Liver cancer
Liver cancer is a malignant neoplasm that develops in the liver. The disease is more common in men than women, but in Russia it is quite rare. Treatment of liver cancer is hampered by late patients seeking help. Aggravating circumstances of treatment and survival rate is liver cirrhosis, which significantly worsens the prognosis and limits the choice of treatment methods for liver cancer.
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The main symptoms of liver cancer
Detecting the disease at an early stage and beginning treatment promptly can be very difficult. Liver cancer is often asymptomatic and is discovered in patients during routine examinations or during screenings for other illnesses or pathologies. There are no obvious discomfort or other painful sensations or signs associated with liver cancer, either at the onset of malignancy in this vital organ or in later stages. Even with advanced liver cancer, when treatment no longer offers such an optimistic prognosis, the symptoms are often quite vague. You should be wary if you experience:
- Significant weight loss for no apparent reason
- Periodic nausea and even vomiting
- Loss of appetite or decreased appetite, refusal of favorite foods
- Symptoms of bloating and pain of varying intensity and frequency in the right hypochondrium
- Increasing pain in the upper abdomen (it may radiate to the back and often worsens at night)
- Symptoms similar to those of diabetes
- A persistent feeling of fatigue, even without physical activity
A serious, most common precursor to a serious disease of the bile ducts and liver is obstructive jaundice, in which not only the whites of the eyes and skin, but also the mucous membranes, take on a dark yellow color. This disrupts blood clotting, a constant, uncontrollable itching sensation appears, stools become light-colored, and urine darkens. The body as a whole undergoes serious, painful changes – it is gradually poisoned by bile products in the liver, which destroy the organ.
Many of the symptoms described above, such as pain in the right side, nausea, fatigue, abdominal distension, and yellowing, are often observed in later stages of liver cancer. Therefore, if you notice even one of these symptoms, you should immediately consult a doctor to begin liver cancer treatment as soon as possible.
The clinical picture of the disease is characterized by enlargement of the liver, elevated bilirubin levels (this can also be a sign of liver cirrhosis), enlarged spleen, fever that is not controlled by antibiotics and anti-inflammatory drugs, and internal bleeding from the esophageal veins.
Some patients with liver cancer experience signs of hypoglycemia and osteoporosis, and thyroid and/or parathyroid dysfunction. Sometimes, symptoms may appear in other organs affected by liver cancer metastases, such as the lungs, bones, and brain.
Causes of liver cancer
In most cases, liver cancer develops due to metastasis from a tumor in another organ. Risk factors for this disease also include:
- Chronic liver diseases such as cirrhosis and hepatitis C and B
- Alcohol abuse
- Overweight and poor diet
- Hemochromatosis (excessive iron accumulation)
- Heart failure
- Diabetes mellitus
- Cholelithiasis
- Syphilis
- Parasites and oncogenic viruses
- Endocrine disorders
- Disorders of the circulatory and lymphatic systems
- Disorders of the biliary tract
- Drugs toxic to the liver
- Genetic predisposition
But The most important risk factor for liver cancer is cirrhosis. Cirrhosis is often the result of long-term chronic liver disease. It can develop for the following reasons:
- Hepatitis B and C, autoimmune hepatitis
- Alcohol abuse
- Insulin-resistant diabetes mellitus
- Poisoning with certain toxins (aflatoxin, vinyl chloride, and other substances)
- Hemochromatosis
In 90% of cases, liver cancer occurs against the background of various pathologies of the liver tissue. Tumors very rarely form in healthy liver tissue.
Etiology and pathogenesis
Liver cancer begins when a normal liver cell loses control of its growth and divides uncontrollably. This process is triggered by changes in the cell's genetic material, leading to the development of a malignant tumor.
Chronic liver diseases, especially hepatitis B and C, as well as cirrhosis, cause long-term inflammation of the liver tissue, damaging its cells. Damaged cells are forced to constantly regenerate, which increases the risk of errors during cell division. Over time, these errors accumulate, causing DNA changes that contribute to tumor formation.
In addition to viral hepatitis, risk factors include alcoholism, smoking, excess weight, and type 2 diabetes. All of these contribute to liver damage, creating conditions favorable for the development of abnormal cells. The liver's ability to actively regenerate accelerates tumor development.
Classification and stages of liver cancer
In medicine, there are two types of liver cancer:
- Primary liver cancer – in this case, the tumor develops directly in the liver, from the cells of this organ. There are two types of such tumors:
- Hepatocellular carcinoma – a liver tumor that arises in hepatocytes – the main cells of the organ;
- Cholangiocarcinoma, or cancer of the intrahepatic and extrahepatic bile ducts – a tumor of the epithelial cells of the hepatic ducts.
- Secondary liver cancer, or metastatic liver cancer, is metastasis from cancer of another organ that has spread to the liver through the blood and lymph due to the progression of the primary oncological disease.
All these types of liver cancer are different types of tumors, but they share a common location. Hepatocellular liver cancer is significantly more common than cholangiocarcinoma. Metastatic liver cancer is almost 30 times more common than primary liver cancer. This is due to the liver's abundant blood supply. Consequently, nearly a third of malignant tumors from other organs can metastasize to this organ.
In some cases, liver cancer is diagnosed as a cluster of cancer cells in the form of small nodules, but sometimes it is diagnosed as a single, large liver tumor that can progress rapidly.
Other types of liver cancer include sarcoma, angiosarcoma, undifferentiated sarcoma, lymphoma, cystadenocarcinoma, fibrolamellar carcinoma, melanoma, and hepatoblastoma.
To understand the severity and extent of the malignancy, a staging system is used. This allows doctors to understand the volume of the primary tumor, the extent of its invasion of surrounding tissue, and its spread to other organs. There are four basic stages of liver cancer: I, II, III, and IV.
At stage I, the tumor is small and located exclusively within the liver. Typically, the patient experiences no symptoms at this early stage, as the liver is capable of compensating for damage to a small portion of its tissue. Detecting this type of tumor is difficult, so the diagnosis is often made incidentally, for example, during examinations for other reasons.
Stage II is characterized by the presence of two or three small tumors within a single area of the liver, or a single large tumor that has already invaded the blood vessels. The first minor symptoms may appear at this stage, such as weakness, fatigue, or discomfort in the right side.
Stage III symptoms are more pronounced: weight loss, abdominal pain, yellowing of the skin and eyes, nausea, and loss of appetite. Stage IV means that the cancer has spread beyond the liver and to other organs (metastasized).
The lungs, bones, and brain are most often affected. By this point, patients experience severe pain, significant weight loss, weakness, and breathing problems. It's important to understand that the earlier stage 1 is diagnosed, the higher the chances of effective treatment and a good prognosis.
If you suspect malignant tumors, please contact our K+31 clinic for diagnosis and treatment of liver cancer.
Epidemiology
Liver cancer is the third leading cause of cancer death, behind only lung and stomach cancer. According to the WHO, approximately 80% of cases occur in the Asia-Pacific region and Africa, where hepatitis B and C viruses are common. They increase the risk of healthy cells becoming malignant.
In Europe and North America, the incidence is lower, but it still remains a serious problem. The situation in Russia is also alarming. Although liver cancer is less common here than in Asia, it remains firmly among the top ten most common types of cancer.
Liver cancer primarily affects men over 50. They are affected approximately three times more often than women. The reason is simple: men are more susceptible to risk factors such as alcohol and smoking, and are also less likely to seek medical attention. Age also plays a significant role. Young people rarely develop liver cancer, but the risk increases significantly with age.
Liver Cancer Diagnosis
During diagnosis, to select the most appropriate liver cancer treatment plan, it is important to determine the tumor size and location, the stage of the disease, its spread, and the liver's reserves.
Accurate and timely diagnosis is essential for effective liver cancer treatment. The first and simplest step is laboratory blood and urine tests. More complex, but available at K+31, hardware diagnostic techniques include:
- Abdominal ultrasound (liver, spleen, pancreas, gallbladder). This is a simple and safe method for diagnosing liver cancer with good sensitivity. It allows us to determine the presence of a malignant tumor in the liver, the degree of its invasion into surrounding tissues, the extent of cancer damage to the hepatic porta, the presence of malignant tumor metastases and fluid in the abdominal cavity, and the degree of liver tissue fibrosis.
- Magnetic resonance imaging (MRI). This method for diagnosing liver cancer is more sensitive and can detect small malignant tumors (less than 1 cm in diameter) even in the presence of liver cirrhosis.
- Chest X-rays and computed tomography (CT), examination of the esophagus, duodenum, and stomach, EGD, and gastroscopy also provide a clear picture of the condition of internal organs (both the liver and those that may have metastasized from liver cancer). Angiography is used to diagnose vascular pathology in liver cancer. PET-CT is used less frequently, but is more often used in cases of secondary liver cancer. In some situations, laparoscopy is performed.
Modern equipment, the diagnostic procedures performed with it, and the results obtained allow us to determine the extent of liver cancer, including:
- Detect the tumor, its location, and accurately determine the size and rate of growth of a malignant liver tumor.
- Obtain information about the presence of liver cancer metastases. li>
- Obtain information about the organs to which the metastases have spread.
These tests help the doctor decide on the most appropriate liver cancer treatment methods and the possibility of effective tumor resectability, i.e., radical surgery.
However, a biopsy is always prescribed to determine the malignancy or benignity of the tumor, as well as other characteristics of the tumor. It is performed under the guidance of an abdominal ultrasound.
To detect liver cancer metastases, ultrasound, X-ray, chest CT, MRI, and other diagnostic methods are used. To assess the liver's functional reserve if the patient is diagnosed with cirrhosis, special tests are performed to evaluate albumin and bilirubin levels in the blood, the prothrombin index, and other indicators.
What are the treatments for liver cancer?
To select the appropriate liver cancer treatment method, it is necessary to consider the extent of the malignant tumor and the functional reserve of the organ at the time of diagnosis. Surgical removal (resection) of the affected area, X-ray endovascular or ablative methods, drug or radiation therapy for liver cancer may be used.
To stop the spread of malignant liver neoplasms of the first or second type, three main treatment methods are used:
- Surgical. This method of liver cancer treatment is indicated for small tumors with a well-defined shape, without metastases to other organs and blood vessels. Liver cells regenerate well, which allows the organ to independently restore itself to its pre-surgery volume. Contraindications to this method include liver cirrhosis and other serious diseases.
- Minimally invasive radiofrequency thermal ablation. Based on the ability to destroy cancer cells using radiofrequency radiation. Chemotherapy for liver cancer, in which chemotherapy drugs are administered systemically or directly into the liver artery. Refers to additional methods of treating liver cancer. Sometimes, two or even more treatment methods must be combined to achieve a positive result.
Surgical intervention (operation)
If a portion of the liver can be removed (the liver is resectable), this is the preferred treatment for liver cancer. Up to 80% of liver tissue can be removed while preserving sufficient liver function to sustain the patient's life. However, this is impossible or only possible with limited success due to fibrotic tissue changes in patients with cirrhosis.
If a patient with cirrhosis has one malignant liver tumor smaller than 5 cm, or two or three tumors smaller than 3 cm, and the cancer has not spread to blood vessels, a liver transplant is possible.
Liver cancer ablation
This liver cancer treatment involves damaging the malignant tumor and its cells using chemical agents or physical means. It is used when there are isolated tumor nodules. Laser, photodynamic, ultrasound, radiofrequency, microwave, low temperatures, and ethanol are used to destroy the tumor.
X-ray endovascular surgery for liver cancer
This liver cancer treatment method is used when the malignant tumor is inoperable, there are no distant metastases, the cancer has not invaded the liver's major vessels, and there is no thrombosis. This method is possible due to the liver's dual blood supply. The hepatic artery supplies the liver with blood for the organ's circulation, while the portal vein supplies blood for the liver's filtration. If the arterial blood supply to the tumor node is blocked, the liver's blood supply is cut off, leading to its shrinkage. This effect is complemented by the effect of the chemotherapy drug injected into the tumor. However, to determine the blood supply to the malignant tumor, a radiocontrast agent is first injected into it.
X-ray endovascular methods are combined with other antitumor therapies. However, they are contraindicated in the presence of decompensated cirrhosis, extrahepatic tumors, coagulopathy with bleeding, or intractable ascites.
Radiation therapy for liver cancer
If surgical removal, ablation, or endovascular surgery are not possible for a patient, radiation therapy is prescribed. However, it is used as a palliative treatment for liver cancer. If the patient has isolated tumors, radiation therapy can be directed directly at them with minimal damage to adjacent healthy tissue.
Drug therapy for liver cancer
Chemotherapy is used to treat some patients. However, in most cases of liver cancer, it is ineffective and cannot replace surgery. Therefore, targeted therapy or immunotherapy, which show better results, are used. Sometimes these methods are combined. Drugs used to treat liver cancer include sorafenib, bevacizumab, atezolizumab, and regorafenib.
General information
Prognosis and complications
Liver cancer determines how long a patient will survive. The outcome depends on many factors, including the stage of the disease, age, overall health, and the presence of comorbidities.
The highest survival rate is observed in stage I of the disease, when the tumor is still small and localized in one place. However, in stages II and III, the prognosis worsens. The tumor has time to grow and begin to affect the functioning of the organ. Treatment becomes more complex, and a full recovery becomes unlikely.
In stage IV, the cancer extends beyond the liver and invades other organs. Patients have a shorter lifespan than in the early stages, despite intensive treatment. One of the main complications is cirrhosis—the replacement of normal liver tissue with scar tissue. Another serious consequence is bleeding. The liver is richly supplied with blood vessels, and a tumor can cause severe bleeding.
Metastases, which are the development of secondary tumor foci in other organs, are also dangerous. Metastatic disease reduces the chances of treatment success, as most medications are poorly effective against them. Finally, liver failure is a major complication. Its severity is directly related to the amount of tissue affected by the disease.
FAQ
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General information about liver cancer
In this dangerous disease, liver cells rapidly multiply, forming a malignant tumor. Liver cancer is one of the most serious types of pathology because this organ plays a vital role in metabolism, blood purification, and the production of essential proteins.
When a tumor develops, the entire organ's function is disrupted, leading to serious consequences for the body. If the tumor is not detected in time, it quickly spreads throughout the body, worsening overall health. A person may not experience any symptoms for a long time until the tumor begins to actively grow and metastasize.
This disease is quite common among all forms of liver cancer: it is diagnosed in approximately hundreds of thousands of people worldwide each year. The main reason doctors consider it particularly dangerous is that symptoms appear late, when liver cancer has already advanced. Therefore, early diagnosis is of paramount importance: detecting the problem at an early stage allows for simpler and more effective treatment.