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Liver Cancer

Liver cancer, which might not exhibit specific symptoms in its early stages, can lead to delayed treatment planning when diagnosed. Therefore, early detection of liver cancer is crucial. As it progresses, symptoms such as unexplained weight loss, loss of appetite, constant abdominal swelling, fluid accumulation, fatigue, and jaundice become apparent. In cases of liver cancer, treatment options include tumor removal or liver transplantation. Specialists from the Uniqacare's Gastroenterology and Hepatology Department provided information about liver cancer.

What is liver cancer?


Malignant (cancerous) tumors originating from the liver's own cells are referred to as primary liver cancer. Due to arising from the liver's own cells, it's known as hepatocellular carcinoma. It's a frequently seen and life-threatening type of tumor. In addition, there are liver tumors that do not originate from hepatocytes. Cholangiocellular carcinoma (arising from the bile ducts) is one example. Moreover, there are liver tumors originating from vascular structures, known as angiosarcoma. If a person's liver is healthy, the risk of developing this type of cancer is very low. Especially those with liver disease or structural liver abnormalities (such as cirrhosis or individuals with a cirrhotic background) are at risk of liver cancer. Liver cancer is one of the most common cancers worldwide. Being life-threatening, it requires early diagnosis. Early diagnosis of this disease is crucial. The main treatment is the removal of the cancerous tissue. Since the liver is vital and serves the person's functional needs, removing only the tumor-affected portion of the liver is quite challenging. Liver transplantation stands out as a significant treatment method for liver cancer patients.


What are the symptoms of liver cancer?


Liver cancer doesn't typically present specific symptoms in its early stages. Therefore, when diagnosed, the cancer often has reached a significant size. Commonly, symptoms such as weight loss, loss of appetite, fatigue, easy exhaustion, jaundice, and abdominal fluid accumulation are observed. Sometimes, there can be a feeling of fullness or discomfort in the upper right side of the abdomen. As the background for the cancer usually involves chronic liver conditions (such as cirrhosis), which also often present similar symptoms, the situation can become confusing. Although liver cancer ranks 6th among cancer types worldwide, it might be more common in our country due to the prevalence of liver-related diseases like cirrhosis. Hence, patients with chronic hepatitis and early-stage cirrhosis should be monitored every 6 months to 1 year with radiological methods like ultrasound, and if necessary, MRI or CT scans, to detect any potential tumor development risk.


What are the causes of liver cancer?


The causes of liver cancer can be listed as follows:

  • Hepatitis B virus infections,

  • Hepatitis D virus infections,

  • Aflatoxin (produced by Aspergillus flavus fungus),

  • Genetic congenital metabolic disorders,

  • Hemochromatosis,

  • Glycogen storage diseases,

  • Chemicals (Nitrites, hydrocarbons, solvents) are also among the causes of liver cancer.


The liver, often referred to as the body's factory, is a central organ that impacts all systems, acts as a blood reservoir, and is part of the immune defense system. The group most at risk for liver cancer is individuals with hepatitis. Since liver cancer doesn't usually present early symptoms, early diagnosis is less likely. About 80% of these cancers develop in individuals with cirrhosis, which is why patients with cirrhosis need close monitoring. People with Hepatitis B and C are 200 times more likely to develop liver cancer compared to those who are not at risk. Hepatitis B can be prevented through vaccination. Treatments developed for Hepatitis C have also shown positive results. Cirrhosis is a condition where liver cells are damaged due to factors such as alcohol, hepatitis, immune-related issues, etc. About 5% of cirrhosis patients are at risk of developing liver cancer. Obesity is also considered a significant risk factor as it can trigger liver fat accumulation and cirrhosis.


How is liver cancer diagnosed?


Liver cancer may not show any symptoms in some cases until it reaches an advanced stage. As the cancer progresses, symptoms like unexplained weight loss, constant abdominal swelling, fluid accumulation, loss of appetite, continuous fatigue, and jaundice can start to appear. Individuals experiencing such complaints should consult a doctor as soon as possible. Nowadays, it's possible to detect any type of development in the liver through imaging methods. Especially high-risk patients should be monitored using the most cost-effective and easily applicable method, which is ultrasonography. Computed tomography (CT), magnetic resonance imaging (MRI), and angiography are other methods that can be employed. Sometimes, a combination of several of these imaging methods can be used to strengthen the diagnosis. A blood test can be performed to measure alpha-fetoprotein (AFP), a tumor marker. Elevated levels of this marker can be significant for cancer. However, it's important to note that even in confirmed cancer cases, AFP levels can still be normal. A normal AFP level doesn't rule out the presence of a tumor. In some cases, a liver biopsy may be performed for diagnosis. However, this is not a method that should be frequently used. The decision to perform a biopsy or not should be made by experienced professionals in the field of liver diseases, such as gastroenterologists and/or surgeons.


What are the treatment methods of liver cancer?


Untreated liver cancer leads to unfavorable outcomes. In such cases, the expected survival time is usually around 6 to 9 months. The most effective method is the surgical removal of the tumor. The feasibility of surgical treatment depends on the stage of the tumor, whether it has spread to surrounding areas, and the degree of any existing liver disease in the patient. Surgical intervention is not suitable for liver cancer that has spread outside the liver. The success of surgery is also influenced by the size of the tumor. Post-surgical survival is much better for tumors with a diameter <5cm compared to those >5cm. Under ideal conditions (tumor size <5cm, solitary, no spread), the expected 5-year survival rate after surgical resection is around 60%.


In cases where surgery is not feasible, Interventional Radiology methods can be employed by an Interventional Radiology Specialist. These methods include radioembolization, chemoembolization, chemotherapy, alcohol injection, and radiofrequency ablation. In suitable cases, these methods can be used in conjunction with surgery. In surgical procedures, it's crucial to ensure that the remaining liver is of sufficient size and quality to support the patient's healthy life.


When surgical removal of the liver tumor is not viable, treatment can be achieved through liver transplantation. There are various reasons that lead to liver transplantation, and liver tumors are one of them. If the tumor meets suitable criteria, liver transplantation is the ideal treatment in terms of outcomes. With liver transplantation, the diseased liver with potential tumor development risk is completely removed, and a healthy liver is transplanted in its place. The risk of tumor recurrence is lower in patients who undergo transplantation.


FREQUENTLY ASKED QUESTIONS ABOUT LIVER CANCER

What are the initial symptoms of liver cancer?


The early stages of liver cancer may not exhibit specific symptoms. As a result, when diagnosed, the cancer is often found to have grown to a significant size. Commonly observed symptoms include weight loss, loss of appetite, fatigue, easy tiredness, jaundice, and accumulation of fluid in the abdomen.


Can liver cancer go away?


Untreated liver cancer leads to unfavorable outcomes. In such cases, the expected survival time is usually around 6 to 9 months. The most effective method is the surgical removal of the tumor. The feasibility of surgical treatment depends on the stage of the tumor, whether it has spread to surrounding areas, and the degree of any existing liver disease in the patient. Surgical intervention is not suitable for liver cancer that has spread outside the liver. The success of surgery is also influenced by the size of the tumor. Post-surgical survival is much better for tumors with a diameter <5cm compared to those >5cm. Under ideal conditions (tumor size <5cm, solitary, no spread), the expected 5-year survival rate after surgical resection is around 60%.


How is liver cancer detected?


The early stages of liver cancer may not exhibit specific symptoms. As a result, when diagnosed, the cancer is often found to have grown to a significant size. Commonly observed symptoms include weight loss, loss of appetite, fatigue, easy tiredness, jaundice, and accumulation of fluid in the abdomen. Sometimes, a feeling of fullness or discomfort in the upper right side of the abdomen may be present. Liver cancer is often associated with chronic liver diseases such as cirrhosis, which can create confusion due to similar symptoms. While liver cancer ranks 6th among cancers worldwide, it is more prevalent in our country due to a higher incidence of cirrhosis-related conditions. Therefore, patients with chronic hepatitis and early-stage cirrhosis should undergo regular follow-ups using radiological methods such as ultrasound, and if necessary, MRI and CT scans, every 6 months to 1 year, to monitor the risk of tumor development.


Where does liver cancer cause pain?


Commonly observed symptoms include weight loss, loss of appetite, fatigue, easy tiredness, jaundice, and accumulation of fluid in the abdomen. Sometimes, a feeling of fullness or discomfort in the upper right side of the abdomen may be present.


Who is at risk of liver cancer?


Liver tumors that develop in individuals with Hepatitis B, Hepatitis C, or cirrhosis often do not exhibit early symptoms. In our country, Hepatitis B and Hepatitis C are among the most common diseases. The presence of hepatitis viruses is a significant risk factor for the development of liver cancer.


At what ages is liver cancer seen?


The average age of liver cancer diagnosis is 62. More than 90% of diagnosed liver cancer patients are over 45 years old, 3% are between 35-44 years old, and less than 3% are under 35 years old.


What are the stages of liver cancer?


For the purpose of treatment planning, liver cancer is generally categorized into 4 stages:

Stage 1: The tumor is within the liver tissue and has not affected any other organ or structure.

Stage 2: Small tumor formations are present within the liver tissue, or malignant tumor tissue is detected reaching blood vessels.

Stage 3: Multiple large tumors have affected the liver tissue, or a large tumor has impacted a major vessel.

Stage 4: Liver cancer has metastasized beyond the liver and spread to other parts of the body.

What is good for liver cancer? There is no specific product or food that is beneficial for liver cancer treatment. It's important not to use any products claimed to be beneficial without consulting a doctor.


What is the significance of interventional radiology in liver cancer treatments?


The types and effectiveness of interventional radiology procedures in cancer treatment have been increasingly expanding with advancing technology. These treatments include radiofrequency (RF) and microwave (MW) ablation, where a needle is inserted into the tumor tissue and the tumor is heated under imaging guidance; chemoembolization and radioembolization (Yttrium-90) therapies, where high-dose chemotherapy or radioactive isotopes are delivered to the tumor through angiographic techniques that block the tumor's blood supply. These methods can provide complete treatment for early-stage small tumors and can also be used to slow down, halt, or reduce tumor growth in advanced cases where other treatments are not applicable.


What distinguishes Yttrium-90 treatment in liver cancer treatment from others?


Yttrium-90 treatment, also known as radioembolization or selective internal radiation therapy (SIRT), involves delivering a high dose of radiation to the liver tumor through microspheres loaded with Yttrium-90 radioisotope, injected into the tumor's arterial supply. This treatment effectively eliminates the tumor's viability. Yttrium-90 treatment is administered in two steps. The first step involves mapping the patient's liver arteries and occluding any vessels related to the stomach-intestinal system if present. A test drug mimicking the Y90 radioactive drug is then injected into the liver to perform a preparatory angiography to assess the suitability of the liver's vascular structure for the treatment. If the vascular structure is deemed suitable for the treatment, the appropriate treatment dose is calculated by a nuclear medicine physician for the second step of the procedure, which is typically conducted about 7-10 days after the preparatory angiography.


Who is eligible for Yttrium-90 treatment for liver cancer?


Patients eligible for this treatment are those whose tumor is limited to the liver, without significant tumors outside the liver. Additionally, the patient's suitability for treatment is assessed during the preparatory angiography.


Is treatment possible for liver metastases?


The treatment of liver metastases depends on factors such as the origin of the metastasis (cancer from which organ), the extent of spread (how many metastases are in the liver), the location of the metastases in the liver, and whether there is metastasis in another location outside the liver. Some lymphomas can be treated with certain chemotherapy combinations. Breast and lung cancers may partially respond to chemotherapy. When considering the treatment of liver metastases, colorectal cancer metastases should be considered separately. Colorectal cancers often metastasize to the liver, and the surgical removal of liver metastases is crucial for treatment.


What does liver metastasis mean?


Metastasis occurs when cancer cells spread from the original site (organ) to another location in the body. When these metastases are observed in the liver, they are referred to as liver metastases.


Is liver metastasis a common occurrence?


Yes, the liver is a large organ that filters blood. As a result, cancer cells entering the bloodstream can become trapped in the liver, leading to growth. Liver metastases are commonly seen, especially from cancers originating in the digestive system (intestines) due to the first pass of blood through the liver. Cancers of organs such as the colon, stomach, pancreas, bile ducts, and small intestine frequently metastasize to the liver. Liver metastases from breast cancer, lung cancer, and lymphomas are also common.


What is the life expectancy for metastatic liver cancer?


The life expectancy for metastatic liver cancer varies from patient to patient, depending on factors such as treatment type and various parameters.


Can liver cancer be resolved with herbal treatment?


Herbal remedies have no established place in the treatment of liver cancer. It's important not to pursue herbal treatment without consulting a doctor.


What are the risk factors for the development of liver cancer?


  • Hepatitis B virus infections

  • Hepatitis C virus infections

  • Hepatitis D virus infections

  • Aflatoxin (aspergillus flavus toxin)

  • Cirrhosis

  • Genetic, congenital, metabolic diseases

  • Hemochromatosis,

    Wilson's disease,

    Glycogen storage disease

  • Chemicals; Nitrites, hydrocarbons, solvents

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