Liver Cancer: Decoding the Symptoms, Causes, and Potential Treatment Options

Getting diagnosed with liver cancer can be a profoundly emotional and overwhelming experience for both patients and their loved ones. That said, if diagnosed at an early stage, liver cancer can be managed and treated. That’s why it is important to understand the symptoms, causes, and treatment options for liver cancer, so that suitable remedial measures can be taken while there is time. To help, in this article, we delve into the early warning signs of liver cancer, its risk factors, and the latest advancements in treatment options. But first, let’s cover some basics. 

What is Liver Cancer?

Liver cancer is a condition where cells in the liver grow uncontrollably and form tumours. The liver, located in the upper right part of the abdomen, is crucial for detoxifying the blood, producing vital proteins, and aiding in digestion. When liver cancer occurs, the normal liver cells mutate and grow abnormally, which can interfere with the liver's ability to perform its essential functions. As the cancer progresses, it can disrupt the liver's ability to process nutrients, filter toxins from the blood, and produce bile, which is necessary for digestion. This can result in an array of symptoms such as weight loss, fatigue, abdominal pain, and jaundice.

How Common is Liver Cancer?

Liver cancer is relatively common and is considered a major global health concern. Its prevalence varies widely depending on geographic location, primarily due to the differences in the underlying risk factors such as chronic hepatitis B and C infections, alcohol consumption, and exposure to aflatoxins. According to the World Health Organization (WHO), liver cancer is one of the leading causes of cancer-related deaths worldwide.

Who is at a High Risk of Developing Liver Cancer?

Liver cancer affects various groups differently:

• Geographical distribution: It is more prevalent in regions with high rates of chronic hepatitis B and C infections, such as East Asia, sub-Saharan Africa, and parts of South America.
• Age and gender: Liver cancer is more commonly diagnosed in individuals over the age of 50, and men are significantly more likely to develop liver cancer compared to women. 
• Risk factors: Individuals with chronic liver diseases, such as hepatitis B or C, cirrhosis, fatty liver disease, or those who consume large amounts of alcohol, are at a higher risk.
• Exposure to toxins: Long-term exposure to certain toxins such as aflatoxins can increase the risk of liver cancer.
• Lifestyle and health: Obesity and type 2 diabetes are also associated with an increased risk of liver cancer, highlighting the role of metabolic health in the development of this disease.

Understanding these factors is crucial for early detection, prevention, and effective treatment of liver cancer.

What are the Types of Liver Cancer?

Liver cancer can be broadly classified into two categories: Primary and secondary, both having several subtypes. Here’s an overview:

Primary Liver Cancer

Primary liver cancer originates in the liver itself. There are several types of primary liver cancer, including:

• Hepatocellular Carcinoma (HCC): This is the most common type of liver cancer, which arises from hepatocytes, the main liver cells. It is often associated with chronic liver diseases such as hepatitis B or C, and cirrhosis.
• Intrahepatic Cholangiocarcinoma (Bile Duct Cancer): This type of liver cancer starts in the bile ducts within the liver and represents a smaller percentage of liver cancers. It is often linked to chronic inflammation of the bile ducts.
• Angiosarcoma/Hemangiosarcoma: These are rare forms of liver cancer originating from the blood vessels in the liver and are known for rapid growth and spread. Its risk factors include exposure to certain chemicals like vinyl chloride and thorium dioxide.
• Hepatoblastoma: This is a rare type of liver cancer that typically affects children under the age of 3. It is often treated successfully with surgery and chemotherapy if detected early.

Secondary Liver Cancer

Secondary liver cancer, also known as metastatic liver cancer, occurs when cancer cells spread to the liver from another part of the body. Unlike primary liver cancer, which originates in the liver, secondary liver cancer begins in another organ and then metastasizes (spreads) to the liver.

Key Characteristics of Secondary Liver Cancer:

• Origin of cancer cells: Secondary liver cancer is characterised by the presence of cancer cells that are identical to those found in the primary tumour site. For instance, if breast cancer spreads to the liver, the cancer cells in the liver are breast cancer cells, not liver cancer cells.
• Common primary sites: The liver is a common site for metastasis due to its rich blood supply and its role in filtering blood from various parts of the body. Common primary sites that metastasize to the liver include colon and rectum (colorectal cancer), breast, lungs, pancreas, and stomach.

What are the Stages of Liver Cancer?

Liver cancer is staged based on the size and extent of the tumour, involvement of lymph nodes, and spread to other parts of the body. Here's an overview of the stages of liver cancer, often classified using systems like the Barcelona Clinic Liver Cancer (BCLC) staging system:

Stage 0/Stage I/Very early stage

• Tumour characteristics: A single tumour smaller than 2 cm (approximately 3/4 of an inch) in diameter.
• Liver function: The liver is functioning well with no increase in bilirubin or significant portal hypertension.
• Symptoms: Typically, there are no symptoms at this stage.

Stage A/Stage II/Early stage

• Tumour characteristics: A single tumour larger than 2 cm or up to three tumours each smaller than 3 cm.
• Liver function: The liver still functions well, and the patient is in good overall health.
• Symptoms: There might be mild symptoms or none at all.

Stage B/Stage III/Intermediate stage

• Tumour characteristics: Multiple tumours that may be larger than 3 cm but are confined to the liver.
• Liver function: Liver function is still relatively preserved, but there might be mild symptoms related to liver function impairment.
• Symptoms: Symptoms might include pain, fatigue, and mild liver dysfunction.

Stage C/Stage IV/Advanced stage

• Tumour characteristics: The cancer has spread to other parts of the body (metastasis) or has invaded blood vessels or lymph nodes.
• Liver function: Liver function may be significantly impaired, and there might be other health issues.
• Symptoms: Symptoms can include significant pain, weight loss, fatigue, jaundice, and other signs of liver failure.

Stage D/End-stage (Referred to as Stage IV in some systems)

• Tumour characteristics: Extensive cancer spread with significant liver damage.
• Liver function: Severely compromised liver function, often with complications like ascites, jaundice, and hepatic encephalopathy.
• Symptoms: Severe symptoms impacting daily life and overall health.

What are the Causes and Risk Factors of Liver Cancer?

Liver cancer can develop due to a variety of causes and risk factors. Understanding these factors can help in early detection and prevention. Common causes and risk factors of liver cancer include:

• Fatty liver (Nonalcoholic Fatty Liver Disease - NAFLD): Fatty liver occurs when excess fat builds up in the liver cells. It is often associated with obesity and metabolic syndrome. Fatty liver can progress to nonalcoholic steatohepatitis (NASH), which can lead to liver cirrhosis and increase the risk of liver cancer.
• Liver cirrhosis: Cirrhosis is a late stage of scarring (fibrosis) of the liver caused by many forms of liver diseases and conditions, such as hepatitis and chronic alcohol abuse. Cirrhosis significantly increases the risk of liver cancer, as the damaged liver cells are more likely to become cancerous.
• Chronic liver infections (Hepatitis B and C): Hepatitis B and C are viral infections that cause inflammation of the liver and can lead to chronic liver disease. Chronic infections with hepatitis B or C viruses are major risk factors for liver cancer. They can cause long-term inflammation and damage, leading to cirrhosis and liver cancer.
• Diabetes: Diabetes, particularly type 2 diabetes, is a metabolic disorder that affects the body's ability to regulate blood sugar levels. People with diabetes have a higher risk of developing liver cancer, partly due to the association with fatty liver disease and obesity.
• Excessive alcohol consumption: Long-term, heavy alcohol consumption can lead to liver damage, inflammation, and cirrhosis. Chronic alcohol abuse is a significant risk factor for liver cancer, as it can cause extensive liver damage and cirrhosis.
• Exposure to chemicals such as Aflatoxins: Aflatoxins are toxic substances produced by certain types of mould that grow on crops such as peanuts, corn, and grains. Long-term exposure to aflatoxins, particularly in areas where food storage conditions allow mould growth, is a known risk factor for liver cancer. 
• Obesity: Obesity is characterised by excessive body fat, which can lead to various health issues, including metabolic disorders. Obesity increases the risk of developing liver cancer, often through its association with fatty liver disease, diabetes, and other metabolic conditions.

Additional Risk Factors

• Genetic disorders: Certain inherited liver diseases, such as hemochromatosis and Wilson's disease, increase the risk of liver cancer.
• Smoking: Tobacco use is a risk factor for many cancers, including liver cancer.
• Gender: Men are more likely to develop liver cancer than women, possibly due to higher rates of hepatitis infections and alcohol consumption.
• Family history: A family history of liver cancer can increase the risk, suggesting a possible genetic predisposition.

What are the Signs and Symptoms of Liver Cancer?

Early Warning Signs of Liver Cancer

Liver cancer can be challenging to detect early as symptoms often do not appear until the disease is advanced. However, being aware of the early warning signs can lead to prompt diagnosis and treatment. Here are some of the common signs and symptoms to watch for:

• Unexplained weight loss: Sudden and unexplained weight loss can be an early sign of liver cancer.
• Loss of appetite: A decreased interest in eating or feeling full after eating small amounts may indicate liver issues.
• Upper abdominal pain: Pain or discomfort in the upper right side of the abdomen is a common symptom.
• Nausea and vomiting: Frequent feelings of nausea or episodes of vomiting can be associated with liver cancer.
• Dark urine: Changes in urine colour, such as darkening, can be a warning sign of liver dysfunction.
• Fever: Unexplained fever can sometimes be a symptom of liver cancer.
• Abdominal swelling: Swelling or bloating in the abdomen may occur due to an enlarged liver or fluid buildup.
• Jaundice: Yellowing of the skin and eyes, known as jaundice, indicates liver problems and is a significant sign.
• Bloating: General bloating or a feeling of fullness in the abdomen can be a symptom of liver cancer.

Recognizing these signs and symptoms early can lead to timely diagnosis and treatment, improving the chances of better outcomes. If you experience any of these symptoms, it's important to consult a healthcare professional for further evaluation.

How is Liver Cancer Diagnosed?

Diagnosing liver cancer involves a combination of tests and procedures to accurately detect the presence and extent of the disease. Here are the common methods used for diagnosing liver cancer:

• Blood tests: Blood tests are often the first step in diagnosing liver cancer. These tests can measure liver function and detect specific tumour markers, such as alpha-fetoprotein (AFP), which may be elevated in cases of liver cancer.
• Ultrasound (Sonography): An ultrasound uses sound waves to create images of the liver. This non-invasive test can help detect tumours and assess the overall condition of the liver.
• Computed Tomography (CT) scan: A CT scan provides detailed cross-sectional images of the liver and surrounding structures. It helps in identifying the size, shape, and location of tumours and can also detect metastasis.
• Magnetic Resonance Imaging (MRI) scan: MRI uses magnetic fields and radio waves to produce detailed images of the liver. It is particularly useful for evaluating liver tumours and differentiating between benign and malignant growths.
• Angiogram: An angiogram involves injecting a contrast dye into the bloodstream to visualise the blood vessels in the liver. It helps in identifying the blood supply to the liver tumours, which is crucial for planning treatment.
• Biopsy: A biopsy involves removing a small sample of liver tissue for examination under a microscope. This is often the definitive method for diagnosing liver cancer, confirming the presence and type of cancer cells.
• Endoscopic Retrograde Cholangiopancreatography (ERCP): ERCP is a procedure that combines endoscopy and fluoroscopy to examine the bile ducts, which can be affected by liver cancer. It helps in diagnosing cancers that may obstruct the bile ducts.
• Percutaneous Transhepatic Cholangiography (PTC): PTC involves inserting a needle through the skin and into the liver to inject contrast dye directly into the bile ducts. This procedure helps in visualising the bile ducts and detecting blockages or tumours.

These diagnostic methods, often used in combination, provide a comprehensive assessment of liver health, helping to confirm the presence of liver cancer and guide appropriate treatment plans.

How is Liver Cancer Treated?

Treatment for liver cancer depends on the stage of the disease, the overall health of the patient, and the liver’s condition. Here are the common treatment options:

Surgery

• Surgery to remove the tumour: Also known as a partial hepatectomy, this surgical procedure involves removing the portion of the liver that contains the tumour. This option is typically considered for patients with a single tumour and sufficient healthy liver tissue.
• Liver transplant surgery: This involves replacing the diseased liver with a healthy liver from a donor. It is often considered for patients with early-stage liver cancer who also have cirrhosis.

Localised Treatments

• Radiofrequency ablation (Heating cancer cells): This technique uses electric currents to heat and destroy cancer cells. A probe is inserted into the liver through the skin to deliver the heat directly to the tumour.
• Cryoablation (Freezing cancer cells): This method involves freezing cancer cells with extreme cold. A cryoprobe is inserted into the liver to apply the freezing temperatures directly to the cancer cells.
• Percutaneous ethanol injection (Injecting alcohol into the tumour): This procedure involves injecting pure alcohol directly into the liver tumour to kill cancer cells. It is typically used for small tumours.
• Chemoembolization (Injecting chemotherapy drugs into the liver): This treatment involves delivering high doses of chemotherapy directly to the liver tumour while blocking the blood supply to the cancer cells, thus trapping the drugs in the liver.
• Radioembolization (Placing beads filled with radiation in the liver): Tiny beads containing radioactive material are injected into the liver’s blood vessels, delivering targeted radiation to the tumour while sparing surrounding healthy tissue.

Radiation Therapy

• This treatment uses high-energy beams to kill cancer cells. It can be delivered externally or internally (brachytherapy) and is often used when surgery is not an option.

Targeted Drug Therapy

• Targeted drugs attack specific abnormalities within cancer cells. For liver cancer, drugs like sorafenib and lenvatinib are used to block the signals that tumours need to grow.

Immuno Therapy

• Immunotherapy helps the body’s immune system recognize and attack cancer cells. Drugs like nivolumab and pembrolizumab have been used to treat liver cancer, particularly in advanced stages.

Chemo Therapy

• Chemotherapy uses drugs to kill rapidly growing cells, including cancer cells. It can be administered orally or intravenously and is often used when liver cancer has spread to other parts of the body.

Palliative Care

• Palliative care focuses on providing relief from the symptoms and stress of the disease. It can include pain management, nutritional support, and other measures to improve quality of life.

Each treatment option has its indications, benefits, and risks. Often, a combination of these treatments is used to manage liver cancer effectively. The choice of treatment depends on individual patient factors, including the stage of cancer and overall liver function.

How to Prevent Liver Cancer?

Preventing liver cancer involves reducing the risk factors associated with the disease and maintaining overall liver health. Here are some strategies to help prevent liver cancer:

• Hepatitis B Vaccine: Getting vaccinated against hepatitis B can significantly reduce the risk of liver cancer. The vaccine is recommended for all infants, children, and adults who are at high risk.
• Avoiding hepatitis infections: Avoid sharing needles, practise safe sex, and ensure proper sterilisation of medical equipment to reduce the risk of hepatitis B and C infections.
• Limit alcohol intake: Excessive alcohol consumption can lead to liver cirrhosis, a significant risk factor for liver cancer. Limiting alcohol intake to moderate levels can reduce this risk.
• Maintaining a healthy weight: Obesity and nonalcoholic fatty liver disease (NAFLD) are risk factors for liver cancer. Maintaining a healthy weight through a balanced diet and regular exercise can lower the risk.
• Managing chronic diseases: Managing conditions such as cirrhosis, fatty liver disease and diabetes through medication, diet, and exercise can help reduce the risk of liver cancer.
• Balanced nutrition: A diet rich in fruits, vegetables, whole grains, and lean proteins supports overall liver health. Reducing the intake of processed foods and sugars can also be beneficial.
• Quit smoking: Smoking increases the risk of many cancers, including liver cancer. Quitting smoking can significantly reduce this risk.
• Workplace safety: Minimising exposure to certain industrial chemicals, such as vinyl chloride and thorium dioxide, which are associated with liver cancer, can reduce risk.
• Regular screening for high-risk individuals:Individuals with chronic hepatitis B or C, cirrhosis, or a family history of liver cancer should undergo regular liver cancer screenings. Early detection can lead to more effective treatment.

Implementing these preventive measures can significantly reduce the risk of developing liver cancer and promote overall liver health.

Final Words

Navigating the complexities of liver cancer can be overwhelming, but you don’t have to do it alone. If you or a loved one has been diagnosed with liver cancer or has been experiencing any of its early signs and symptoms, waste no time in consulting a specialist at Max Hospitals. Equipped with extensive experience and state-of-the-art technology, we are ideally positioned to provide you with a personalised treatment plan and the expert care needed to manage liver cancer effectively.