Liver cancer: causes, symptoms, and treatment

The liver is an important body organ located in the upper right portion of the abdomen, beneath the diaphragm and above the stomach. It is the largest internal organ; its primary job is to clean the blood and help remove toxins and waste from the body. The liver performs many important tasks for the body, including the absorption of vitamins and minerals from food, metabolizing fats, carbs, and protein, and helping in digestion.

Liver cancer is a cancer type that starts in the cells of the liver and is one of the most common cancers worldwide. It occurs more commonly in men and it affects them three times more than women. 

Liver cancer types

Liver cancer is life-threatening and is one of the fastest-growing cancers. When it develops in the liver, it destroys liver cells and interferes with liver function. It is of two types mainly, primary and secondary.
Primary liver cancer is when cancer begins in the cells of the liver and then spreads.
Secondary liver cancer develops when cancer cells from other organs spread to the liver, also called metastasizing. Like in other cancers, liver cancer cells can also break away from the main site and travel to other areas of the body through the bloodstream. When these cells reach other organs or tissues, they can begin to grow there. There are many types of liver cancer, and each one corresponds to different parts of the liver or part of the liver cells that are affected. Primary liver cancer begins as a single lump growing in the organ or can also stray simultaneously in many places within the organ. Primary liver cancer is of three types:

1. Hepatocellular carcinoma 

It is known as hepatoma and is the most common type of liver cancer that develops in the hepatocytes, which are the main cells that make up the liver. This type of liver cancer symptom can be seen in people with long-term hepatitis or cirrhosis. 

2. Cholangiocarcinoma 

It is another type of primary liver cancer, also known as bile duct cancer, that develops in a small tube in your liver. The time cancer starts developing in ducts, it is called intrahepatic bile duct cancer, and when it begins in ducts outside the liver, it is called extrahepatic bile duct cancer and is a rare kind of liver cancer.

3. Liver angiosarcoma

It is another rare type of primary liver cancer that starts in the organ's blood vessels. This type of cancer progresses very quickly and is diagnosed as stage 4 liver cancer stage. 

4. Hepatoblastoma 

It is another very rare type of cancer most commonly found in children, especially those under three. It can only be cured with surgery and chemotherapy. 

Liver cancer is life-threatening, and people with this medical condition may experience no symptoms; thus, it is necessary to undergo regular health check-ups. If in case people experience some minor symptoms like pain in the top right abdominal area near the shoulder blade, weakness, a hard lump under the ribs, or yellowing of skin or eyes, visit a doctor immediately. 

The main cause of liver cancer

A tumor in the liver is a condition that can occur when something affects the healthy liver cells, i.e., DNA. Liver cancer causes include DNA mutations. The condition occurs when liver cells develop changes in DNA, and these mutations cause changes in the instructions that DNA provides for chemical processes in the body. This situation leads to cell disturbance, which begins to grow uncontrollably and eventually form a liver tumor. A mass of cancerous cells is called a liver tumor; however, liver cancer also causes chronic hepatitis infections. However, it is not yet clear about the exact causes of liver cancer as it can happen to anyone, also in people with no underlying diseases.

Risk factors of liver cancer

Liver cancer risk factors include anything that increases a person's chance of developing it. However, there are cases in which people having many risk factors never develop liver cancer, while people with no risk factors show signs of liver cancer. You need to know the risk factors, and discussing them with your doctor can help you make more informed and make healthy lifestyle choices. Listed below are the risk factors of liver cancer to help you identify them at the early stages itself:

Cirrhosis 

It is a condition that develops when liver cells are damaged and replaced by scar tissue. The condition is mostly caused by alcohol abuse and people with too much iron in the liver because of hemochromatosis and many other types of chronic liver diseases. 

Obesity, diabetes, and NAFLD

Obesity is a condition that causes fat to be deposited in the liver and which leads to a condition termed NAFLD. NAFLD and diabetes are not related to each other, which also makes diabetic people more prone to liver tumors. 

Viral hepatitis 

It is a condition in which hepatitis viruses damage the liver. There are two types of hepatitis that are common hepatitis B and hepatitis C. It is the most common risk factor causing liver cancer worldwide, especially hepatitis C as it has no vaccine to prevent it.

Age and gender

 Those above the age of 60 are at more risk of liver cancer, and the condition is more among men than women.

Environmental factors 

 Risk factors also involve environmental factors like exposure to some chemicals or consuming food groups contaminated with a toxin made by a mold termed Aflatoxin.

Stages of liver cancer

Liver cancer stages can be categorized according to their size and location. The process also involves defining the extent of cancer and is called staging. Liver cancer stages are :

Stage 1: At this stage, a person will have a single tumor in the liver that is about 2 cm.

Stage 2: At this stage, a person will have more than one liver tumor that measures 3 cm. It may have spread to a person's lymph nodes.

Stage 3: At this stage, a person may have more than one tumor that measures about 5 cm. It may have spread to a person's lymph nodes, large blood vessels, or any other organs of the body.

Stage 4: Stage 4 liver cancer is very critical as the cancer is spread to all other body parts like lungs or bones along with lymph nodes.

Liver cancer symptoms

The liver cancer symptoms do not usually become visible until the disease reaches the advanced stage. However, the symptoms can be :

Jaundice

• Abdominal pain
• Unexplained weight loss
• Pain close to right shoulder blade
• Enlarged liver or spleen or else both
• Fatigue
• Nausea
• Vomiting
• Back pain
• Fever
• Itching
• Feeling full

 Liver cancer symptoms may also include swollen veins, which are one of the visible signs under the abdominal skin, along with bleeding and bruising.

Liver cancer diagnosis - how it is done

To start liver cancer treatment, it is important to diagnose it accurately, and for it, a team of liver cancer experts will be needed to conduct a variety of tests and tools designed specifically for this. The experts will use the designed tools to diagnose and evaluate cancer and accordingly develop personalized treatment plans for it. Your doctor may suspect a tumor if they find any liver cancer symptoms during your physical examination. Below are tests conducted to detect it:

• Doctors will do blood tests for cancer, like liver function tests, to check the liver enzymes, proteins, and many other substances that will showcase the condition of the liver, whether it is healthy or damaged. They may also conduct tests for AFP, and if there is a high AFP, it may indicate a liver tumor. 
• Doctors will do an ultrasound or sonography to get images of soft tissue structures. They will use ultrasound to look for tumors in the liver. 
• CT Scan can also be done by a doctor as it is a special type of X-ray that takes detailed images of a person's liver. It provides clear details about liver tumor size as well as its location.
• MRI tests give clear images of the body and are done using a large magnet, radio waves, and a computer. 
• An angiogram is a test that helps doctors to examine blood vessels in the liver. Throughout the test, the expert injects dye into an artery to track the blood vessels' activity and to seek for blockages.
• A biopsy is a process done by expert doctors and removes liver tissue to look for every stage, including stage 4 liver cancer symptoms. It is the confirmed way to detect liver cancer diagnosis. 

Liver cancer treatment

Liver cancer treatment can be done, but it is a long way to go as it will depend upon the location of the tumor and its type. However, the treatment of primary and secondary liver cancer is the same. It may also depend upon the size and to what extent it has spread and the patient's general health.

Treatment at an early stage of liver cancer 

 Surgery that is done to remove the liver tumor completely is the only way to improve the chances of recovery for patients whose cancer is treatable and who are in the early stages of liver cancer. Some surgical options are:

1. Partial hepatectomy 

It is a surgery that is done to remove a small tumor that only occupies a limited section of the liver. At this stage, cancer can be removed by removing that part of the organ to stop the spreading of the tumor. Only patients with healthy liver function are suitable for this kind of surgery. 

2. Liver transplant

 A liver transplant is done on patients who must have a tumor smaller than 5 cm or many tumors smaller than 3cm. A successful liver transplant reduces the risk of cancer returning again and also guarantees normal liver function.

Treatment of incurable liver tumor

Liver cancer is poor, and the bad part is that people experience liver cancer symptoms at a late stage. It is better to talk to your doctor if you experience any changes in your body or liver functioning. Regular screening for people who are more prone to the condition is also needed. Advanced liver cancer or stage 4 liver cancer is crucial in which a tumor spreads to other body areas and has extremely slow survival rates. A cancer care team will be required to treat advanced-stage liver tumors and slow down their growth. Some treatment options are :

1. Chemotherapy is a treatment process in which experts will inject drugs into the bloodstream to kill liver cancer cells.
2. Radiation therapy is a treatment done by a cancer care team by directing radiation at the tours to kill them significantly. There can be some side effects like vomiting, nausea, and fatigue a patient can experience during this treatment.
3. Ablative therapy is done by a surgeon that uses radio waves to shrink the size of a liver tumor through electromagnetic waves and heat to prevent growth. Experts also say that destroying the tumor by freezing is sometimes done by experts and is known as cryoablation. 

Prevention of liver cancer 

Liver cancer can be prevented and has lower survival rates than other cancers. People can reduce the risks of the condition and can improve their chances of early detection. Some liver cancer prevention ways are listed below:

• Vaccinate children against Hepatitis B

The vaccine is available for Hepatitis B and WHO recommends it for all children and infants up to the age of 18 years. It is important to vaccinate all children to prevent liver cancer. However, there is no vaccine available for hepatitis C to date. 

• Treat hepatitis C 

Sadly there is no vaccine for the condition, but it can be cured with antiviral treatment, and many people with it have a normal life expectancy.

• Avoid sharing needles and use safe sex practices. 

Hepatitis B and c are the most common causes of liver cancer. Both can spread from person to person through sharing contaminated needles and unprotected sex; thus, avoid both to prevent a liver tumor.

• Limit alcohol consumption and tobacco use

It is necessary to be alert and avoid alcohol and tobacco use as both increase the risk of cirrhosis, which can lead to liver cancer.

• Maintain healthy weight

It is important to check your weight and avoid obesity, as it will help you reduce fatty liver conditions linked with liver cancer.

FAQs 

1. What is the most common symptom of liver cancer?

The most common liver cancer symptoms are jaundice, fatigue, pain, weight loss, easy bruising, and bleeding.

2. What causes liver cancer?

One of the most common causes that are attributed to liver cancer is severe Hepatitis infection. But it can also be seen in people who have not expected the condition. The exact liver cancer causes are still unclear.

3. Are fatty liver and liver cancer related to each other?

Patients who have a specific type of fatty liver disease like NAFLD or NASH are at high risk of liver tumors in the future. This does not mean it will automatically develop cancer, as diseases are not considered malignant.

4. Is upper back pain a sign of liver cancer?

Not upper back pain, but the pain in the right shoulder and back could be a sign of liver disease. People experiencing this pain must visit the doctor to get a checkup done.

5. How can we know if cancer has spread?

Liver cancer extent, type, and location can be detected by conducting some tests like standard lab tests, imaging tests, heart tests, and by checking medical history.

6. How successful is a liver transplant?

A liver transplant is one of the liver cancer treatments that are not much complicated and are successful. The success rates depend upon the donor and recipient's overall health, age, and medications consumed in recent weeks. 

7. Can liver cancer progress quickly?

This cancer begins in the cells lining the liver's blood vessels and often grows quickly.

8. Is cancer in the liver curable?

If a person's cancer is at stage A and diagnosed, it is possible to cure it completely. But if a person experiences stage 4 liver cancer symptoms, it will take time to be cured, and many treatment options are needed.

Conclusion

Liver cancer, especially primary liver cancer, is a life-threatening illness, and often people don't know all about liver cancer symptoms and risk factors. Many of them get to know when the condition reaches advanced stages. However, you cannot prevent liver cancer as it can hit anyone, but you can take vital steps to reduce the risk of developing the disease. It is advised to exercise regularly to maintain a healthy weight and drink alcohol in moderation, as excess drinking can affect the liver, which can lead to liver cancer. It is also important to see your healthcare provider on a regular basis and report any abnormal signs or symptoms to avoid the condition or to detect early signs.