Liver Cancer

Liver cancer is the abnormal growth of cells from the liver. There are several types of cancer that can occur in the liver. The most common type is hepatocellular carcinoma – this begins in the primary liver cells, the hepatocytes.

Other less common cancers originating from the liver include:

• Cholangiocarcinoma (bile duct cancer)
• Hepatoblastoma (rare cancer affecting young children)
• Hemangiosarcoma (cancer arising from the blood vessels of the liver)

Metastatic cancer – that is cancer from a different origin that spreads to the liver, is more common than cancers that begin in the liver itself.

It is important to detect liver cancer early as the tumour can progressively enlarge till they rupture, disturb the functions of the liver, or spread through the bloodstream to other parts of the body.

In the early stages, patients with liver cancer usually do not experience any specific symptoms. However, when these symptoms do emerge, they include:

• Vague upper abdominal pain; this may extend to the right shoulder blade
• General weakness and fatigue
• Loss of weight and appetite
• Swelling in the abdomen; either a mass or fluid
• Jaundice; yellowish discolouration of the skin and whites of the eye
• Itching

• Chronic infection caused by Hepatitis B and Hepatitis C viruses
• Alcohol abuse; causes damage to the liver
• Liver cirrhosis; when the liver cells are damaged and replaced with scar tissue
• Aflatoxin; a poisonous substance produced by mould found on peanuts
• Diabetes
• Having a relative with liver cancer

Hepatitis B and C can be transmitted by coming into contact with infected body fluids such as saliva, blood, sperm and other secretions. Liver cancer often develops due to severe damage to the liver by chronic diseases or toxins, including alcohol. Patients suffering from liver cirrhosis face a higher risk of liver cancer.

Reducing the risk of liver cancer is possible. Some protective measures include getting vaccinated with the Hepatitis B vaccine. There is currently no vaccine against hepatitis C, but you can also protect yourself from it by not engaging in unprotected sex, not abusing drugs and not sharing intravenous drug needles. Avoiding alcohol abuse and addiction is another important protective measure against liver cancer.

There are several tests for liver cancer. When liver cancer is detected early, it is small and easier to remove surgically. Survival rates when it is detected early is also higher, and there are more options for treatment. Higher risk groups such as patients who have liver cirrhosis or who are suffering from chronic Hepatitis B infection should discuss with their doctor the benefits of regular screening.

A blood sample can be taken to detect the presence of alpha-fetoprotein (AFP). This tumour marker is often raised in people with liver cancer. If this marker is elevated in adults, it will alert your doctor to begin further investigations. By itself, this is insensitive as a screening test, and your doctor will need to use other tests to diagnose liver cancer.

Patients suspected of having liver cancer may require a liver biopsy. This involves taking small amounts of tissue from the liver for examination. It checks for the presence of cancer, and also how aggressive it is likely to be (grade).

An ultrasound scan is helpful in detecting any abnormalities in the liver. Computerised tomography (CT) and magnetic resonance imaging scans (MRI) are used to find the characteristics of cancer in order to reach a diagnosis. These scans will also help to confirm the extent and spread of liver cancer.

Treatment options for liver cancer depends on what the stage and grade of the cancer is. Other considerations include the age and general health of the individual.

Treatment is multidisciplinary, personalised and precise and there are a variety of treatment options available. These may include the following, and possibly in combination:

• Surgical resection if the tumour is confined to a localised area
• Alcohol injections
• Radiofrequency ablation
• Cryoablation
• Liver transplantation
• Radiation therapy, in particular stereotactic body radiation therapy (SBRT) and proton beam therapy (PBT)
• Chemotherapy
• Targeted Therapy
• Immunotherapy

Once the diagnosis is made the consultation with an oncologist is essential in order to understand which treatment options are the most suitable. It is advantageous to be seen by an oncologist with subspecialty interest in treating liver cancer using both drug and radiation therapy for a holistic assessment.