiation are used to target and kill cancerous cells in the liver.
- Immunotherapy: It is a treatment process where a person’s immune system is activated with immune checkpoint inhibitors to target and kill the cancerous cells.
- Chemoembolization: Also known as transarterial chemoembolization (TACE), it is a type of cancer treatment that is meant for liver cancer. It uses powerful cytotoxic drugs to target and kill the liver cancer cells by injecting them into the blood vessels that lead into the liver.
- Targeted therapy: It is a type of treatment similar to chemotherapy where powerful drugs and similar substances are used to identify and attack specific cancer cells in the liver without affecting the normal cells.
- Radiofrequency ablation: It is a type of treatment where the tumour is targeted and destroyed or removed with high-energy radio waves.
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<span data-metadata=""><span data-buffer="">What are the different side effects of liver cancer treatment?
The cancer treatment process involves the alteration, removal, or destruction of cancerous tumours, but the process can also affect other normal cells in the human body. It can lead to side effects such as the following;
- Nausea and vomiting
- Fatigue
- Neuropathy
- Redness or swelling
- Fever
- Abdominal pain
- Mouth sores
- Change in bowel habits
- Hair loss
- Loss of appetite
<span data-metadata=""><span data-buffer="">What are the supportive therapies for liver cancer?
- Pain management: Patients can seek medical help to manage pain due to chemotherapy. Treatment processes like ozone therapy, HDIVC, acupuncture and acupressure also help in addressing this.
- Nutrition: Patients often lose tremendous weight due to chemotherapy-induced nausea and vomiting. Lack of appetite, as a result, leads to malnutrition, osteoporosis and other health challenges. Patients can consult an onco nutritionist who suggests a suitable diet and fasting routines to help the patients cope with nausea. Patients are required to consume enough water, nutrients, proteins and carbohydrates during treatment. People who find it difficult to have solid can have semi-solid or liquid food.
- Physiotherapy: Patients who have undergone surgery or a liver transplant might find it challenging to do basic physical activities like getting up from bed, going to the toilet, and sitting on a chair. A physiotherapist helps the patient through all these activities.
- Counselling: Cancer diagnosis and it’s treatment take a toll on an individual and their caregivers. Mental health counselling helps patients, and their caregivers cope with the process of dealing with the disease. Patients can try meditation and yoga exercises to cope with the stress.
What lifestyle changes and follow-up care should liver cancer patients make?
- Patients who suffer from smoking or alcohol addiction can seek deaddiction services. Excluding alcohol from one’s lifestyle increases the chance of surviving liver cancer. While both alcohol and tobacco raise the risk of almost all types of cancer, the liver is an organ engaged in body detoxification. Thus reducing or quitting alcohol usage helps to relieve the liver of that task.
- Patients should have a minimum of 7-9 hours long continuous sleep.
- Patients should consume plenty of fruits, vegetables and food items that are rich in fibre, like beans, peas, lentils, whole grains, nuts, and seeds.
- Reduce the intake of red meat and processed food.
- Eat smaller portions of food at regular intervals as opposed to three big meals, especially for patients with nausea and vomiting issues.
- Patients should try to keep themselves occupied as much as possible to ensure better brain activity while ensuring enough rest.
Follow-up treatment is crucial for avoiding the recurrence of liver cancer, as it is generally expected from cancer patients who are in remission. Patients should talk to their doctors about how often they should undergo blood tests and physical examinations.
The oncologist analyses patients for recurrence of liver cancer and secondary cancer growth. Patients are encouraged to retain a health record in addition to routine check-ups to ensure a smooth process.
In conclusion,
A 56-year-old woman recently opened up about surviving metastatic cancer, which included a massive tumour in her liver. Modern-day treatment methods, notably immunotherapy, have increased the survival rates of cancer patients, including liver cancer. People can always put up a fight as opposed to bending their knees to uncertainty.