Definition of Liver Cancer, Symptoms, Treatment, Prevention

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Definition of Liver Cancer, Symptoms, Treatment, Prevention

Definition of Liver Cancer

Liver cancer is cancer that begins in the liver and can spread to other organs. Liver cancer occurs when cells in the liver mutate, then divide uncontrollably and form tumors.

The liver has many important functions for the body. Some of them are cleaning the blood of toxins and harmful substances, such as alcohol, helping the process of digestion of food, and controlling blood clotting.

Liver cancer is one of the five types of cancer that causes the most deaths. Based on research by the World Health Organization (WHO) in 2020, liver cancer is responsible for more than 800,000 cancer deaths worldwide.

Types of Liver Cancer

Liver cancer is divided into primary liver cancer and secondary liver cancer. Here is the explanation:

Primary liver cancer

Primary liver cancer is cancer that begins in the liver. There are several types of primary liver cancer, namely:

  • Hepatocellular carcinoma is liver cancer that begins in the main cells that make up liver tissue (hepatocyte cells). Hepatocellular carcinoma is the most common type of primary liver cancer, accounting for 75% of all cases of liver cancer.
  • Liver angiosarcoma is liver cancer that begins in the cells of the blood vessels in the liver. Angiosarcoma tends to develop rapidly and is often only detected at an advanced stage.
  • Cholangiocarcinoma is liver cancer that grows in the cells of the bile ducts. Cholangiocarcinoma can start in the bile ducts that are inside the liver ( intrahepatic ) or in the bile ducts outside the liver ( extrahepatic ).
  • Hepatoblastoma
    Hepatoblastoma is a liver cancer that starts from immature liver cells. This cancer is very rare and usually only occurs in children under 3 years of age.

Secondary liver cancer

Secondary liver cancer is cancer that grows in other organs and then spreads to the liver. Cancers from other organs that most often spread to the liver are stomach cancer, colon cancer, lung cancer, and breast cancer.

Risk Factors and Prevention

Liver cancer is more common in people who have long-term (chronic) hepatitis B or hepatitis C. In addition, people who often consume alcoholic beverages in excess are also more at risk of developing liver cancer.

Therefore, the risk of developing liver cancer can be reduced by taking precautions against hepatitis B, for example by vaccinating against hepatitis B and practicing safe sex. Another way is to avoid or limit the consumption of alcoholic beverages.

Liver Cancer Symptoms and Complications

The most common symptoms experienced by patients with liver cancer are loss of appetite, nausea, vomiting, and drastic weight loss. Patients can also experience complaints of jaundice and swollen stomach.

If you experience these symptoms, immediately consult a doctor so that the complaint can be examined. Early detection and treatment will reduce the risk of complications in the form of further liver damage and failure.

Causes of Liver Cancer

Liver cancer occurs when cells in the liver undergo changes or mutations. These changes cause the cells to grow abnormally and form tumors.

It is not yet known what causes liver cells to mutate. However, there are several conditions that can support the occurrence of the mutation. This means that a person with this condition will be more at risk of developing liver cancer. According to Institute for Cancer Genetics and Informatics | Liver cancer: Essential facts

Liver Cancer Risk Factors

The following are conditions that can increase the risk of liver cancer:

  • Chronic hepatitis B or hepatitis C infection
  • Cirrhosis or scarring that forms in the liver
  • Fatty liver disease
  • Smoking habits
  • Excessive consumption of alcoholic beverages
  • Liver diseases inherited from parents, such as hemochromatosis and Wilson’s disease
  • The body’s resistance is weak, for example due to suffering from HIV/AIDS or having just undergone an organ transplant
  • History of gallstones or having had a gallbladder removal operation ( cholecystectomy )
  • Certain conditions, such as diabetes, lupus, overweight or obesity
  • Exposure to aflactocin, which is a poison from a fungus that grows on plant food that is not stored properly
  • Exposure to chemicals, such as arsenic, vinyl chloride, and trichloroethylene

Symptoms of Liver Cancer

Generally, new liver cancer symptoms will appear when the cancer has entered an advanced stage. However, in some cases, symptoms can also appear earlier.

Some complaints that should be wary of because they can be signs and symptoms of liver cancer are:

  • Loss of appetite
  • It’s easy to feel full even if you only eat a little
  • Nausea and vomiting
  • Bloated
  • Losing weight for no reason
  • The body is easily tired and weak
  • Itchy rash
  • Accumulation of fluid in the abdomen ( ascites ), which is characterized by an enlarged abdomen
  • Yellowing of the skin and whites of the eyes
  • Dark urine
  • Stool is white like chalk
  • The body is easy to bruise and bleed
  • Pain in the upper right abdomen or near the right shoulder blade
  • The feeling of fullness under the right rib due to swelling of the liver
  • The feeling of fullness under the left rib due to an enlarged spleen

Some types of liver cancer can produce certain hormones. This hormone can affect other organs and cause additional symptoms, such as:

  • Enlarged breasts in men ( gynecomastia )
  • Testicles shrink
  • Weak muscles
  • Reddish skin, including the face
  • Increased blood cholesterol

When to go to the doctor

Check with your doctor if you notice any of the above symptoms, especially if the symptoms are bothersome and make you unable to move.

If you belong to a group of people who are at risk of developing liver cancer, do a liver cancer screening every 6-12 months. Screening for liver cancer can be done with abdominal ultrasound and a blood test to measure levels of a protein in the blood called alpha-fetoprotein (AFP).

Liver cancer screening increases the chances of liver cancer being detected at an early stage. That way, the chances of the patient to recover will also be higher.

Liver Cancer Diagnosis

To diagnose, the doctor will ask about the symptoms experienced and the patient’s medical history. The doctor will also ask if the patient has a habit of smoking or consuming alcoholic beverages.

If from the question and answer session the patient is suspected of having liver cancer, the doctor will carry out supporting examinations to confirm the diagnosis. These inspections include:

  • Blood tests, to check liver function, measure alpha-fetoprotein levels and determine the patient’s overall health condition
  • Scans with ultrasound, CT scan, or MRI, to determine the location of cancer in the liver and the spread of cancer to other organs
  • Liver biopsy, which is the process of taking a small portion of cancer tissue to determine the specific type of liver cancer
  • Laparoscopy, to check the condition in the stomach using a camera tube, if the previous examination has not been sufficient to determine the diagnosis

Liver Cancer Stage

Based on the results of the above examination, the doctor will determine the stage of liver cancer suffered by the patient. This staging will also determine the type of treatment that is right for the patient.

The following are the stages of liver cancer:

Stadium A

Stage A indicates that the patient’s liver has one tumor of any size or 2-3 tumors less than 3 cm in size. Liver function is still fairly normal or only mild to moderate disturbances and the patient does not feel sick.

B Stadium

In stage B, there are several large tumors in the liver. Even so, liver function has not been impaired or impaired to a mild-moderate degree, and the patient’s condition is generally still good.

Stadium C

At this stage, the cancer has spread to the blood vessels, lymph nodes, or other organs of the body. The patient’s physical condition began to decline. Liver function can still be good or has been disturbed to a mild to moderate degree.

D Stadium

Stage D indicates that the cancer has spread to other organs, such as the bones and lungs. At this stage, the liver has been severely damaged and the patient’s condition has deteriorated.

Liver Cancer Treatment

Treatment methods for liver cancer depend on the stage of cancer, the age of the patient, and the overall health condition of the patient. Some of the commonly used treatment methods are:

Surgery

Surgery is performed if there is only one cancer of the liver, liver function is still good, and the cancer has not spread to other organs. One type of surgery to treat liver cancer is a partial hepatectomy, which is surgery to remove the part of the liver that is affected by cancer.

Another surgical option is liver transplantation, which is a procedure to remove the patient’s liver and replace it with a liver from a donor. Liver transplant is done if the cancer is in a position that is difficult to remove.

Ablation

Ablation is an action to destroy cancer without having to remove it. This method is used in small cancers and in patients who cannot undergo hepatectomy or liver transplantation.

There are several types of ablation, namely:

  • Radiofrequency ablation (RFA), which is performed using high-powered sound waves
  • Microwave ablation (MWA), which is performed using electromagnetic waves
  • Cryoablation or cryotherapy, which is performed using liquid nitrogen
  • Ethanol ablation or percutaneous ethanol injection (PEI), which is done by injecting ethanol directly into the tumor

Embolization

Embolization is a procedure in which drugs are injected to block or reduce blood flow to cancer cells in the liver. This procedure is performed on cancers that are more than 5 cm in size with liver function that is still quite good.

Chemotherapy

Chemotherapy is the administration of drugs to kill cancer cells. This procedure is used in liver cancer that cannot be removed surgically, as well as in liver cancer that cannot be treated by ablation, embolization, and targeted therapy.

Chemotherapy drugs can be given as a single drug or in combination. The types of drugs commonly used in chemotherapy include:

  • Capecitabine
  • Cisplatin
  • Gemcitabine
  • Doxorubicin

Chemoembolization

Chemoembolization or transarterial chemoembolization (TACE) is a therapy that combines embolization with chemotherapy. TACE is done by injecting a drug into the cancer area and blocking blood flow to the cancer cells in the liver.

Chemoembolization is performed in patients who cannot undergo surgery and in patients who are waiting for liver donors. Chemoembolization can also be done to shrink the tumor, so that the tumor can be removed through a surgical procedure.

Target therapy

Targeted therapy is the administration of drugs in tablet form that target specific proteins in cancer cells. This therapy can be done in advanced liver cancer. However, not all liver cancers respond well to this therapy.

Drugs commonly used in targeted therapy are protein kinase inhibitors, such as sorafenib and regorafenib, and monoclonal antibodies, such as bevacizumab and ramucirumab. These drugs work by blocking a protein that cancer cells need to grow.

Immunotherapy

Immunotherapy is the administration of drugs that stimulate the immune system to kill cancer cells. This method is usually only used in advanced liver cancer.

Types of drugs used in immunotherapy include:

  • Atezolizumab
  • Ipilimumab
  • Nivolumab
  • Pembrolizumab

Radiotherapy

Radiotherapy or radiation therapy aims to kill cancer cells by using high-energy radiation. One type of radiotherapy to treat liver cancer is external radiotherapy, namely by directing radiation rays to the patient’s body.

Another method of radiotherapy is stereotactic body radiotherapy. This procedure is performed by firing a beam of radiation into the tumor cells in a focused manner so that it does not hit the surrounding healthy tissue.

Radioembolization

Radioembolization is a type of internal radiotherapy to treat cancer that cannot be removed surgically. This procedure may also be performed for bowel cancer that has spread to the liver (secondary liver cancer).

Radioembolization is done by inserting small balls called microspheres into the blood vessels that supply blood to the liver. This microsphere will then clog the small blood vessels that are around and inside cancer so that the cancer loses its intake of nutrients and oxygen from the blood.

In addition to blocking the blood supply to cancer cells, the microsphere also releases radiation to destroy the cancer cells.

Liver Cancer Complications

Liver cancer can cause a number of complications, both due to suppression of liver cancer on other organs, increased levels of hormones produced by cancer, and liver failure. Some of these complications are:

  • Anemia or lack of red blood cells
  • Bleeding, such as nosebleeds or bleeding gums
  • Ascites so large that it suppresses breathing
  • Peritonitis, if ascites is left too long
  • Blockage in the bile duct
  • Portal hypertension which can lead to rupture of esophageal blood vessels (esophageal varices )
  • Hepatorenal syndrome or kidney disease due to damage to the liver
  • Hepatic encephalopathy or brain damage due to liver damage

In addition, liver cancer cells can also spread (metastasize) to other organs. The growth of cancer in other organs can cause a variety of additional health problems, depending on the location of the new cancer.

Liver Cancer Prevention

Liver cancer cannot be prevented, but you can take the following steps to lower your risk of developing liver cancer:

  • Maintain an ideal weight
  • Avoid consumption of alcoholic beverages and smoking
  • Use personal protective equipment when exposed to chemicals
  • Have safe sex
  • Stay away from drugs
  • Get vaccinated against hepatitis B

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