What Is Liver Cancer?
The liver continuously filters blood that circulates through the body, converting nutrients and drugs absorbed from the digestive tract into ready-to-use chemicals. The liver performs many other important functions, such as removing toxins and other chemical waste products from the blood and readying them for excretion. Because all the blood in the body must pass through it, the liver is unusually accessible to cancer cells traveling in the bloodstream.
What causes liver cancer?
Many factors may play a role in the development of cancer. Because the liver filters blood from all parts of the body, cancer cells from elsewhere can lodge in the liver and start to grow. Cancers that begin in the gut often spread to the liver. The ability of the liver to regenerate may also be linked to the development of liver cancers.
How are liver cancers classified?
There are many types of liver tumours, only some of which are cancers. The most important classification is whether the tumours are benign (relatively harmless) or malignant (capable of spreading from the liver and thus more serious)
Hemangioma is the most common type of benign liver tumour. It is an abnormal growth of blood vessels of the liver that begins in the fetus. More than 10% of the normal population has hemanigomas in the liver. Most people with hemangiomas have no symptoms and require no treatment. Some hemangiomas may rarely enlarge and bleed in which case they may require surgical removal.
Hepatic adenomas are benign tumours of liver cells. Most do not cause symptoms and do not require treatment. However, if they are large they may cause pain or blood loss and may need to be removed. Hepatic adenomas occur more frequently in women and seem to be triggered in some cases by the birth control pill or by pregnancy.
Focal nodular hyperplasia (FNH) is a tumour-like growth of several cell types. Although FNH tumours are benign, it can be hard to distinguish them from liver cancers.
The most common form of primary liver cancer (cancer that starts in the liver) in adults is called hepatocellular carcinoma (HCC). It is a cancer of liver cells. This type of cancer can have different growth patterns. Some begin as a single tumour that grows larger. It may spread to other parts of the liver in later stages of the disease.
Liver cancer may also develop in more than one site in the liver and may grow into multiple tumours. This pattern is most often seen in people with liver cirrhosis.
Another liver cancer is called cholangiocarcinoma. It originates in the small bile ducts which are tubes that carry bile to the gall bladder. Most often, however, when cancer occurs in the liver, it did not start there, but spread to the liver from a cancer that began somewhere else in the body. These types of cancers are named after the place where they began (primary site) and are considered secondary liver cancers or cancer metastases.
What are the risk factors associated with liver cancer?
- In the absence of chronic liver disease liver cancer is rare. However, in patients with underlying liver disease, liver cancer may be quite common. The exact cause of liver cancer is not known. Scientists have identified many risk factors that can make someone more likely to develop liver cancer:
- Among those with chronic liver disease, men are more likely to develop liver cancer than are women. The reason for this is unknown.
- Viral infectionof the liver: Chronic infection with either hepatitis B or hepatitis C may lead to the development of cancer.
- Certain types of inherited liver disease such ashemochromatosis, which results in accumulation of too much iron in the liver, as well as alpha-1 antitrypsin deficiency, and tyrosinemia can lead to the development of liver cancer later in life.
- Cirrhosis is the formation of scar tissue in the liver. This can often lead to cancer. Major causes of liver cirrhosis are alcohol use, chronic hepatitis B and C, and non-alcoholic steatohepatitis (NASH). Most causes of cirrhosis are also associated with the development of liver cancer.
- Alcohol: excessive alcohol use is a known risk factor for development of alcoholic cirrhosis and liver cancer.
- Obesity increases the risk of liver cancer in those patients in whom it causes liver disease.
- Tobacco use increases the risk of liver cancer if you already have chronic liver disease.
- Anabolic steroids: long-term use of anabolic steroids can increase the risk of liver cancer.
What are the symptoms of liver cancer?
In the early stages, liver cancer does not cause symptoms. Some common symptoms of advanced liver cancer include:
- weight loss
- loss of appetite
- abdominal pain
- fluid in the abdomen (ascites)
How is liver cancer detected?
- blood testto check for increased levels of alpha-fetoprotein (AFP)
- computer tomography scan (CT)
- magnetic resonance imaging (MRI)
Which treatments are used for liver cancer?
In creating your treatment plan, important factors to consider include the stage (extent) of the cancer and the health of the rest of your liver. But you and your cancer care team will also want to take into account the possible side effects of treatment, your overall health, and the chances of curing the disease, extending life, or relieving symptoms. Based on these factors, your treatment options may include:
- Surgery (partial hepatectomy or liver transplant)
- Tumor ablation
- Tumor embolization
- Radiation therapy
- Targeted therapy
Which doctors treat liver cancer?
Depending on your situation, you may have different types of doctors on your treatment team. These doctors may include:
- A surgeon: a doctor who treats diseases with surgery.
- A radiation oncologist: a doctor who treats cancer with radiation therapy.
- A medical oncologist: a doctor who treats cancer with medicines such as chemotherapy.
- A gastroenterologist: a doctor who specializes in treating diseases of the digestive system, including the liver.
Many other specialists may be involved in your care as well, including nurse practitioners, nurses, nutrition specialists, social workers, and other health professionals.
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