Liver cancer- HCC

Liver Cancer

The liver is the largest internal organ in the human body, playing a crucial role in digestion and metabolism. Its key functions include:

• Filtering blood from the intestines.

• Processing and storing nutrients absorbed from food.

• Converting nutrients into energy.

• Producing clotting factors for blood coagulation.

• Detoxifying harmful substances from the body.

• Regulating blood sugar levels.

What is Liver Cancer?

Liver cancer occurs when healthy cells in the liver begin to grow uncontrollably, forming a mass or tumor.

• Primary liver cancer originates in the liver itself.

• Metastatic liver cancer occurs when cancer from other parts of the body spreads to the liver.

This section focuses on primary liver cancer.

Types of Primary Liver Cancer

Liver cancer can develop in different types of cells, resulting in distinct types of primary liver cancers:

• Hepatocellular Carcinoma (HCC):

Accounts for 73% of all liver cancers. It originates in hepatocytes, the main liver cells.

• Cholangiocarcinoma (Bile Duct Cancer):

Represents 18% of liver cancers, originating in the bile ducts within the liver.

• Angiosarcoma:

A rare type (1%) that begins in the blood vessels of the liver.

Statistics

• In India, approximately 34,743 new liver cancer cases are diagnosed annually.

• It ranks 10th among all cancers in incidence and 8th in cancer-related mortality, with 33,793 deaths annually.

Survival Rate

Liver cancer generally has a low survival rate compared to other cancers:

• 5-year survival rate: 21% in the United States.

This means only 21 out of 100 people survive for five years after diagnosis.

Risk Factors

A risk factor increases the likelihood of developing cancer, though it may not directly cause the disease. Key risk factors for liver cancer include:

• Liver Cirrhosis:

A condition where healthy liver tissue is replaced by scar tissue. It is primarily caused by alcohol consumption, fatty liver disease, and hepatitis infection.

• Obesity, Fatty Liver, and Diabetes:

Excess weight can lead to fatty liver, increasing the risk of HCC.

• Viral Hepatitis B and C:

Chronic infection with these viruses is a major cause of liver cancer, spreading through blood or bodily fluids.

• Age:

People above 60 years are at higher risk.

• Gender:

Men are more likely to develop liver cancer than women.

• Exposure to Chemicals:

Contact with certain chemicals may increase the risk.

Symptoms of Liver Cancer

• Pain in the upper right abdomen, shoulder, or back.

• Unexplained weight loss.

• Fatigue and weakness.

• Jaundice (yellowing of the skin and eyes).

• Lump under the right ribcage due to an enlarged liver.

Diagnosis

• Physical Examination:

Doctors check for lumps, jaundice, or fluid accumulation in the abdomen.

• Blood Test (AFP):

Elevated levels of alpha-fetoprotein (AFP) indicate HCC in 50-70% of cases.

• Ultrasound:

Detects abnormal growths in the liver.

• CT Scan / MRI:

Provides detailed images of the liver and surrounding organs.

• Angiogram:

X-ray of blood vessels to assess blood supply to the tumor.

• Laparoscopy:

A minimally invasive surgery to examine the liver directly.

• Biopsy:

A tissue sample is taken for microscopic examination to confirm the presence of cancer.

• Biomarker Testing:

Identifies genetic changes in the tumor to guide treatment.

Stages of Liver Cancer (BCLC Staging System)

1. Very Early Stage:

• Tumor size < 2 cm.

• No pressure in the portal vein; bilirubin levels are normal.

• Surgery may be possible.

2. Early Stage:

• Tumor size < 5 cm, with or without portal vein pressure.

• Treatments include surgery, liver transplantation, or radiofrequency ablation (RFA).

3. Intermediate Stage:

• Multiple tumors or a larger tumor.

• Transarterial Chemoembolization (TACE) is recommended.

4. Advanced Stage:

• Cancer has spread to the portal vein, lymph nodes, or other organs.

Treatment Options

1. Surgery

• Hepatectomy:

• Removes only the cancerous portion of the liver. This option is possible if the rest of the liver is healthy.

• The liver can regenerate within a few weeks after surgery.

• Liver Transplantation:

• The diseased liver is replaced with a healthy donor liver.

2. Radiofrequency Ablation (RFA)

• Uses heat to destroy cancer cells.

3. Percutaneous Ethanol Injection:

• Injects alcohol directly into the tumor to kill cancer cells, used rarely.

4. Radiation Therapy

• Uses high-energy radiation to target and destroy cancer cells.

• Stereotactic Body Radiation Therapy (SBRT):

• Delivers high doses of radiation to the tumor with minimal damage to surrounding tissues. Suitable for tumors < 5 cm.

5. Targeted Therapy

• Drugs that target specific proteins or genes in cancer cells.

• Common drugs include bevacizumab, atezolizumab, lenvatinib, sorafenib, ramucirumab, cabozantinib, and regorafenib.

6. Immunotherapy

• Boosts the immune system to fight cancer.

• Common drugs include nivolumab, pembrolizumab, ipilimumab, atezolizumab, tremelimumab, and durvalumab.

Follow-Up Care for Liver Cancer

After treatment, regular follow-up care is essential to:

• Monitor for recurrence of cancer.

• Manage side effects of treatment.

• Regular blood tests, imaging studies, and physical examinations are recommended at specific intervals.

.

Liver cancer is a challenging disease with a low survival rate. Early detection and appropriate treatment, including surgery, targeted therapies, and immunotherapy, can improve outcomes. However, consistent monitoring and follow-up care are essential to manage the disease effectively and improve the patient’s quality of life.

‍