Liver Cancer symptoms

S of liver cancer

On physical examination, an enlarged, sometimes tender, liver is the most common finding. Liver cancers are very vascular (containing many blood vessels) tumors. Thus, increased amounts of blood feed into the hepatic artery (artery to the liver) and cause turbulent blood flow in the artery. The turbulence results in a distinct sound in the liver (hepatic bruit) that can be heard with a stethoscope in about one quarter to one half of patients with liver cancer.

Any sign of advanced liver disease (for example, ascites, jaundice, or muscle wasting) means a poor prognosis. Rarely, a patient with liver cancer can become suddenly jaundiced when the tumor erodes into the bile duct. The jaundice occurs in this situation because both sloughing of the tumor into the duct and bleeding that clots in the duct can block the duct.

Regarding the distant metastases, liver cancer frequently spreads to the lungs, presumably by way of the blood stream. Usually, patients do not have symptoms from the lung metastases, which are diagnosed by radiologic (x-ray) studies. Rarely, in very advanced cases, liver cancer can spread to the bone or brain.

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Types of liver cancer

Types of liver cancer

Some cancers begin in the cells of the liver itself – these are called primary liver cancer. More commonly, cancers start in cells in other organs of the body but then spread to the liver – this is called secondary liver cancer. Your doctor may use the term ‘liver metastasis’ (which is another way of saying that cancer has spread to the liver). It is possible for there to be several cancer deposits (metastases) in the liver.

There is more than one sort of primary liver cancer. One such type starts within the cells which make up most of the liver tissue – this is known as a hepatoma, or sometimes hepatocellular carcinoma (HCC for short).

Another type begins in the cells which line the tubes (or ducts) that carry the bile out of the liver – this bile duct cancer is known as a cholangiocarcinoma. Hepatomas usually occur in people who have an underlying liver disease, such as scarring of the liver (also known as cirrhosis) and can be a long-term result of chronic hepatitis. There is no association between cirrhosis and the development of cholangiocarcinoma.

However, in the UK, secondary liver cancer is about 30 times more common than these primary liver cancers. Secondary cancer occurs in people who have a primary cancer which has begun elsewhere. The usual sites in the body where primary tumours develop before spreading to the liver include the lung, breast, large bowel,
stomach and pancreas. Cancer cells usually spread to the liver from the primary tumour through the bloodstream.

Other, much less common, types of cancers can occur in the liver. These grow at different speeds. Your doctor will explain if you have one of these sorts of tumour.

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Treatment of liver cancer

Treatment of liver cancer
The treatment options are dictated by the stage of liver cancer and the overall condition of the patient. The only proven cure for liver cancer is liver transplantation for a solitary, small (<3cm) tumor. Now, many physicians may dispute this statement. They may argue that a small tumor can be surgically removed (partial hepatic resection) without the need for a liver transplantation. Moreover, they may claim that the one and three year survival rates for resection are perhaps comparable to those for liver transplantation.

The results of the various medical treatments (chemotherapy, chemoembolization, ablation, and proton beam therapy) remain disappointing. Moreover, for reasons noted earlier (primarily the variability in natural history), there have been no systematic study comparisons of the different treatments. As a result, individual patients will find that the various treatment options available to them depend largely on the local expertise.

How do we know if a particular treatment worked for a particular patient? Well, hopefully, the patient will feel better. However, a clinical response to treatment is usually defined more objectively. Thus, a response is defined as a decrease in the size of the tumor on imaging studies along with a reduction of the alpha-fetoprotein in the blood, if the level was elevated prior to treatment.

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Symptoms of liver

Symptoms of liver cancer

The initial symptoms (the clinical presentations) of liver cancer are variable. In countries where liver cancer is very common, the cancer generally is discovered at a very advanced stage of disease for several reasons.
For one thing, areas where there is a high frequency of liver cancer are generally developing countries where access to healthcare is limited. For another, screening examinations for patients at risk for developing liver cancer are not available in these areas.
In addition, patients from these regions actually have more aggressive liver cancer disease. In other words, the tumor usually reaches an advanced stage and causes symptoms more rapidly. In contrast, patients in areas of low liver cancer frequency tend to have liver cancer tumors that progress more slowly and, therefore, remain without symptoms longer.

In advanced liver cancer, the tumor can spread locally to neighboring tissues or, through the blood vessels, to elsewhere in the body (distant metastasis). Locally, liver cancer can invade the veins that drain the liver (hepatic veins). The tumor can then block these veins, which results in congestion of the liver.

The congestion occurs because the blocked veins cannot drain the blood out of the liver. (Normally, the blood in the hepatic veins leaving the liver flows through the inferior vena ceva which is the largest vein that drains into the heart.) In African patients, the tumor frequently blocks the inferior vena cava.

Blockage of either the hepatic veins or the inferior vena cava results in a very swollen liver and massive formation of ascites. In some patients, as previously mentioned, the tumor can invade the portal vein and lead to the rupture of esophageal varices.

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Risk

Risk of liver cancer
The role of hepatitis B virus (HBV) infection in causing liver cancer is well established. Several lines of evidence point to this strong association. As noted earlier, the frequency of liver cancer relates to (correlates with) the frequency of chronic hepatitis B virus infection. In addition, the patients with hepatitis B virus who are at greatest risk for liver cancer are men with hepatitis B virus cirrhosis (scarring of the liver) and a family history of liver cancer. Perhaps the most convincing evidence, however, comes from a prospective (looking forward in time) study done in the 1970's in Taiwan involving male government employees over the age of 40. In this study, the investigators found that the risk of developing liver cancer was 200 times higher among employees who had chronic hepatitis B virus as compared to employees without chronic hepatitis B virus!
Studies in animals also have provided evidence that hepatitis B virus can cause liver cancer. For example, we have learned that liver cancer develops in other mammals that are naturally infected with hepatitis B virus-related viruses. Finally, by infecting transgenic mice with certain parts of the hepatitis B virus, scientists caused liver cancer to develop in mice that do not usually develop liver cancer. (Transgenic mice are mice that have been injected with new or foreign genetic material.)

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liver cancer

Cancers that start in the liver

Several types of cancer can start in the liver.

hepatocellular carcinoma: This is the most common form of liver cancer in adults. It begins in the hepatocytes the main type of liver cell. About 3 out of 4 cancers that start in the liver are this type. Most of the information in this article refers to hepatocellular cancer.

This type of cancer can have different growth patterns.

• Some begin as a single tumor that grows larger. Only late in the disease does it spread to other parts of the liver.

• This type of cancer may also begin in many spots throughout the liver, not as a single tumor. This is most often seen in people with cirrhosis and is the most common pattern seen in the United States.

Doctors can figure out the subtypes of hepatocellular cancer by looking at the cancer under a microscope. Most of these subtypes do not affect treatment or the patient's outlook. But one rare type, called fibrolamellar, has a much better outlook (prognosis) than other forms of liver cancer.

hepatoblastoma: There is a very rare kind of liver cancer that develops in children. It is usually found in children younger than 4 years old. About 70% of children with this disease are treated successfully with surgery and chemotherapy. The survival rate is greater than 90% for early-stage disease.

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Liver cancer

What is liver cancer?

Liver cancer is a cancer that starts in the liver. To understand liver cancer, it helps to know about how the normal liver looks and works.

The liver is the largest organ inside the body. It lies under your right ribs, just below the right lung. If you were to poke your fingers up under your right ribs, you would almost touch your liver.

The liver is shaped like a pyramid and is divided into right and left lobes. Unlike most other organs, the liver gets blood from 2 sources. The hepatic artery supplies the liver with blood that is rich in oxygen. The portal vein carries nutrient-rich blood from the intestines to the liver.

The liver has many vital functions you cannot live without:

1. It breaks down and stores many of the nutrients absorbed from the intestine.
2. It makes some of the clotting factors needed to stop bleeding from a cut or injury.
3. It secretes bile into the intestine to help absorb nutrients.
4. It plays an important part in removing toxic wastes from the body.

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