Liver cancer, also known as hepatic cancer or hepatocellular carcinoma (HCC), is one of the most common and deadly cancers worldwide. It typically develops in individuals with underlying chronic liver disease, especially cirrhosis or hepatitis B and C infections. As the liver plays a crucial role in detoxifying the body, producing proteins, and storing nutrients, the onset of cancer in this organ can have significant implications for overall health. In this article, we’ll explore the causes, symptoms, diagnosis, and treatment options for liver cancer.

What is Liver Cancer?

Liver cancer primarily refers to hepatocellular carcinoma (HCC), which is the most common form of liver cancer. It originates in the liver cells themselves. There are other rare types of liver cancer, including cholangiocarcinoma, which originates in the bile ducts, and hepatoblastoma, a rare cancer seen in children. However, HCC is by far the most prevalent form and typically develops in people with chronic liver diseases.

Causes and Risk Factors of Liver Cancer

Liver cancer does not develop overnight; it is often the result of long-term liver damage. Several factors increase the risk of developing liver cancer, including:

1. Chronic Hepatitis B and C Infection: These viral infections are major risk factors for liver cancer. Both viruses cause chronic inflammation and liver damage, which can eventually lead to the development of cirrhosis and, later, liver cancer.
2. Cirrhosis: Cirrhosis of the liver, a condition in which normal liver tissue is replaced by scar tissue, is the most significant risk factor for HCC. Common causes of cirrhosis include chronic alcohol abuse, hepatitis infections, and non-alcoholic fatty liver disease (NAFLD).
3. Non-Alcoholic Fatty Liver Disease (NAFLD): Increasingly, NAFLD is linked to liver cancer, particularly when it progresses to non-alcoholic steatohepatitis (NASH). NASH involves liver inflammation and can lead to cirrhosis and liver cancer.
4. Alcohol Abuse: Chronic heavy drinking can lead to liver cirrhosis and liver cancer. Alcohol-induced liver damage often accelerates the progression of liver disease.
5. Aflatoxin Exposure: Aflatoxins are toxic compounds produced by certain molds (Aspergillus) found on improperly stored grains and nuts. Exposure to high levels of aflatoxin is a known risk factor for liver cancer, especially in regions where food storage practices are poor.
6. Hemochromatosis: This genetic disorder causes excessive iron accumulation in the body, which can damage the liver over time and increase the risk of liver cancer.
7. Obesity and Type 2 Diabetes: Both conditions are associated with an increased risk of developing NAFLD and NASH, which, as mentioned, can progress to cirrhosis and liver cancer.
8. Family History of Liver Cancer: A family history of liver cancer can increase the risk, especially in individuals with chronic liver conditions.
9. Exposure to Chemicals: Certain chemicals, including industrial solvents, pesticides, and vinyl chloride, can increase the risk of liver cancer.
10. Gender and Age: Men are more likely to develop liver cancer than women, and the risk increases with age, particularly after 50 years old.

Symptoms of Liver Cancer

In the early stages, liver cancer may not cause noticeable symptoms. As the tumor grows and the liver’s function deteriorates, more pronounced symptoms can develop. Common symptoms of liver cancer include:

• Abdominal Pain: Pain or discomfort in the upper right side of the abdomen can occur as the tumor grows and presses on surrounding organs.
• Unexplained Weight Loss: A sudden loss of weight without a change in diet or exercise routine may be a sign of liver cancer.
• Loss of Appetite: A decrease in appetite or feeling full after eating only a small amount of food is common.
• Jaundice: Yellowing of the skin and eyes due to a buildup of bilirubin in the blood, caused by impaired liver function.
• Fatigue and Weakness: Persistent tiredness or weakness, which can interfere with daily activities, is a common symptom.
• Swelling in the Abdomen: Fluid buildup in the abdomen (ascites) or enlargement of the liver (hepatomegaly) may be noticeable.
• Nausea and Vomiting: Persistent nausea or vomiting can occur, especially as the liver becomes less efficient in detoxifying the body.
• Itchy Skin: Itchy skin (pruritus) can occur as a result of bile buildup in the bloodstream, often a sign of liver dysfunction.

Diagnosis of Liver Cancer

Liver cancer is diagnosed through a combination of medical history, physical exams, imaging tests, and sometimes a biopsy. Here are some of the diagnostic steps commonly used:

1. Blood Tests:
   • Alpha-fetoprotein (AFP): AFP is a protein that is often elevated in people with liver cancer. However, high AFP levels can also occur in other conditions, so it is not definitive for liver cancer.
   • Liver Function Tests: Blood tests that measure liver enzymes (AST, ALT) and bilirubin levels help assess how well the liver is functioning and whether cancer is impairing liver function.
2. Imaging Tests:
   • Ultrasound: A non-invasive and commonly used test to detect liver tumors or abnormalities. It’s often the first test performed when liver cancer is suspected.
   • CT Scan (Computed Tomography): A CT scan provides detailed cross-sectional images of the liver, helping to detect tumors, evaluate their size, and check for metastasis (spread of cancer).
   • MRI (Magnetic Resonance Imaging): An MRI can give more detailed images of the liver and blood vessels and is useful in planning surgical treatment.
   • Angiography: In some cases, an angiogram may be done to assess the blood vessels in the liver and detect tumors that are fed by blood vessels.
3. Liver Biopsy: If imaging tests indicate the presence of a tumor, a liver biopsy may be needed to confirm the diagnosis. During a biopsy, a small sample of liver tissue is removed and examined for cancer cells.

Treatment of Liver Cancer

The treatment of liver cancer depends on the stage of the disease, the size and location of the tumor, the underlying liver function, and the overall health of the patient. Common treatment options include:

1. Surgical Treatments:
   • Liver Resection: If the tumor is confined to one part of the liver and the rest of the liver is healthy, surgery may involve removing the tumor along with a portion of the liver.
   • Liver Transplant: For patients with early-stage liver cancer and underlying cirrhosis, a liver transplant may be an option. A liver transplant involves removing the diseased liver and replacing it with a healthy one from a donor.
2. Ablation and Embolization:
   • Radiofrequency Ablation (RFA): This technique uses heat to destroy small tumors in the liver.
   • Microwave Ablation: Similar to RFA, microwave energy is used to destroy cancer cells.
   • Transarterial Chemoembolization (TACE): A procedure that delivers chemotherapy directly to the tumor through the blood vessels and then blocks the blood supply to the tumor, effectively starving it of oxygen and nutrients.
   • Transarterial Radioembolization (TARE): A similar procedure that uses radioactive beads to target the tumor and deliver radiation directly to it.
3. Targeted Therapy:
   Targeted therapies aim to block specific pathways that cancer cells use to grow. Drugs like sorafenib (Nexavar) and lenvatinib (Lenvima) are used to target liver cancer cells and slow tumor growth.
4. Immunotherapy:
   Immunotherapy helps the immune system recognize and destroy cancer cells. Checkpoint inhibitors like nivolumab (Opdivo) and pembrolizumab (Keytruda) have shown promise in treating liver cancer.
5. Chemotherapy:
   Chemotherapy is not often used as the first-line treatment for liver cancer, as it is generally less effective. However, it may be used in some cases to shrink the tumor or reduce symptoms.
6. Palliative Care:
   For patients with advanced liver cancer, palliative care focuses on improving quality of life and managing symptoms rather than curing the disease. This may involve pain management, nutritional support, and other symptom-relief strategies.

Prevention of Liver Cancer

While liver cancer cannot always be prevented, the risk can be reduced by managing the underlying causes and taking preventive measures:

• Vaccination: Hepatitis B vaccination can reduce the risk of liver cancer caused by hepatitis B virus.
• Treatment of Chronic Hepatitis: Antiviral drugs can help control hepatitis B and C, reducing the risk of liver cancer.
• Avoiding Alcohol: Limiting alcohol consumption helps reduce the risk of cirrhosis and liver cancer.
• Maintaining a Healthy Weight: Managing obesity and preventing fatty liver disease can lower the risk of liver cancer.
• Regular Monitoring: People with chronic liver disease, cirrhosis, or a family history of liver cancer should undergo regular screening to detect liver cancer at an early stage.

Conclusion

Liver cancer is a serious and often fatal disease, but with early detection and appropriate treatment, outcomes can be improved. By addressing risk factors, seeking timely medical intervention, and considering all available treatment options, patients can manage the disease and improve their quality of life.