Definition

A liver tumor is an abnormal growth of liver tissue. Cells that should naturally die in a tumor grow, forming a mass.

The liver, the largest internal organ in the body, plays a crucial role in digestion, nutrient storage, blood clotting factor production, and detoxification of substances like alcohol, drugs, and metabolic waste.

Liver tumors can be classified as benign or malignant. 

• Benign liver tumors typically do not cause symptoms and are often discovered incidentally during radiological examinations.
• Malignant liver cancer may originate in the liver or result from the spread of cancer from other organs. While less common, malignant liver cancer is more serious and has the potential to spread to other organs.

Cause

The exact cause of liver tumors remains unknown and may vary depending on the characteristics and type of tumor. Before delving into the causes, it's important to understand the various types of benign and malignant liver tumors:

Benign Tumors

• Hemangioma: The most commonly encountered benign liver tumor, formed due to abnormal blood vessels. Hemangiomas occur in around 5% of adults.
• Liver Cyst: A fluid-filled sac that can enlarge over time, often without producing symptoms. Therapy may be required if the cyst grows too large and causes discomfort.
• Hepatocellular Adenoma: A rare benign liver tumor often associated with certain medications such as steroids or birth control pills. Most cases remain undetected and rarely progress to cancer, although rupture and bleeding can occur in some cases.
• Focal Nodular Hyperplasia: This benign tumor typically appears scar-like or scar tissue-like formations and is more commonly observed in women aged 20-30.

Malignant Tumors

• Hepatocellular Carcinoma: A frequently encountered type of liver cancer, often associated with chronic liver damage due to hepatitis viruses (hepatitis B and hepatitis C) or alcohol abuse. It primarily affects men over 50 years of age.
• Cholangiocarcinoma: A rare type of cancer that affects the bile ducts.
• Gallbladder Carcinoma: A rare cancer originating in the gallbladder.
• Hepatoblastoma: The most common malignant liver cancer in children under 5 years old, although it can also occur in adults.

Risk factor

While liver tumors can affect anyone, certain factors increase the risk of developing them, include:

• Hepatitis B or C infection.
• Liver cirrhosis is characterized by the formation of scar tissue in the liver. Approximately 80% of patients with hepatocellular carcinoma, a malignant liver cancer, usually have liver cirrhosis.
• Smoking.
• Obesity.
• Long-term excessive alcohol consumption.
• Use of hormonal contraceptives.
• Hemochromatosis is a hereditary condition that causes iron overload in the liver due to excessive iron absorption from food.
• Ingestion of arsenic from drinking water

Symptoms

Benign liver tumors rarely cause symptoms, and any symptoms typically arise only when the tumor grows large enough to disturb organ function. In many cases, benign liver tumors are discovered incidentally during routine medical check-ups or radiological examinations, such as ultrasound (USG), CT scans, or MRI scans.

On the other hand, malignant liver cancer rarely exhibits symptoms in its early stages. Symptoms tend to develop as the cancer progresses or reaches an advanced stage.

The symptoms experienced can vary from person to person and may include:

• Pain in the upper abdomen
• Nausea or vomiting
• Abdominal swelling
• Body itching
• Yellowing of the skin (jaundice)
• Pale or white-colored stools
• Significant and unexplained weight loss
• Loss of appetite
• Weakness

Diagnosis

Diagnosing liver tumors involves a thorough medical interview, physical examination, and diagnostic tests. The doctor begins by inquiring about the patient's current symptoms, past medical history, family history, and previous treatments.

Next, the entire body is examined to assess any physical signs of liver health and tumor presence. Following this, several diagnostic tests are performed to confirm the diagnosis, including:

• Blood tests: These are useful for assessing liver function and detecting signs of hepatitis infection. Elevated levels of the tumor marker AFP are often observed in liver cancer patients.
• Radiological examination: Various imaging procedures can be utilized to visualize the liver and identify tumor tissue, determine tumor size, assess blood vessel involvement, and evaluate surrounding tissues. Options include ultrasound (USG), CT, MRI, or PET scans.
• Tissue biopsy:  involves obtaining a sample of liver tissue using a small needle inserted through the skin into the liver. The sample is then examined under a microscope to identify the presence of tumor cells.

Management

The management of liver tumors depends on several factors, including the type of tumor, cancer stage (for malignant tumors), age, current health status, medical history, tolerance for treatment, and disease prognosis.

Doctors consider patients' preferences and opinions when deciding on the appropriate treatment. For both benign and malignant tumors, treatment options include:

• Surgery: Typically chosen when the liver tumor is small and the liver is functioning normally. Surgery involves the removal of tumor tissue from the liver.
• Radiation therapy: Utilizes high-energy rays to kill or shrink cancer cells.
• Chemotherapy: Involves the use of anti-cancer drugs to kill cancer cells.
• Liver transplantation: In cases where tumors are extensive, requiring the removal of a significant portion of the liver or the entire organ, liver transplantation using a donor organ may be considered.

Complications

Malignant liver cancer poses a significant threat as cancerous cells can mutate and spread to other organs, a process known as metastasis. If left untreated, malignant liver cancer can significantly reduce the quality of life and may lead to death. Additionally, medical procedures aimed at treating liver cancer can also pose risks. Surgical procedures, for example, carry the risk of bleeding and infection.

Prevention

Preventing liver tumors can be challenging due to the unknown exact causes. However, adopting a healthy lifestyle can help mitigate risks. This includes maintaining a balanced and nutritious diet, exercising regularly, and reducing alcohol intake to prevent liver damage.

Additionally, taking preventive measures against hepatitis infection is crucial. This can be achieved through vaccination, practicing good hand hygiene, and, for sexually active individuals, practicing safe sex.

When to see a doctor?

If you experience the symptoms or risk factors associated with liver tumors, it's crucial to seek medical attention promptly. Once diagnosed with a liver tumor, ensure regular check-ups and adhere to the prescribed treatment plan.

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