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Liver Cancer

Also called : Hepatocellular carcinoma

Your liver is the largest organ inside your body. It filters harmful substances from the blood, digests fats from food and stores the sugar that your body uses for energy. Primary liver cancer starts in the liver. Metastatic liver cancer starts somewhere else and spreads to your liver.

Risk factors for primary liver cancer include : -
  • Having hepatitis
  • Having cirrhosis, or scarring of liver
  • Being male
  • Low weight at birth

You cannot live without your liver. It has many vital jobs: -
  • It breaks down and stores many of the nutrients absorbed from the intestine.
  • It makes some of the clotting factors needed to stop bleeding from a cut or injury.
  • It makes bile that goes into the intestine to help absorb nutrients.
  • It plays an important part in getting rid of toxic wastes from the body.
Because the liver is made up of different types of cells, many types of tumors can form in the liver. Some of these are cancer and some are not. Tumors that are cancer are called malignant. The medical word for tumors that are not cancer is benign. These tumors have different causes and are treated different ways. The outlook for your health or your recovery (prognosis) depends on what type of tumor you have.

What Causes Liver Cancer?

A risk factoris anything that affects a person's chance of getting a disease. Different cancers have different risk factors. Some risk factors like smoking can be controlled. Others, like a person's age or family history, can't be changed. But risk factors don't tell us everything. Having a risk factor, or even many, does not mean that a person will get cancer. And many people who get the disease don't have any known risk factors.

Risk factors

These are some risk factors that make a person more likely to develop hepatocellular carcinoma (HCC): -
  • Gender : - Men are more likely to get liver cancer than are women. This could be because of the behaviors listed below, such as smoking and alcohol abuse.
  • Race/ethnicity : - In the United States, Asian Americans and Pacific Islanders have the highest rates of liver cancer, followed by American Indians/Alaska Natives and Hispanics/Latinos, African Americans, and whites.
  • Certain types of liver disease : - The most common risk factor for liver cancer is infection with hepatitis B virus (HBV) or hepatitis C virus (HCV). These infections lead to cirrhosis and are common in many parts of the world. In this country, hepatitis C is the most common cause of liver cancer, while in other countries, hepatitis B is more common. These viruses are spread from person to person through sharing dirty needles (such as in drug use), unprotected sex, or childbirth. They can also be passed on through blood transfusions. This is rare in the US because blood products are now tested for these viruses. People with hepatitis A infection do not have an increased risk of liver cancer.

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There are also some inherited liver diseases that increase the risk of liver cancer.
  • Cirrhosis : - Cirrhosis is a disease in which liver cells are damaged and replaced with scar tissue. This can often lead to cancer. In the United States, the major causes of liver cirrhosis are alcohol abuse and hepatitis B and C. Non-alcoholic fatty liver is a fairly common disease in which people who don't drink alcohol develop a fatty liver and go on to develop cirrhosis. Another cause is a disease (called hemachromatosis) that results in too much iron in the liver. Some other rare diseases can cause cirrhosis, too.
  • Diabetes : - Diabetes can increase the risk of liver cancer. This is more common in people with diabetes who also have other risk factors such as heavy drinking and/or hepatitis.
  • Obesity : - Being very overweight might increase the risk of getting liver cancer.
  • Aflatoxins : - These cancer-causing substances are made by a fungus that can get into peanuts, wheat, soybeans, groundnuts, corn, and rice. Long-term exposure to aflatoxins can increase the risk of liver cancer. In the United States and Europe, these foods are tested for aflatoxins.
  • Vinyl chloride and thorium dioxide (Thorotrast) : - These chemicals are risk factors for some types of liver cancer. They have become much less important since Thorotrast is no longer used and exposure to vinyl chloride is strictly controlled.
  • Anabolic steroids : - These male hormones are used by some athletes to increase their strength. Long-term use of these can slightly increase the risk of liver cancer.
  • Arsenic : - Drinking water that comes from wells can have arsenic in it. This increases the risk of liver cancer and is a concern in some parts of the United States.

Liver transplant

A liver transplant is an option for people with small liver cancers. For now, transplant is saved for those with a few small tumors that cannot be totally removed, either because of where they are or because not enough normal liver would be left.

Not many livers are available for transplant for patients with cancer because they are most often used for more curable diseases. Patients often must wait a long time -- often too long for a liver to be found. For this reason, some doctors suggest a limited resection first and then a transplant if the cancer comes back.

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How is liver cancer diagnosed?

Blood tests

Liver cancer is not diagnosed by routine blood tests, including a standard panel of liver tests. This is why the diagnosis of liver cancer depends so much on the vigilance of the physician screening with a tumor marker (alpha-fetoprotein) in the blood and radiological imaging studies. Since most patients with liver cancer have associated liver disease (cirrhosis), their liver blood tests may not be normal to begin with. If these blood tests become abnormal or worsen due to liver cancer, this usually signifies extensive cancerous involvement of the liver. At that time, any medical or surgical treatment would be too late.

Tumor ablation and embolization

Ablation refers to treatment that destroys the tumor without removing it. There are a number of ways to do this. These treatments are usually used for patients with only a few small tumors that cannot be taken out with surgery. They are also sometimes used to treat liver cancer in patients waiting for a transplant. These methods are not meant to cure the cancer but can help people live longer.

Radiation treatment

Radiation therapy is treatment that uses high-energy rays to kill cancer cells or shrink tumors. External beam radiation aims radiation from outside the body to the cancer. Liver cancer cells can be killed by radiation, but this treatment can't be used at very high doses because normal liver tissue is killed, too. This type of radiation may be used to shrink a liver tumor or to give relief from symptoms like pain, but it does not cure the liver cancer and usually does not help people live longer.

Possible side effects of radiation treatment

Side effects of radiation treatment might include sunburn-like skin problems at the place where the radiation enters the body, nausea, vomiting, and tiredness. Often these go away after treatment is finished. Radiation might also make chemo side effects worse.

Targeted therapy

As researchers have learned more about the changes in cells that cause cancer, they have been able develop newer drugs that are aimed at these changes. Targeted drugs do not work the same as standard chemo drugs (which are described in the next section). They tend to focus on killing the cancer cells and cause less damage to normal tissues. And they often have different, and less severe, side effects.


Chemotherapy (or "chemo") is the use of drugs to kill cancer cells. Usually the drugs are given into a vein or by mouth. Once the drugs get in the blood, they spread throughout the body. This makes them useful for cancer that has spread to distant organs.

Hepatic artery infusion

Because standard chemo does not work very well for liver cancer, doctors have studied putting chemo drugs right into the hepatic artery. This is called hepatic artery infusion (HAI). The chemo goes to the whole liver through the hepatic artery, but the healthy liver breaks down most of the drug before it can reach the rest of the body. This gets more chemo to the tumor and may cause fewer or less severe side effects.

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What are the treatment options for liver cancer?

The treatment options are dictated by the stage of liver cancer and the overall condition of the patient. The only proven cure for liver cancer is liver transplantation for a solitary, small (<3cm) tumor. Now, many physicians may dispute this statement. They may argue that a small tumor can be surgically removed (partial hepatic resection) without the need for a liver transplantation. Moreover, they may claim that the one and three year survival rates for resection are perhaps comparable to those for liver transplantation.

However, most patients with liver cancer also have cirrhosis of the liver and would not tolerate liver resection surgery. But, they probably could tolerate the transplantation operation, which involves removal of the patient's entire diseased liver just prior to transplanting a donor liver. Furthermore, many patients who undergo hepatic resections will develop a recurrence of liver cancer elsewhere in the liver within several years. In fact, some experts believe that once a liver develops liver cancer, there is a tendency for that liver to develop other tumors at the same time (synchronous multicentric occurrence) or at a later time (metachronous multicentric occurrence).

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