The liver is the largest internal organ and has several essential functions, including metabolism, detoxification, and the storage of various nutrients. Different types of cells in the liver perform these functions. These cells have predetermined division patterns based on the information present in the genes. At times, these cells may forego their designated functions and start dividing abnormally due to mutations, leading to the formation of a cancerous mass or tumor.
It is important not to ignore any symptoms that could possibly indicate liver carcinoma, as this condition needs prompt medical attention for effective management.
Liver cancer is one of the primary causes of cancer deaths globally. There has been a steady increase in the number of people diagnosed with and dying from this condition. Studies have suggested that various lifestyle factors contribute to this rise in the incidence rate.
Reports suggest that liver carcinoma is one of the most common cancer types, with the male-female ratio for hepatocellular carcinoma standing at 4:1 and the age of presentation spanning from 40 to 70.
There are various types of liver cancer, depending on the type of cell from which it arises. Of all the types of liver cancer, hepatocellular carcinoma is the most common.
HCC occurs in the cells of the liver (hepatocytes). The condition is also called hematoma and is the most common type of liver cancer. It accounts for almost 75% of all liver cancers and about 85 to 90% of all primary liver cancers. Patients with cirrhosis and chronic hepatitis have an increased risk for HCC.
This is an aggressive form of liver carcinoma that develops in the bile ducts of the liver. Cholangiocarcinoma may be intrahepatic or extrahepatic.
It is a rare tumor that occurs in the liver cells. It most commonly occurs in early childhood. Hepatoblastoma generally starts in the right lobe of the liver.
It is a rare form of liver carcinoma that generally develops in teenagers and adults below the age of 40. The clinical findings and behavior of fibrolamellar carcinoma are significantly different from those of HCC.
Metastatic liver cancer begins in the liver and spreads to other organs, such as the lungs. It is also referred to as advanced-stage liver carcinoma, which will often require a multimodal treatment approach. In these cases, the treatment goal is to prolong survival and improve the quality of life.
Hepatic angiosarcoma is an aggressive liver carcinoma that develops in the lymphatic or blood vessels. Patients with angiosarcoma experience jaundice, abdominal pain, and fatigue.
The TNM staging system assists oncologists in staging different cancers based on various criteria. It includes the extent of tumor (T), lymph node spread (N), and cancer metastasis (M).
The information obtained during TNM staging is used to assign a specific stage to each patient’s liver cancer case, where the stages 0, 1, 2, 3, and 4 (0, I, II, III, and IV) are used to indicate different stages of the disease. Stage 0 is often used to indicate precancerous lesions.
Stage 1 liver cancer is subdivided into Stage 1A and Stage 1B. In Stage 1A liver cancer, the liver tumor is ≤2 cm, has not grown into the blood vessels and has not spread to the lymph nodes. In Stage 1A liver cancer, the liver tumor is >2 cm, has not grown into the blood vessels, and has not spread to the lymph nodes.
Stage 2 liver cancer involves either a single liver tumor >2 cm in size that has grown into blood vessels OR two tumors, none larger than 5 cm. In both cases, the liver tumor does not spread to lymph nodes.
The patients with Stage 3A liver cancer have multiple tumors, of which one is ≥5 cm. The tumor does not spread to lymph nodes or distant sites. In stage 3B liver cancer, a tumor of any size grows into the major branch of the large liver vein. The cancer does not spread to lymph nodes or distant sites.
Patients with Stage 4A liver cancer have a tumor that would have spread to the nearby lymph nodes and not to distant sites. Patients with Stage 4B liver cancer have a tumor that has spread to distant sites, such as the lungs or bones. It may be referred to as end-stage liver cancer with a low survival rate.
In the early stages, liver cancer may not have any symptoms. The symptoms start becoming apparent as the disease progresses into advanced stages. Also, the exact cause of liver cancer is still unknown. Taking appropriate measures to improve and protect liver health and opting for regular health check-ups can help protect oneself against liver cancer.
Liver cancer may develop in any individual, and the exact reasons for liver cancer remain unknown. However, there is an increased risk of developing liver cancer in certain groups of people. Men are found to have a relatively higher risk of developing liver cancer than women. Those with underlying liver conditions, like liver cirrhosis and chronic hepatitis, also have a higher risk of developing liver cancer. In addition, heavy alcohol drinkers, especially those with liver diseases, have a higher risk for liver cancer.
The liver has a myriad of functions in the human body, and when it is affected by cancer, it may cause various symptoms. The following are some of the important liver cancer symptoms:
Patients with liver cancer may experience pain in the upper right abdomen due to the tumor growing in the liver.
Weight loss is one of the most common symptoms of liver cancer. The liver plays a pivotal role in food metabolism, and when the tumor interferes with this process, it may lead to malnutrition and unintended weight loss in those with liver cancer.
Fatigue is another common symptom of liver cancer. Cancer affects the liver’s ability to take part in energy production, and this causes fatigue in liver cancer patients.
Since liver cancer causes the abdomen to enlarge, those with liver cancer may experience a loss of appetite or feel full after eating food in small quantities.
Reduced liver function caused by liver cancer can negatively impact the digestive system, which can lead to nausea and vomiting.
When the liver stops functioning, bilirubin is not metabolized properly, and its levels in the body begin to rise. This leads to jaundice, which causes yellowing of the skin and eyes in liver cancer patients.
Due to bilirubin buildup, those with liver cancer may pass dark-colored urine. The urine color may be brown, amber, or orange, and this is one of the important liver cancer symptoms that should not be ignored.
Passing pale stools is also one of the liver cancer symptoms. Liver cancer may affect the organ’s ability to produce bile, the substance responsible for digestion.
Those with liver cancer may have a low-grade but persistent fever of unknown origin.
Patients with liver cancer may experience easy bruising and bleeding, as the tumor affects the liver’s clotting abilities.
Liver cancer can cause fluid build-up in the abdomen and lead to swelling. This is one of the end-stage liver cancer symptoms.
The symptoms of different types of liver cancer are:
Hepatocellular carcinoma is the most common liver cancer. Hepatocellular carcinoma symptoms include nausea and vomiting, loss of appetite, weight loss, a feeling of fullness on the right side (liver enlargement) or left side (spleen enlargement), abdominal pain, itching skin, and yellowing of the eyes and skin (jaundice). Hepatocellular carcinoma causes include chronic liver infections and hemochromatosis.
It is an aggressive form of liver cancer. Patients with bile duct cancer may experience weakness and fatigue, yellowing of the eyes and skin, white-colored stools, severe itching, night sweats, fever, loss of appetite, abdominal pain, and unexplained weight loss.
Hepatoblastoma usually occurs in children under 3 or 4 years old. Children with hepatoblastoma experience abdominal pain and irritation, fatigue, and weakness due to anemia, yellowing of the skin and eyes, loss of appetite, weight loss, a lump in the abdomen, and fever.
Patients with fibrolamellar carcinoma experience the presence of a palpable mass, abdominal pain, generalized fatigue, loss of appetite, nausea, abdominal fullness, and pain in the back or shoulder.
Metastatic liver cancer begins in the liver and spreads to other organs. The symptoms of metastatic liver cancer depend on the organ to which the cancer spreads. For instance, if the cancer spreads to the bones, patients experience bone pain and have an increased fracture risk. If the cancer spreads to the lungs, patients may experience chest pain and trouble breathing.
Angiosarcoma or liver tumor symptoms include abdominal distension, pain, discomfort, jaundice, fatigue, and weight loss. Patients may also have an enlarged liver and abdominal swelling.
Studies have identified multiple factors as possible liver cancer reasons or risk factors. It is important to note that having any of these risk factors does not guarantee a liver cancer diagnosis; however, it does mean one has a higher chance of developing liver cancer.
Liver cancer symptoms in females are similar to liver cancer symptoms in males. Some of the possible liver cancer causes or risk factors include:
Chronic liver diseases like steatohepatitis and cirrhosis may result in liver cancer. It is due to the accumulation of excess fat in the liver or the development of scar tissues, resulting in inflammatory processes.
Having chronic viral liver infections, such as hepatitis B and C, may be one of the possible reasons for liver cancer.
Various inherited liver conditions, such as Wilson’s disease and hemochromatosis, are also identified as risk factors or possible reasons for liver cancer.
It is an irreversible and progressive condition that results in the development of scar tissue in the liver. Patients with this condition may have a higher risk of developing liver cancer.
It is characterized by the accumulation of fat in >5% of the liver cells. The severity ranges from simple steatosis to non-alcoholic steatohepatitis (NASH). It has been estimated that about 4% to 27% of patients with NASH with cirrhosis develop hepatocellular carcinoma.
Obesity is also a causative factor for liver cancer. Obesity increases the risk of NAFLD, which is found to be an important liver cancer risk factor.
Diabetes is another factor that may result in liver cancer. Patients with diabetes may have elevated oxidative stress, lipotoxicity, hepatic insulin resistance, and a chronic low pro-inflammatory state that may cause NAFLD.
This condition is characterized by excessive iron storage in the body's organs.
Smoking has immunological, oncological, and toxicological effects on the liver. Smoking results in the production of cytotoxic substances that cause necro-inflammation and fibrosis. It also assists in producing interleukins and tumor necrosis factor-alpha, which are responsible for chronic liver injury.
Heavy alcohol intake regularly for a substantial period may cause liver injury, inflammation, and scarring, all of which can increase the risk of liver cancer.
Prolonged exposure to aflatoxins, especially aflatoxin B1, may cause liver cancer. The risk of liver cancer further increases if the patient is infected with the hepatitis virus.
People should visit the hepatologists if they experience yellowing of the skin and eyes, indigestion, loss of appetite, abdominal pain, weight loss, nausea and vomiting, and generalized weakness and fatigue.
Effective liver cancer management involves accurate diagnosis and timely treatment. Before arriving at a conclusive diagnosis, the doctors will recommend a battery of tests, ranging from blood tests to imaging scans. Upon arriving at a definitive diagnosis, the doctors devise a personalized treatment plan, which may include surgery, radiation therapy, chemotherapy, immunotherapy, and targeted therapy. Once the treatment is complete, the patient will be on follow-up for efficient monitoring.
The success of liver cancer treatment largely depends on the stage at which the disease is diagnosed and treated. Depending on the stage, the treatment goal will vary too. Early-stage liver cancers have a better prognosis than advanced-stage cancers.
Patients may be asked to undergo several examinations before a conclusive liver cancer diagnosis is made. Most recommended liver cancer tests include blood tests, liver biopsies, and imaging.
When patients present with symptoms that indicate liver cancer, the doctor will recommend a thorough physical examination. The doctor may check the abdomen for the presence of a lump. Further, the skin and the eyes are examined to check for signs of jaundice. The left lower part of the abdomen is examined to check for an enlarged spleen. The doctor may also ask the patient when the symptoms developed, their severity, and their progression.
The medical history of the patient is also evaluated, and the doctor may particularly check if the patient has congenital liver diseases such as hemochromatosis and Wilson's disease. If liver cancer is suspected, the patient is advised to undergo further examinations.
Blood tests for the liver are recommended to evaluate the liver's health status. The liver secretes several chemicals, including enzymes, into the blood. Alterations in the levels of these chemicals may indicate liver disease.
The alpha-fetoprotein tumor marker test detects the level of alpha-fetoprotein in the blood. The alpha-fetoprotein level may rise in the presence of various cancers, such as liver, lung, and ovarian cancer. However, this test is not a confirmatory test for cancer, as elevations in alpha-fetoprotein levels may also be due to other medical conditions, such as hepatitis and cirrhosis. Further, a negative alpha-fetoprotein marker test does not confirm the absence of cancer either.
These tests are used to determine the overall health of the liver. The enzymes secreted by the liver, such as alkaline phosphatase (ALP), aspartate transaminase (AST), and alanine transaminase (ALT), are usually examined in liver function tests.
If the doctor finds an abdominal swelling or strongly suspects the presence of liver disease, they may advise the patient to undergo various imaging tests, including:
Ultrasound is usually the initial test recommended for patients suspected of liver disease. Liver cancer ultrasound involves the use of sound waves to create images of the liver. Conventional ultrasound may assist the doctor in determining the morphology, location, size, boundary, and flow of blood to tumors. However, ultrasound may miss small tumors and cannot differentiate between malignant and benign tumors.
Computed tomography is recommended as the second-line diagnostic test for examining the presence of liver tumors after the primary evaluation tests, such as alpha-fetoprotein or abdominal ultrasound. The technique uses X-rays to obtain images. It is also used for assessing the stage of cancer. Further, it also assists the doctors in guiding the needle during a biopsy (a CT-guided biopsy). CT is preferred over ultrasound and MRI as it effectively evaluates the extrahepatic abdomen.
An MRI provides detailed information about liver cancer. Unlike a CT scan, an MRI scan uses strong magnets and radio waves to obtain detailed images of the liver. This imaging method helps in differentiating between malignant and benign tumors. It also provides information about the blockage in the blood vessels in and around the liver due to the tumor. It helps oncologists determine whether liver cancer has spread to other body parts.
It is an advanced imaging technique that involves the use of a radiotracer. The radiotracer comprises the radioactive glucose analogs that are taken up by the rapidly dividing cells. The radiotracers are then traced through specialized instruments. A PET scan provides detailed information about the presence of cancer, its location, and the stage of liver cancer. It also scans the entire body to determine liver cancer metastasis.
A biopsy is generally the confirmatory test for diagnosing cancer. The doctor obtains a small sample of abnormal tissue from the liver and sends it to the laboratory to examine the sample for malignancy. Different liver biopsy procedures are available to diagnose liver cancer, including:
In this procedure, the doctor inserts a long, hollow needle into the abdomen and guides it to the liver to obtain the sample. Sometimes, the needle is guided with imaging techniques such as CT or ultrasound. The doctor applies local anesthesia to the skin before the procedure.
In some patients, the doctor requires a large sample for examination, and in such cases, a needle biopsy may not help. A surgical biopsy is performed in such cases. Further, if the tumor is very small, the entire tumor is removed during a surgical biopsy and sent for examination.
Endoscopic biopsy is a minimally invasive procedure to obtain a large number of samples or completely remove the tumor for further examination. The procedure is done under anesthesia and involves a few small incisions in the abdomen.
An angiogram is recommended to determine the health of the blood vessels and identify the vessels that supply blood to the tumor. In this process, the doctor injects a contrast agent into the artery, and the images are obtained through an x-ray. Angiograms also guide various non-surgical cancer treatments, like embolization.
Doctors perform laparoscopies with the help of a laparoscope. This long, flexible tube with a camera at the tip allows the doctors to view the organs of the abdomen to check for signs of cancer. Laparoscopy is rarely used in the diagnosis of liver cancer.
Several factors affect the choice of liver cancer treatment. These factors include the stage of the disease, location and size of the tumor, response to prior treatment, and overall health of the patient. Oncologists prescribe liver cancer treatment by stage.
Liver surgery to remove tumors or liver transplants are considered the best options for liver cancer treatment. The outcomes of liver cancer treatment are excellent when all the malignant cells are removed.
This procedure is recommended for patients who have liver cancer limited to the liver. The oncosurgeons perform several imaging tests, such as an MRI or CT scan, to evaluate if cancer can be surgically removed. Liver surgery types include hepatectomy and lobectomy.
A liver transplant is a procedure that involves replacing the diseased liver with a new, healthy one. It is a good option when the disease has spread to a significant part of the liver.
Chemotherapy for liver cancer treats the disease by killing the cancer cells or preventing their division with drugs. The drug is administered orally or through injection. Chemotherapy is also used with radiation therapy or surgery as an adjuvant therapy. It is also prescribed for the management of advanced liver cancer.
When radiation therapy is administered as a liver cancer treatment, radiation oncologists direct high-energy radiation at the cancer cells to damage them. The radiation can be delivered through an external radiation source or by placing radioactive seeds near or in the tumor. It may also be administered as adjuvant therapy along with chemotherapy or surgery.
Certain pathways and substances, such as enzymes and proteins, are specific to cancer cells, and they support the growth and proliferation of cancer cells. Liver cancer medications administered as a part of targeted therapy target these vital processes, pathways, and biocomponents and prevent the growth of cancer cells.
Immunotherapy for liver cancer involves stimulating the patient's immune system to kill the cancer cells. Immune cells normally identify and kill the abnormal cells. However, certain abnormal or cancerous cells hide from the immune system and form tumors. Liver cancer medicine administered as a part of immunotherapy makes the cancer cells vulnerable to the immune system, so they are identified and killed by the immune system.
Gene therapy is an advanced liver tumor treatment. Gene therapy involves introducing new genes into the cancer cells, resulting in their death. In a recent study, gene therapy involving microRNA-22 resulted in successful hepatocellular carcinoma treatment in mice. Further, this therapy also reduced liver inflammation.
HCG is one of the most advanced and superior centers for liver cancer diagnosis and treatment. It is one of the very few centers in India with all types of diagnostic and treatment facilities for liver cancer under a single roof. The technicians at the center are experts in performing imaging tests. At HCG, the treatment plans are devised based on individual case parameters, and this helps the team deliver personalized care to every patient and help them return to the best state of health possible.
Multiple studies have found that certain lifestyle and non-lifestyle-related factors can increase the risk of liver cancer. Having these risk factors does not guarantee a liver cancer diagnosis; they only increase one’s risk of developing liver cancer.
When it comes to liver cancer prevention, there are no known ways to prevent liver cancer. That said, certain measures can be adopted to reduce the risk of developing liver cancer.
Several factors increase the risk of liver cancer. The following are some of the important liver cancer risk factors:
Various underlying chronic medical conditions increase the risk of liver cancer. Patients with diabetes are at higher liver cancer risk. Further, chronic liver conditions, such as non-alcoholic fatty liver disease and non-alcoholic steatohepatitis, also increase the risk of liver cancer.
Patients with liver cirrhosis have an enhanced risk of liver cancer. In liver cirrhosis, the healthy liver cells are replaced with scar tissues, and there is a reduction in liver function. Cirrhosis may occur due to chronic viral infections of the liver and chronic alcohol use.
Chronic viral infections, hepatitis B and C are the common liver cancer risk factors. Hepatitis B results in chronic inflammation in the liver, and this may lead to the formation of liver cancer. Hepatitis C infection may cause cirrhosis that results in liver cancer. Chronic hepatitis B infection is the primary cause of liver cancer in Africa and Asia, while hepatitis C infection is the primary cause in Europe, North America, and Japan.
Liver cancer is commonly diagnosed in the elderly population. Only 3.1% of patients with liver cancer are under the age of 45 years. However, some forms of liver cancer, such as fibrolamellar carcinoma, are commonly diagnosed in individuals under 40 years of age. Some liver cancer types, such as hepatocellular carcinoma, are more common in men, while some types, such as fibrolamellar carcinoma, are more common in women.
People with a family history of liver cancer are at increased risk for developing this condition. A study reported four times increased risk of liver cancer in people with a sibling, parent, or child suffering from liver cancer.
Certain inherited conditions, such as hemochromatosis and Wilson's disease, that affect the liver are also considered liver cancer risk factors. Hemochromatosis is a condition that involves abnormal accumulation of iron in the body, leading to cirrhosis and liver cancer.
Obese or very overweight people have an increased risk of fatty liver disease and cirrhosis due to fat accumulation and liver inflammation. This inflammation can become chronic and increase the risk of liver cancer.
Smoking also increases the risk of liver cancer. Studies have concluded that people who smoked and discontinued are at less risk of liver cancer than those who still smoke.
Heavy alcohol intake for a significant period results in cirrhosis and liver failure. Cirrhosis is an important liver cancer risk factor.
Aflatoxins are cancer-causing chemicals. The fungus produces these chemicals, contaminating wheat, peanuts, corn, groundnuts, and rice. Exposure to aflatoxins raises the liver cancer risk, especially in patients with hepatitis infection.
Certain rare conditions, such as tyrosinemia, porphyria cutanea tarda, alpha1-antitrypsin deficiency, and glycogen storage diseases, are also identified as liver cancer risk factors.
“How to prevent liver cancer?” or “How to avoid liver cancer?” is a very important question. While it is important to know that there are no known ways to prevent liver cancer, there are some measures that one can take to reduce their risk of liver cancer:
Getting vaccinated for hepatitis B infection reduces the risk of getting the disease, lowers the chances of hepatitis B infection, and serves as an effective liver cancer preventive measure. People at increased risk for hepatitis B infection should undergo routine screening.
Preventing hepatitis C infection can help in the potential prevention of liver cancer. The preventive measures include avoiding unprotected sex, not injecting illegal drugs, and getting tattoos at clean shops.
When diagnosed with a hepatitis B or C infection, it is important to promptly see a doctor and receive the necessary treatment.
Limiting alcohol intake may increase the chances of liver cancer prevention. Moderate alcohol intake is ≤2 drinks per day for men and ≤1 drink per day for women. Limiting alcohol consumption lowers the risk of cirrhosis, which is also found to increase the risk of liver cancer.
Prevention of liver cancer can also be achieved by maintaining a healthy weight. If the patients are not overweight or obese, they should maintain their weight with healthy food and exercise habits. If the patients are obese or overweight, they need to lose weight by limiting calorie intake and increasing physical activity.
Our doctors often have people ask them how to prevent liver cancer naturally. Eating a healthy diet assists in optimal liver function and is an important measure that increases the chances of liver cancer prevention. Including fresh fruits and vegetables in the diet, especially fiber-rich foods, is helpful. Foods to fight liver cancer include eggs, beans, and soy. These may be included in the potential liver cancer prevention diet.
Reducing exposure to aflatoxins by avoiding contaminated food can lower one’s risk of developing liver cancer.
Exposure to certain toxins, such as thorium dioxide and vinyl chloride, raises the risk of liver cancer. Avoiding chronic exposure to these toxins can increase the chances of liver cancer prevention.
Quitting smoking can increase the chances of liver cancer prevention. Quitting smoking helps reduce inflammation and fat buildup in the liver, which are known to increase liver cancer risk.
Routine screening, especially in people with a high risk of liver cancer, helps diagnose and treat liver cancer at an early stage with favorable outcomes.
Liver carcinoma develops in the liver. Primary liver cancer initiates in the liver, while secondary liver cancer (liver metastases) spreads to the liver from other organs. There are several types of liver cancer, such as hepatocellular carcinoma, cholangiocarcinoma, angiocarcinoma, and hepatoblastoma. The liver cancer stages are defined based on the TNM staging system.
