Besides being largest internal organ, it is also the heaviest organ, weighing on an average 1.6 Kg.
Reddish brown solid organ which is rubber like when touched.
Liver plays a vital role in our survival. It performs several critically important functions such as
Metabolism of drugs and toxins
Removing waste products of the normal metabolism
Formation of various enzymes and proteins such as blood clotting factors
Formation of bile that helps in the digestion or fats and removing metabolic waste and toxins through intestine.
Liver cancer, cancer that affects the liver cells.
Cancer is the uncontrolled growth of abnormal cells in the body.
When the liver cells become cancerous it is referred to as liver cancer.
The liver cancer can be
Primary, the one that starts in the liver
Secondary or Metastatic that had started in some other organ, however, spread to the liver eventually.
Such cancer is normally named after the organ where it began such as the cancer that began in colon and then spread to the liver, is referred to as metastatic colon cancer, not liver cancer.
Secondary liver cancers are more common than the primary liver cancer.
Primary liver cancer can again be of several types, the most common of them all is Hepatocellular(HCC) Liver Cancer.
It can manifest as a single growth that enlarges with time and in later stages it affects other liver tissues or multiple small nodules that usually happen in patients with chronic liver damage.
Here, we will talk about the most common type of liver cancer, Hepatocellular carcinoma(HCC) and will talk about it when we will talk of liver cancer.
Although there are further more types of liver cancer which are
Intrahepatic Cholangio Carcinoma, Bile Duct Cancer- This type of cancer, constitutes 10 to 20 percent of primary liver cancer. It affects the cells lining the bile ducts within the liver, the tubes that carry bile from the liver to the gall bladder where bile is stored. Interestingly, most of the bile duct cancers or Cholangiocarcinoms initiate in the ducts that are outside the liver.
Angiosarcoma or Hemangiosarcoma Rare. This cancer originates in the cells lining the blood vessels of liver. This cancer grows rapidly and by the time it is discovered, it loses the chance to be removed through surgery. Difficult to treat, although chemotherapy and radiotherapy do slow down the pace of the disease.
Hepatoblastoma Rare. Occurs in children who are usually younger than 4 yrs. This cancer cells are like fetal liver cells. Surgery and chemotherapy are carried out as treatment options, with a good success rate, provided the cancer is still confined to the tumor.
Signs and symptoms in the early stage of the liver cancer, are often absent in most people.
However, when they do manifest they may be one or more of the following:
Anorexia(loss of appetite)
Unexplained weight loss
Swelling in the abdomen
Pain in the upper abdomen
Peculiar white chalky faeces/stool
Nausea and vomiting
There are certain things that make a person susceptible to develop a specific medical condition.
These factors are referred to as the risk factors of that particular medical condition.
In case of primary liver cancer, the risk factors are
Chronic(long standing) infection with Hepatitis B and Hepatitis C Virus. (viral infection of the liver).
Progressive and irreversible damage to the liver caused by a medical condition called Cirrhosis. Cirrhosis is characterized by scarring of the liver which makes it almost impossible for the liver to function effectively. It is again caused by chronic alcoholism and chronic viral infection of the liver (Hepatitis B and Hepatitis C)
Certain conditions such as Hemochromatosis and Wilson's disease that are caused due to faulty genes passed on to the person from his parents.(Inherited diseases or genetic disorders)
Presence of Diabetes
Non Alcoholic Fatty liver disease Its a general term used for diseases that are caused due to accumulation of fat in the liver cells, which is not due to intake of alcohol. It is absolutely normal for the liver to have 5 to 10 percent fat, however if it exceeds it, it is termed as fatty liver. Normally seen in obese people. It eventually progresses to cirrhosis.
Role of Alfatoxins in causing liver cancer: Exposure to Alfatoxins is associated with increased chances of developing liver cancer. Dietary exposure of alfatoxins is responsible for HCC(Hepatocellular Carcinoma) in millions of people. These are the toxic compunds (poisonous carcinogens) produced by Aspergillus Molds that infest staple crops worldwide. More common is chronic low level exposure of alfatoxin, particularly Alfatoxin B1. However, its acute high level exposure is less common. People who eat alfatoxin contaminated dietary products are more prone to develop liver cancer.
Excessive intake of alcohol may increase your risk of developing liver cancer.
For patients who present with signs and symptoms related to the presence of the liver cancer may be advised tests or investigations.
Medical History and clinical examination will be done.
If it suggests the possibility of the presence of the liver cancer. Further tests would be ordered such as
Tests to check for the presence of Viral Hepatitis B & C
LFT(Liver Function Test) To evaluate the liver function. Usually, the liver cancer patient has an underlying liver disease such as cirrhosis or hepatitis that compromises the liver function. Under such circumstances, going for a liver resection surgery in order to cure the cancer in its early stages, will not be a wise option as removing a large chunk of liver will render the liver non functional leading to liver failure. Furthermore, chemotherapy and targeted therapy will also not serve the purpose. Carrying out this test will give your liver speacialist an idea about the liver function status and the possible treatment modalities that he can chose from.
Blood coagulation profile(Blood clotting tests) Interestingly, liver makes certain proteins that helps the blood clot. Diseased or damaged liver loses the ability to form clotting factors which lead to increased risk of bleeding and to assess this risk the liver specialist orders this test.
Alpha Fetoprotein Blood test: Alpha Fetoprotein(AFP) level can be high in case of any liver disease, liver cancer, in pregnant women or any cancer. A patient with a liver tumor coupled with high level of AFP signals towards presence of liver cancer although it is not a confirmatory test. Patients with early stage liver cancer may have normal AFP levels and patients with high AFP levles may not have liver cancer. However, AFP level may be utilized to see the efficacy of the treatment and watch out for the recurrence of the liver cancer after treatment.
Imaging such as USG, CT (Computed tomography)scan and MRI(Magnetic Resonance Imaging)
Biopsy To remove a tissue sample to see if it is cancer.
Once liver cancer diagnosis is confirmed, to further check for the extent of damage(staging), tests would be carried out.
Staging helps to define the size, location and spread of cancer.
It not only helps the liver cancer specialist to devise the most suitable treatment plan for the patient but also help determine the prognosis.
Bone scan To see if the cancer has spread to the bone.
A 1 Surgery is a viable option for patients with primary liver cancer that is still in its early stage and is confined to liver.
In other words, surgery will not do any good if the cancer has spread beyond the liver.
Also, before going ahead with the surgery in which the cancer affected part of the liver will be removed(liver resection or lobectomy), the oncosurgeon makes sure that after the removal, the remaining liver will function efficiently.
Certain tests are done to check the liver function.
A2 Removal (cutting away) of the cancer affected part and its surrounding healthy tissue of the liver is referred to as Liver resection.
A3 Liver resection(Hemi Hepatectomy;Lobectomy;partial Hepatectomy) is indicated under the following conditions:
Liver cancer is organ confined and small.
Cancer has not encroached the blood vessels
Liver is healthy otherwise with good function and even the patient is healthy enough to tolerate the major surgery.
One amazing quality of liver is that it has incredible regeneration capacity which means it can restore its lost tissue and can therefore ensure normal function eventually.
However, it is not so if the liver is damaged with other disease such as Cirrhosis.
In certain cancers, where the liver is healthy except the presence of small solitary tumor (Fibrolamellar cancer, a rare form of liver cancer) liver resection surgery is an appropriate treatment choice.
Liver cancer can recur even after resection if by any chance the cancer has already spread before surgery and remained undetected, so resection surgery is kept for those tumors that have least chances of spread.
Moreover, for the patints with Cirrhosis, they do not have enough healthy liver to cope up, after removing part of liver.
As a result, liver resection in a patient with cirrhotic liver(damaged liver) will make him vulnerable to develop liver failure.
For such patients, liver transplantation surgery will remain a viable option.
A4 When one entire lobe is removed from the liver, it is referred to as lobectomy or Hemi Hepatectomy.
A5 Liver Transplant is a possibility in a patient with HCC(Hepatocellular Liver Cancer) under following conditions:
Less than or equal to 3 small tumors, each maximum 3 cm across.
Single liver tumor which is maximum 5 cm across
Single liver tumor that has no grown for at least 6 months whether with or without treatment; size no more than 5 to 7 cm across
A prerequisite for liver transplant is a compatible liver donor.
The patient needs to be fit enough to have liver transplant as it is a major surgery and a severely damaged cirrhotic liver may render you inoperable or unfit for the surgery.
A detailed evaluation is done both of the patient and the donor to evaluate if the liver transplant surgery will be a viable option for the patient.
If possible,liver transplant is a better option in a liver cancer patient. It diminishes the possibility of the recurrence of new liver cancer and also makes sure that the liver functions normally.
A6 Liver resection surgery is a mojor surgery and like any other major surgery it is also associated with its own set of risks and side effects.
It is imperative that the credentials of the surgeon are confirmed as it needs highly skilled and experienced GastroIntestinal Liver Oncosurgeon.
Generally, patients with liver cancer also have accompanying liver disease, so while planning for liver resection surgery the surgeon has two goals in mind that he must achieve through the surgery.
To remove the cancerous tissue completely
To leave sufficient liver tissue for optimal liver function, after the surgery
Possible complications may be
Recurrence of liver cancer
A7 A live cancer patient with a cirrhotic liver is considered an eligible candidate for a liver resction surgery only if
Liver is functioning adequately(at least 30%) even after removal of the liver tumor.
Presence of only single tumor that has still not encroached the blood vessels.
A8 3 to 5 hours
A9 6 to 8 weeks is the usual time for the resected liver to restore its lost tissue through liver regeneration.
A10 Usually 5 to 6 weeks. However, it may vary from patient to patient.
A11 TARE (Trans Arterial Radio Embolization), a novel radiation treatment that has improved the survival rate of liver cancer patients. It is a minimally invasive procedure that permits the doctor to deliver the radiation directly to the liver, thus ensuring minimal side effects.
Not every patient is a suitable candidate for this procedure. Although, this procedure may be used in case of both primary(cancer originated in liver) as well as secondary liver cancer (Cancer from some other organ spread to the liver eventually). Patients with predominantly liver disease, however, with a relatively normal Liver function tests, as made sure by running lab investigations, are considered suitable for this procedure.
A12 A catheter or a flexible tube is inserted through an incision, into an artery in the upper part of the thigh, that goes directly into the liver.
Tiny beads of a radioactive element, referred to as Y-90 or Yttrium 90 are delivered to the liver through this catheter, placed in the artery. Thus, radioactive element targets the cancer cells in the liver with precision and spares the normal liver area.
Doctor who specializes in Vascular and Interventional Radiology, carries out this procedure.
Saket, New Delhi
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