Liver cancer
What’s that?
Liver cancer is a malignant neoplasm that develops from hepatocytes. Its other name is hepatocellular, hepatic cell cancer. It is a formidable pathology that runs aggressively without treatment for the next few years, leading to the death of the patient. Attentive attitude to your health – passing preventive examinations and contacting a doctor at the first signs of trouble with the digestive organs – will reduce the risk of cancer or provide early diagnosis of this pathology, and therefore, improve the prognosis, help to preserve the quality of life of the patient.
About the disease
Hepatocellular carcinoma develops on a long-term inflammatory process and cirrhotic changes in the liver. It occupies the 6th place among all malignant neoplasms of the organism and accounts for up to 80% of cases of all malignant neoplasms of the liver. Every year, almost 800 thousand new cases of this pathology are verified. Men suffer from it more often than women.
For a long time, it runs asymptomatic, at the same time – rapidly progressing, often diagnosed at a neglected stage, with large sizes or a large number of tumor foci, its distant metastases.
Types
There are several classifications of liver cancer.
According to the morphological features of the tumor are distinguished:
- nodal;
- massive;
- diffuse hepatocellular carcinoma.
TNM classification (T – tumor, N – nodus – lymph node, M – metastasis) is widely used. According to the size and localization of the neoplasm, involvement of lymph nodes in the process, and presence of distant metastases, oncologists determine the stage of liver cancer, the optimal treatment tactics, and the probability of achieving remission. These parameters are also influenced by the degree of histological differentiation of the neoplasm (the more differentiated the tumor, the more favorable the course of the process, and vice versa) and the degree of fibrosis of hepatocytes.
Symptoms
In the initial stages of the process, hepatocellular carcinoma is asymptomatic and can be detected incidentally during an examination in connection with other pathologies of the digestive organs. As a rule, it occurs in patients who have hepatitis or cirrhosis, and with quality dispensary observation, it is possible to diagnose the initial degree of liver cancer.
As the tumor grows, the patient becomes concerned:
- discomfort, pain in the epigastrium, right subcostal region;
- decreased appetite;
- nausea;
- unexplained weight loss;
- increase in the size of the abdomen (due to an enlarged liver, growing tumor, or accumulation of fluid in the abdominal cavity – ascites);
- yellow tint of the skin, visible mucous membranes, sclerae;
- appearance of vascular stars (telangiectasia) on the abdominal skin, varicose veins of the anterior abdominal wall;
- nosebleeds;
- severe generalized weakness;
- in case of tumor decay – increased body temperature, headache, and other symptoms of intoxication of the body.
The clinical blood test of such a patient will show anemia.
All symptoms and signs of liver cancer in women and men are nonspecific, but their presence indicates the pathology of this organ, which means that timely referral to a doctor and qualitative examination will help to verify the problem and start adequate therapy.
Reasons
The main etiologic factor of hepatocellular carcinoma is a long-term inflammatory process in the liver or fibrotic/cirrhotic changes in its tissue.
Other causes of liver cancer (provoking factors):
- alcohol abuse;
- Unhealthy diet (plenty of fatty, fried food);
- Taking hepatotoxic drugs (including some antibiotics, glucocorticoids);
- obesity;
- exposure to hepatotoxic substances from the outside;
- genetic diseases of the liver, metabolism (Wilson-Conovalov disease, hemochromatosis, tyrosinemia and others);
- hepatic vein thrombosis (Budd-Chiari syndrome).
Chronic inflammation or damaged for other reasons hepatocytes are repeatedly repaired and regenerated. This process is not without errors and mutations in genes, because of which, one day, a cancerous tumor begins to grow.
Diagnosis
Patients from the risk group (suffering from hepatitis or cirrhosis) are subject to dispensary observation by a gastroenterologist with periodic check-ups and examinations, which will help to assess their condition and detect the first signs of liver cancer. Thus, twice a year, they take blood for alpha-fetoprotein (a marker of hepatocellular carcinoma) and undergo an ultrasound of the abdominal cavity.
For a patient with suspected cancer, these test methods will help to verify the diagnosis:
- Computed or magnetic resonance imaging with contrast;
- Percutaneous puncture or aspiration biopsy of the tumor under ultrasound control for subsequent histological examination.
When the diagnosis is verified, the severity of the process is determined, and the doctor will recommend the best treatment option for the patient’s situation.
Treatment
The tactics of liver cancer treatment depend on the prevalence of the tumor process and the functional status of the affected organ.
The following treatments may be recommended to the patient:
- surgical removal of the part of the liver in which the neoplasm is localized;
- liver transplant;
- endovascular surgery;
- ablation;
- radiation therapy;
- medication.
Resection (removal of a part) of the liver is the preferred method of treating small-sized tumors that do not affect blood vessels or nerves in patients who do not have cirrhosis. Transplantation of the affected organ is indicated as the terminal method.
The essence of ablation methods lies in damaging the neoplasm with chemical or physical agents – with the help of ultrasound, radiofrequency, low temperatures, etc. As a rule, it is used in the presence of single tumors in the liver up to 5 cm in diameter.
Endovascular treatment is performed for advanced forms of cancer that cannot be treated surgically. As a rule, it is not an independent treatment method but is combined with other methods. The essence of such treatment is introducing an oil solution of a chemo agent into the neoplasm, which will limit the blood supply to the tumor and directly destroy it. The method is used only in the absence of distant cancer metastases, signs of tumor sprouting into large blood vessels of the liver, or thrombosis of these vessels.
Radiation therapy is used in patients with contraindications to other treatment methods and is, in fact, a variant of palliative therapy.
Chemotherapy for liver cancer is ineffective – only one patient notes its positive effect out of five. Today, other options for drug treatment of hepatocellular carcinoma are widely used – immune and targeted therapy. They significantly increase patients’ duration and quality of life suffering from this pathology.
All these treatment options are available in more than 850 hospitals worldwide (https://doctor.global/results/diseases/liver-cancer). For example, major liver resection is performed in 23 clinics across Turkey for an approximate price of $13.2 K(https://doctor.global/results/asia/turkey/all-cities/all-specializations/procedures/major-liver-resection).
Prevention
Reducing the risk of developing hepatocellular carcinoma will help to prevent diseases against which it develops – hepatitis and liver cirrhosis. If they have already been diagnosed, it is essential to quality, dynamic monitoring of the patient, which will track the condition of the liver and identify predispositions for the development of oncologic pathology.
Rehabilitation
Rehabilitation measures depend on the scope of surgical intervention, the patient’s initial condition, and several other factors. After tumor removal, the patient, for some time, is in the hospital under the constant supervision of medical personnel to monitor the healing process of tissues, and timely diagnosis of postoperative complications. In parallel, he can receive other types of antitumor treatment and therapy to correct existing symptoms of pathology. After discharge, the patient is subject to outpatient treatment and dispensary observation with periodic check-ups and examinations. Such tactics will help to detect tumor recurrence in time and take adequate measures to eliminate it.
