Disease States

Liver Cancer

Types of liver cancer

Liver cancer is a disease in which liver cells become "malignant," that is, they become abnormal and grow uncontrollably, forming a tumour. When the cancer originates in the liver it is called "primary" liver cancer. This differs from “secondary” liver cancer, in which tumours in other organs such as bowel, rectum, breast, head or neck have spread to the liver. These liver tumours are also known as liver metastases. The most common form of primary liver cancer is called hepatocellular carcinoma (HCC).

Unresectable liver cancer

Primary or secondary liver cancer can form large, hard-to-remove tumours that have spread widely throughout the liver by the time the condition is diagnosed. In addition, the liver can be damaged by both the cancer and underlying infections or other conditions that contributed to the cancer. This makes some forms of primary or secondary liver cancer unsuitable for treatment with surgery and hence, unresectable

How does liver cancer affect the body?

The liver is one of the largest and active organs in the body. Located in the right upper quadrant of the abdomen under the rib cage, the liver performs numerous vital functions. The liver plays an important role in digestion, synthesis and storage of energy-rich carbohydrates, as well as the production of numerous proteins, lipids, and hormones. The liver also filters and stores blood and breaks down medicines as well as potentially toxic substances. Thus, the liver plays many vital roles in the body's response to various nutritional and physiological needs and challenges. Liver cancer can interfere with the liver’s ability to perform its many important actions. This has numerous effects on the body, producing symptoms that are related to a lack of normal liver function.

Symptoms of liver cancer

The first symptoms of liver cancer, as with other types of cancer, are often vague. A person may feel poorly, lose their appetite, experience weight loss, fever, weakness and a general feeling of being rundown.

Over time, they may feel pain in the upper abdomen on the right side that may radiate to the back and shoulder. One may also notice a lump in the upper abdomen and suffer feelings of fullness and bloating.

As liver function becomes more impaired the person may have bouts of fever, nausea/vomiting and develop jaundice (yellowing of the skin and whites of the eyes) and dark urine.

These symptoms can be experienced separately or together; however, a person who experiences these symptoms may not have liver cancer, since these same symptoms can be caused by a benign (non-cancerous) liver tumour or by other medical conditions. Therefore, a doctor should always be consulted to determine the exact cause of these symptoms.

Primary liver cancer (HCC): Causes

As with all cancer types, HCC develops when normal cells mutate into cancerous cells that grow and act in an abnormal manner. Unlike most cancers, the cause of HCC can often be identified in individual patients. Chronic infections of hepatitis B or C cause continual damage to the liver and have been shown to be risk factors for HCC. This repeated damage to the liver can cause scarring called cirrhosis, which can ultimately lead to the development of HCC. Cirrhosis can also be caused by alcohol abuse.

Additional and more rare causes of HCC include autoimmune diseases such as biliary cirrhosis (damage to the bile ducts that causes bile to build up within the liver which results in liver damage and cirrhosis) and autoimmune hepatitis, where the immune system attacks normal liver tissue causing damage.

Diagnosis of liver cancer

The diagnosis of liver cancer begins much like the diagnosis of any disease. First, the doctor records a medical history, and then does a physical examination. Based on the findings from that history and examination the doctor then orders certain tests to help with diagnosis:

  • Blood tests to determine how well the liver is functioning
  • Blood tests to look for tumour markers (substances that are produced by cancer cell or by other cells in response to cancer). The tumour marker alpha-fetoprotein (AFP) is often at abnormally high levels in a patient with liver cancer, as well as some other cancers
  • Chest and abdominal x-rays
  • Angiogram: A procedure in which a flexible plastic tube (catheter) is inserted into the main blood vessel that takes blood to the liver. Dye is then injected through the tube so that the blood vessels in the liver can be seen on an x-ray. Angiography can help a doctor tell whether the cancer is primary or secondary liver cancer. This test is usually done in the hospital
  • CT scan: computerised use of x-rays in making three-dimensional images
  • MRI scans: Images produced by radio waves and a strong magnetic field
  • Liver scans that use radioactive material to help identify abnormality in the liver
  • Liver biopsy: A procedure in which a small sample of the liver is removed through a needle or during an operation and checked under a microscope for the presence of cancer cells. This procedure can confirm the presence and type of liver cancer
  • Laparoscopy: A ‘key-hole’ procedure in which the doctor makes a small incision in the abdomen and inserts small tube-shaped instruments with the aid of a camera. The doctor may also take a small sample of the liver for inspection under a microscope.