Definition

The liver is an abdominal organ, roughly the size of a soccer ball, situated in the upper right of the abdomen beneath the diaphragm. Liver cancer, also known as hepatic neoplasm, occurs when cells in the liver undergo uncontrolled growth, leading to abnormalities. It is the second leading cause of cancer-related deaths, with a higher incidence in males (11.5 per 100,000) compared to females (3.9 per 100,000).

The most common type of liver cancer is hepatocellular carcinoma (HCC). Other less common types include cholangiocarcinoma intrahepatic and hepatoblastoma. Hepatocellular carcinoma is particularly prevalent.

Liver cancer can manifest in two main ways: primary liver cancer, where the cancer originates in the liver cells, and metastatic liver cancer, where cancer from other parts of the body spreads to the liver. Metastatic liver cancer is named based on the primary site of origin, such as metastatic colon cancer, indicating cancer that originated in the colon and spread to the liver. This type is more frequently encountered than primary liver cancer.

Causes

Liver cancer develops when the DNA in liver cells undergo mutations, leading to alterations in the normal chemical processes within the cells. These mutations result in uncontrolled cell growth and the formation of masses or tumors. 

While liver cancer can occur without an underlying disease, one common association is with chronic hepatitis infections. Chronic infections with hepatitis B or C viruses are significant risk factors for liver cancer. However, in some cases, liver cancer can occur without a clear underlying cause. 

Risk factor

Liver cancer is associated with various risk factors that increase the likelihood of its development. Some key risk factors include:

• Chronic Hepatitis Infection (B or C)
• Liver Cirrhosis: A progressive and irreversible condition where healthy liver tissue is replaced by scar tissue, often resulting from chronic liver diseases.
• Hereditary Liver Diseases: Conditions such as hemochromatosis and Wilson's disease are inherited disorders affecting the liver.
• Diabetes
• Non-Alcoholic Fatty Liver Disease (NAFLD)
• Excessive Alcohol Consumption
• Aflatoxin Exposure: Aflatoxins are poisonous substances produced by certain molds that can contaminate food, particularly nuts and grains. Prolonged exposure to aflatoxins is associated with an increased risk of liver cancer

Symptoms

Liver cancer often does not cause noticeable symptoms in its early stages. owever, as the cancer progresses, individuals may experience various symptoms, including:

• Unexplained Weight Loss
• Loss of appetite
• Upper right abdominal pain
• Nausea and Vomiting:
• Fatigue
• Swollen Abdomen
• Jaundice: Yellowing of the eyes and skin
• Pale stool

Diagnosis

The diagnosis of liver cancer involves a comprehensive approach, including a medical interview, physical examination, and various diagnostic tests.

Medical Interview

The symptoms of liver cancer can vary, and many patients may not experience noticeable symptoms in the early stages of the disease. However, some individuals may present with symptoms related to chronic liver disease. Common complaints may include discomfort or bloating in the upper part of the abdomen, weight loss, fever, loss of appetite, and diarrhea. Symptoms of acute liver decompensation, such as ascites, encephalopathy, jaundice, and hematemesis (blood vomit), raise suspicion of liver cancer.

Physical Examination

During the physical examination, doctors look for signs of chronic liver disease or cirrhosis, including hepatomegaly (enlarged liver), splenomegaly (enlarged spleen), ascites, jaundice, and the presence of caput medusa (dilated veins around the navel). Caput medusa occurs due to the widening of veins.

Diagnostic Tests

Following the medical interview and physical examination, doctors may recommend specific diagnostic tests based on the clinical indications. These tests include:

• Laboratory Tests: Blood samples are analyzed to assess liver function and detect any abnormalities. Continuous monitoring of laboratory parameters is essential for suspected or diagnosed liver cancer patients.
• Imaging Studies: Techniques such as ultrasonography, CT scans, and MRI scans provide detailed images of the liver, helping identify any abnormal growths or lesions.
• Biopsy: A liver biopsy involves the extraction of a small tissue sample from the liver for microscopic examination. This is a key procedure to confirm the presence of cancerous cells. However, it carries risks such as bleeding, bruising, and infection.

Management

Liver cancer, particularly hepatocellular carcinoma (HCC), poses significant challenges in terms of treatment. Treatment choice depends on factors such as the cancer stage and the patient's age. Several treatment options may be considered:

• Surgery 

For small tumors and when the liver functions well, surgical removal of the tumor may be recommended. Liver transplantation may be considered if the liver's function is compromised. This involves removing the cancerous liver and replacing it with a donor liver.

• Localized therapy

Targeted therapies involve delivering treatment directly to cancer cells or the surrounding area. This can be achieved through methods like heating, freezing, injecting alcohol into cancer cells, or administering chemotherapy drugs directly into the liver.

• Radiation therapy

Radiation therapy uses high-energy sources, such as X-rays or protons, to destroy cancer cells and reduce tumor size. This option may be chosen when other treatments are not feasible.

• Immunotherapy

Immunotherapy harnesses the body's immune system to target and attack cancer cells. It disrupts the mechanisms cancer cells use to evade the immune system, prompting an immune response against the cancer.

• Chemotherapy

Chemotherapy involves using medications to kill rapidly dividing cells, including cancer cells. It can be administered intravenously, orally, or a combination of both.

• Supportive or palliative care

This form of care is focused on alleviating suffering and managing symptoms associated with liver cancer. It is often employed alongside more aggressive treatments like surgery, chemotherapy, or radiation therapy.

Complications

Complications of liver cancer can be severe, with one of the most critical being liver organ failure. The presence of cachexia or wasting syndrome, characterized by extreme weight loss, can further exacerbate the condition, potentially leading to death. Additionally, complications may arise from bleeding within the abdomen or organs or even tearing of the tumor. Liver cancer is known for its ability to metastasize beyond the liver, resulting in extrahepatic metastasis to organs like the adrenal glands, peritoneum (the thin membrane lining abdominal organs), brain, skin, oral cavity, and other tissues.

Prevention

To minimize the risk of liver cirrhosis, a condition characterized by the transformation of liver tissue into scar tissue, individuals can take several preventive measures:

• Limit Alcohol Consumption: Restricting the intake of alcohol is crucial in reducing the risk of liver cirrhosis.
• Maintain Ideal Body Weight: Achieving and maintaining an ideal body weight benefits overall liver health.
• Quit Smoking: If you are a smoker, quitting smoking can contribute to lowering the risk of liver cirrhosis.
• Hepatitis Vaccination: Vaccinating against hepatitis, particularly hepatitis B, can prevent infection and subsequent liver damage.
• Practice Safe Behaviors: Preventing hepatitis C involves avoiding the sharing of needles, practicing safe sex by using protection unless your partner is hepatitis C negative, and ensuring clean and sterile equipment in tattooing.
• Routine Treatment for Hepatitis B or C: If diagnosed with hepatitis B or C, following routine medical treatment and monitoring is essential to manage the condition effectively.
• Regular Screening: Regular screening for hepatitis B or C, cirrhosis, and hepatitis C is recommended to detect potential issues early on in individuals without hepatitis B or C and those at risk of cirrhosis.

When to see a doctor?

If you are at risk of liver cancer, it is crucial to undergo regular check-ups with your doctor to prevent the development of liver cancer and its potential complications. If you experience any of the symptoms mentioned earlier, seek medical attention promptly to ensure early detection and appropriate management.