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Liver Cancer

What are some other names for liver cancer? What are the types of liver cancer?

How common is the problem? Who is more likely to be affected?

Hepatocellular carcinoma (HCC) accounts for most primary liver cancers. It is more common in men and is usually seen in people aged more than 60. People who have scarring of the liver (cirrhosis), hepatitis B or C infection, alcohol abuse have higher risk of developing HCC. Uncommonly, patients with obesity, auto-immune hepatitis, aflatoxin toxicity and others may develop HCC.

About 10 to 20 percent of people with cirrhosis due to Hepatitis B or C infection will develop liver cancer, particularly in Asian countries, where Hepatitis B viral (HBV) infection is very common.

Why does it happen? How does it progress / spread?

What are the signs and symptoms of liver cancer?

Which tests and examinations are required to diagnose / evaluate this disease?

What is the best treatment for liver cancer?

Liver cancer can be cured only when found at an early stage, before it has spread to other organs. Treatment strategy may vary depending on the size of the tumor, and presence of cirrhosis in the underlying liver. If there is no cirrhosis, the tumor may be surgically removed or destroyed using other techniques. Treatment options for liver cancer may include:

Surgery: Currently, the best chance for potentially curing liver cancer is by surgery. Generally, in patients with normal liver, tumor can be removed (resection) and the remaining healthy liver is sufficient for the patient. However, in patients with cirrhosis of the liver, the diseased liver might not provide sufficient reserve and therefore the entire liver might have to be removed and another one put in (liver transplant). The type of surgery also depends on many other factors such as the origin of tumor, size of the tumor, number of tumors, their location in the liver, invasion of blood vessels and patients’ fitness to withstand major surgery.

Liver resection may be performed for patients who have a single tumor or multiple lesions in one side of liver. The feasibility of performing a liver resection for removing the tumor depends on the pre-operative evaluation done by CT or MRI scan. Resection may involve removing the right or left lobe (side) of the liver, or removing a smaller segment of the liver.

Liver Transplantation involves removal of the diseased liver completely, which is then replaced with a healthy liver from a donor. In patients with liver cirrhosis, transplantation not only removes their tumor completely, but also the cirrhotic liver, which has the potential to form more tumors in the future.

Radiofrequency Tumor Ablation (RFA) is used to burn the tumor in place. It may be used for very small tumors and when surgical removal of the tumor is not possible. RFA may not be possible for larger tumors, tumors near the blood vessels or surface of the liver. RFA may help prolong survival for some liver cancer patients.

Trans-arterial Chemo-Embolization (TACE) involves the injection of chemotherapy drugs directly into the blood vessels supplying the liver (and therefore the tumor). This way, the side effects of chemotherapy on the whole body are minimized. Also, the artery is then blocked using tiny pellets (gelfoam), thus cutting off blood supply to the tumor, making it harder for the tumor to grow without blood supply.

Intra-hepatic radiation may be delivered to the liver using radio-isotopes such as Yttrium-90 using microscopic spheres (theraspheres). Delivering radiation locally to the liver minimizes the side effects of radiation to the rest of body. Patients in whom the tumor has invaded blood vessels of the liver may benefit from this therapy.

Radiation Therapy: High-energy rays may be used to shrink or kill liver cancer cells. Radiation can only be used in low doses, as normal liver tissue is destroyed along with cancer cells. Radiation therapy does not cure liver cancer, and is typically used to shrink the tumor to relieve pain.

Chemotherapy: One or a combination of chemotherapy drugs may be used to kill cancer cells. Chemotherapy is not generally used to treat liver cancer because of a low response rates and frequent side effects, but lot of research is looking into novel ways to administer chemotherapy.

What are the precautions to be taken? How can it be prevented?

Many infants are infected with HBV at birth because of the high rate of infection among women of childbearing age. If it can be detected and treated early, the incidence of liver tumor may be reduced. The use of a vaccine against HBV is recommended for everyone, especially the health care workers and others who are often exposed to this virus

What is the expected prognosis (outlook) after various treatments?

The outcome without treatment is poor. About 10 - 20% of hepatocellular carcinomas can be removed completely using surgery and these patients may have a good long term outcome. If the cancer cannot be completely removed, the disease may be fatal in a short duration. Patients who undergo various non-surgical treatment may have variable outcomes.