What Is Liver Cancer?
Liver cancer is an uncontrolled growth of liver cells. The cells are programmed for the division at a normal rate. However, when this program gets disturbed due to any reason, the cells start growing in an uncontrolled fashion. Liver cancer may be of two types i.e. primary liver cancer or metastatic liver cancer.
Primary live cancer arises due to uncontrolled cellular division in liver cells. The most common liver cancer is hepatocellular carcinoma which starts in hepatocytes. Other types of liver cancer include hepatoblastoma, angiosarcoma, hemangiosarcoma, and intrahepatic cholangiocarcinoma.
Metastatic liver cancer spreads to the liver from other organs. Such cancer originates originally in other organs.
What Are The Stages Of Liver Cancer?
For a better understanding of the severity of disease and to provide accurate treatment, liver cancer is divided into various stages. These stages are determined based on the TNM system. T depicts the size of the tumor; N depicts the spreading of the tumor to nearby lymph nodes and M stands for cancer that metastasizes to distant sites.
The numbering is done once the stage of liver cancer is determined, a process known as stage grouping. A stage grouping is done to indicate the overall stage of liver cancer. Following are the various stages of liver cancer:
Stage IA (T1a N0 M0): Single tumor with size less than 2 cm and not spread to organs and lymph nodes.
Stage IB (T1b N0 M0): Single tumor more than 2 cm and not spread to lymph nodes and organs.
Stage II (T2 N0 M0):Either a tumor larger than 2 c and grown into blood vessels or more than one tumor all less than 5 cm. Tumor/s are not spread to other organs or lymph nodes.
Stage IIIA (T3 N0 M0): More than one tumor and with at least one tumor larger than 5 cm. The tumor has not spread to lymph nodes or other organs.
Stage IIIB (T4 N0M0): One tumor has grown into a large vein of the liver but not spread to lymph nodes or organs.
Stage IVA(AnyT N1 M0): Single or multiple tumors of any size that has spread to lymph nodes but not to distant organs.
Stage IVB (AnyT Any N M1):Single or multiple tumors of any size that may or may not spread to lymph nodes but has spread to distant organs.
What Are The Symptoms Of Liver Cancer?
There are no specific symptoms of liver cancer. The symptoms may also be due to various other diseases. If the patient experiences these symptoms, he should immediately book an appointment with the doctor. Following are the common symptoms of liver cancer:
- Weakness and lethargy
- Loss of appetite
- Nausea and vomiting
- Yellowing of eyes and skin, a sign of jaundice
- Enlarged liver and spleen
- Accumulation of fluid in the abdomen
- Fullness after eating a light meal
- Liver tumors may also secrete some hormones that may cause hypercalcemia, breast enlargement, and abnormal cholesterol levels.
What Are The Risk Factors For Liver Cancer?
The liver is an essential organ and proper care is required to function properly. Various factors increase the risk of liver cancer. Following are the risk factors for liver cancer:
- Chronic viral infection such a hepatitis B or hepatitis C
- Men who take 15 drinks or more in a week and women who take 8 drinks or more per week.
- Exposure to toxins
How Liver Cancer Is Diagnosed?
Diagnosis of liver cancer is done through the following methods:
Physical examination: The doctor will evaluate you for possible symptoms and risk factors for liver cancer. The doctor will give attention to the abdomen including the spleen. Further, the doctor may examine your skin, eyes, and nails for possible symptoms of jaundice.
Labs tests: To determine the presence of liver cancer and liver dysfunction, various lab tests are advised. These lab tests include Liver function tests, Alphafeto protein tests, kidney function tests, CBC, blood clotting tests, and tests for viral hepatitis.
Imaging tests:Various imaging tests are done to confirm liver cancer. These tests include ultrasound, Magnetic Resonance Imaging, CT scan, and angiography. Ultrasound helps to identify tumors in the liver. CT scan provides information such as location, shape, and size of the tumor. MRI allows the doctor to look for a tumor in other parts of the body. Angiography is done to confirm the presence of tumor in blood vessels.
Biopsy: Biopsy is the confirmatory test for liver cancer. A biopsy is a process of removing asample of tissue and examining it for cancer. A biopsy may be surgical, needle or laparoscopic.
What Are The Treatment Options For Liver Cancer?
There are various options available for liver cancer treatment in India. These are:
Surgery: Surgery is the primary treatment option in early liver cancer. Surgery may include partial hepatectomy and liver transplant. A liver transplantation in India is done at a high success rate.
Chemotherapy: Chemotherapy is the process of killing the tumor cells through medications. This is done when tumors cells are not removed with other options. As tumors of the liver are not much affected by chemotherapy, this is probably the last resort in liver cancer. A combination of various drugs is found to be more effective as compared to a single drug. Commonly used drugs are cisplatin, doxorubicin, gemcitabine, and 5-fluorouracil.
Radiation Therapy: Radiation therapy is a useful option when various other treatment options are either not possible or do not provide adequate removal of tumor cells. The high energy radiation beam is directed to the tumor cells to kill them. Radiation therapy can be external beam radiation therapy or stereotactic body radiation therapy.
Targeted Therapy: In many patients, the drugs normally used in chemotherapy are not effective. In such patients, targeted therapies are used. They have a different mechanism of action and side effect profile as compared to normal chemotherapy drugs. Drugs used in targeted therapy are Sorafenib, Regorafenib, cabozantinib, Ramucirumab, and lenvatinib.
Embolization Therapy: Tumor cells require energy to grow. This energy is given by blood. In embolization, the blood flow to the tumor cells is stopped. This results in the death of tumor cells. Embolization can be Trans-arterial embolization and Trans-arterial chemoembolization, Radioembolization, and Drug-eluting bead chemoembolization.
Ablation: In ablation, the cancer cells are destroyed. This is done in patients with small liver tumors and in which surgery is not possible. Various types of ablation include radiofrequency ablation, microwave ablation, ethanol ablation, and cryoablation.
Immunotherapy: Drugs used in immunotherapy helps the immune system to kill the cancerous cells. Drugs used in immunotherapy include pembrolizumaband nivolumab.