Liver Cancer: Causes, Manifestations, Treatment

Liver cancer is a serious disease. It is usually the result of another long-term illness, e.g. in hepatocellular carcinoma, which is preceded by cirrhosis caused by the formation of scar tissue known as fibrosis.

Cancer is a general term for the malignant type of oncological disease.

The Liver

It is a very important unpaired organ. The liver plays several irreplaceable roles in the body. We cannot live without it. Any dysfunction of the liver would affect the whole organism, and there is no back-up mechanism to make up for the dysfunction.

It processes the nutrients that we get from food. It also has an irreplaceable metabolic and detoxifying function. It serves as a storehouse of glycogen, proteins and fats. During embryonic development, it helps the process of hematopoiesis, i.e. the formation of blood cellular components. The liver also produces and excretes bile (exocrine function). Bile aids the digestion of lipids in the small intestine.

A Tumour is...

Oncological diseases (cancers) are a group of severe diseases. Tumour is a general term used to describe cells that grow independently and not controlled by the organism, like normal cells. Tumours are classified based on several criteria.

A common classification, known even by the general public, divides tumours into benign and malignant tumours. There is also a classification based on morphological features (organ enlargement, outgrowths), and another one based on the tissue out of which they grow. For example:

• mesenchymal tumour, which grows from tissues, such as blood vessels, blood cells, fat cells or muscle cells
• epithelial tumour, which appears on the skin and surface tissue, but also on glandular epithelium
• neuroectodermal tumour, which involves the central nervous system, nerves, but also of melanocytes (found in the skin)
• embryonal tumour, such as germ cell tumours arising from stem cells

Table: Classification of Tumours into Benign and Malignant

Also read the article: Are Tumor and Cancer the Same?

What is Liver Cancer?

Liver cancer is a malignant cancer. It may be primary, meaning that it comes from cells and tissues of the liver, or secondary, meaning that it is caused by metastasis from other parts of the body, most often from the digestive system.

Primary liver tumours are less common. Secondary tumours are the main cause of liver cancer. Thus, the cause is metastasis, that is, spread to the liver from tumours in other parts of the body. Malignant diseases of the abdomen typically spread to the liver through the bloodstream through a vein called v. portae.

Liver tumours occur mainly in developing countries, especially in Asia, West and Central Africa. In contrast, they are less common in Europe. They occur more frequently in men than in women (4:1). Liver cancer is the second most common cause of death due to cancer.

Liver cancer includes several malignancies, such as:

• Hepatocellular carcinoma is the most common malignant liver tumor
• fibrolamellar carcinoma, most common in liver cirrhosis, has a relatively good prognosis
• cholangiocarcinoma, which affects the bile ducts inside the liver, is not detected until a late stage, when it is no longer possible to operate on it
• hepatoblastoma
• angiosarcoma
• fibrosarcoma
• liver metastases are most common of pancreatic cancer (50%), colon (25%), stomach (20%)

The risk of developing a malignant liver tumour is increased by risk factors, such as liver cirrhosis and viral hepatitis B and C. A serious complication of these two diseases is hepatocellular carcinoma, which occurs after decades.

Hepatocellular Carcinoma

This disease ranks 5th among all malignant diseases. It is estimated that 1 million people worldwide will die from this cause. In up to 80% of cases, it is diagnosed when it is already at an advanced stage.

Hepatocellular carcinoma is formed by altered liver cells. And these grow into their surroundings. They behave invasively. They frequently invade the blood vessels that results in further complications.

The penetration of tumour cells into the blood vessels results in the spread of cancer to other parts of the liver. However, it also metastasizes to other parts and organs of the body. In most cases, liver cancer metastasizes to the lungs and the lymph nodes. Expansion to the bone is less common.

In order to determine the stage of hepatocellular carcinoma (HCC) the so-called BCLC staging from Barcelona is used. This classification is abbreviated BCLC, which stands for Barcelona Clinic Liver Cancer.

Table: BCLC Staging of Liver Cancer

In most cases, the development of liver cancer is conditioned by another long-term disease. Primary tumours are less common than secondary tumours. This means that, in most cases, the cancer is caused by metastases, i.e. the transmission of another malignant tumor to the liver.

The most common causes of metastasis include tumours in the abdominal cavity, such as cancer of the pancreas, colon, stomach, and rectum.

In men, metastases come from the prostate, in women from the uterus and ovaries. Metastases are also from other parts of the body, such as kidney, lung or breast cancer.

Of course, in the case of advanced stage cancer, the cancer cells are transferred from the liver to other organs, most often in the lungs and lymph nodes. The stages of cancer that are characterized by metastasis are listed in the table.

In addition to metastases, other long-term liver disease causes an outbreak. This disease is liver cirrhosis. The second group of diseases are infectious viral hepatitis, especially hepatitis B and C.

TIP: An article on viral hepatitis and how it is transmitted.

There are some risk factors involved in the development of liver cancer, including:

• liver cirrhosis (due to alcoholism, drug-induced liver injury poisons, viruses)
• hepatitis B and C, prevalence in cancer after 10 to 30 years
• being overweight and obese
• non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH)
• chronic inflammatory diseases of the digestive tract (ulcerative colitis)
• parasitic diseases (in Africa and Asia)
• alcoholism, up to 4 times more often with cirrhosis present
• smoking
• risky food intake and poor eating habits
  • foods high in aflatoxin (mold poison) and patulin (formed by fruit rot)
  • excessive intake of animal fats
  • lack of fiber
  • lack of minerals and vitamins
  • harmful substances from food processing (nitrosamine, benzpyrin), such as smoking, grilling, speed salt
  • for high fertilizer content
• long-term use of oral hormonal contraceptives
• excessive steroid use
• hemochromatosis
• Wilson's disease
• porphyria
• chemicals such as vinyl chloride, hydrazine, trichlorethylene
• arsenic contamination of water

Disease prevention is important. This mainly includes the exclusion or, at least, the reduction of risk factors. Changing eating habits and weight adjustment play an important role.

There is effective vaccination for viral hepatitis, but this is no longer the case for hepatitis C. Of course, in the presence of risk factors, regular monitoring is important. In 80% of cases, the disease is diagnosed at an advanced stage. Even in this case, preventive check-ups are very important.

In liver cancer, survival rate is reported to be more than 5 years after diagnosis of the disease, but in less than 5 percent of cases.

Liver cancer manifests itself clinically only at an advanced stage, which means it can be asymptomatic for a long time. This is also the cause of a bad prognosis (the likely course of a medical condition).

It is best if it is caught in the first two stages.

Early detection of liver cancer can be accidental, e.g. at a preventive check-up iby a GP. This disease is also a good example that regular preventive check-ups are important.

The symptoms of the disease vary depending on the root cause of the cancer. In cirrhosis, it depends on the extent of liver damage. Cancer impairs liver function, exacerbating the difficulties of cirrhosis.

The worsening of liver cirrhosis presents with symptoms, such as:

• icterus, i.e. jaundice, a yellowish or greenish pigmentation of the skin and whites of the eyes due to high bilirubin levels
• ascites, or swelling of the abdomen
• hepatic encephalopathy, and therefore impaired brain function due to liver failure
• gastrointestinal bleeding from esophageal varices

Among other diseases, there are issues that are typical of the original disease. There are also general symptoms of liver cancer and non-specific problems, such as:

• tiredness
• weakness
• nausea, feeling sick (vomiting)
• elevated body temperature - fever
• night sweats
• itchy skin
• weight loss
• loss of appetite
• feeling of abdominal discomfort
• havin the feeling of a full stomach, bloating, flatulence
• indigestion
• pain under the right rib arch (in the right hypochondria)

Other symptoms that occur in long-term liver disease and are exacerbated by cancer include:

• icterus, i.e. jaundice (yellow skin and whites of the eyes)
• portal hypertension
• swelling
  • of lower limbs
  • abdominal swelling, i.e. ascites, peritoneal cavity fluid, peritoneal fluid excess, hydroperitoneum, abdominal dropsy
  • later also the upper limbs
  • to anasarka, which is a swelling of the soft tissues of the whole body
• enlarged liver, or hepatomegaly
• feeling of resistance, i.e. swollen hard lump under the right rib cage (in the right hypogastrium)
• enlargement of the spleen (splenomegaly)
• spider angioma or spider naevus (dilated subcutaneous vessels, best visible on the nose)
• gynecomastia, which is an abnormal enlargement of one or both breasts in men
• impaired blood clotting, bleeding
• reddening of the palms (palmar erythema)

The pain is often described as dull and long-lasting, even persistent. The pain area is mostly below the right rib cage, and can radiate to the upper abdomen (epigastria). People with this disease often report a feeling of discomfort in the abdomen with a vague pain.

As a serious complication called acute abdomen may occur with bleeding into the abdominal cavity. This condition is life-threatening. At an advanced stage, it metastasizes, which in turn causes problems in the affected area.

The problem of late onset is a complication in the diagnosis and treatment of liver cancer. In the best case, the diagnosis is made at random during a preventive examination. The advanced stage of the disease is manifested by the symptoms that the person describes in the medical history.

Clinical symptoms and difficulties are monitored, and a physical examination is performed. These methods are complemented by imaging tests. These include abdominal ultrasound, CT and MRI. Also, an AFP blood test, short for alpha-fetoprotein, can be performed.

AFP is a protein that is typically found in larger amounts in the fetus. The level drops as the person ages. It is used as a marker to identify certain diseases, including viral hepatitis, cirrhosis, hepatocellular carcinoma, ovarian, testicular teratocarcinoma, and others.

A biopsy and histological examination of the collected material are used to diagnose cancer. Cancer staging is done on the basis of examinations. The result is a prognosis and recommendations for a workable treatment.

The basic problem of cancer is risk factors. These result in the formation of cancer cells. Of course, the highest rate is also attributed to alcoholism, which is related to liver cirrhosis, similar to viral hepatitis B and C.

Once the problems are triggered, the overall condition of the liver is affected. For example, if cirrhosis has a large extent, liver function deteriorates. This results in jaundice, i.e. a yellow discolouration of the whites of the eye and skin, which makes the swelling of the abdomen more prominent.

Problems with the central nervous system for hepatic encephalopathy come to the fore. There is a risk of bleeding from the esophageal varices, but also minor and long-term bleeding into the digestive system and overall reduced blood clotting.

Among non-specific problems, fatigue, loss of appetite and weight loss may be the first to be observed, and not just because of reduced dietary intake. It is associated with nausea, a feeling of abdominal discomfort or fullness of the abdomen.

In the next stage, there is abdominal pain, pain in the right side, mainly in the area under the right rib cage, which radiates to the upper area of the abdomen (under the sternum). The enlarged liver can be felt when touched.

Swelling, initially swollen lower limbs, swollen stomach (ascites), occurs at a late stage. An adverse manifestation is the swelling of the whole body, i.e. anasarca, i.e. when fluids penetrate the soft tissues. These symptoms are identical to issues in cirrhosis, failure of function, and not just as a result of liver cancer.

So, differential diagnosis is important. The primary cause of liver problems may also lie in cancer other than the liver. This has spread there by metastasis. In a later stage, hepatocellular carcinoma metastasizes elsewhere in the body.

The affected area later causes the typical symptoms of the disease. Late detection of the disease results in a poor prognosis and complicated treatment. The disease is fatal, but with early diagnosis and proper treatment, it is possible to prolong the patient's life by several years.