20October2019

Andaman Chronicle

The Daily Diary of the Islands

Liver Cancer

By Dr Arun Kumar Verma, Senior Oncologist Max Hospital

Liver cancer is cancer that starts in the cells of your liver. Our liver is almost equal to a  football-sized organ that sits in the upper right portion of oour abdomen, beneath your diaphragm and above our stomach.

There are various types of cancer that can form in the liver. The most common type of liver cancer is hepatocellular carcinoma, which begins in the main type of liver cell (hepatocyte). Other types of liver cancer, such as intrahepatic cholangiocarcinoma and hepatoblastoma, are much less common.

Cancer that spreads to the liver is more common than cancer that begins in the liver cells. Cancer that begins in another area of the body — such as the colon, lung or breast — and then spreads to the liver is called metastatic cancer rather than liver cancer. This type of cancer is named after the organ in which it began — such as metastatic colon cancer to describe cancer that begins in the colon and spreads to the liver.

Symptoms

Most people don't have signs and symptoms in the early stages of primary liver cancer. When signs and symptoms do appear, they may include:

·         Weight loss

·         Loss of appetite

·         Upper abdominal pain

·         Nausea and vomiting

·         Weakness and fatigue

·         Abdominal swelling

·         Yellow discoloration of your skin and the whites of your eyes (jaundice)

·         White, chalky stools

Causes

The exact cause of liver cancer is not known.

However, most cases are linked to scarring of the liver, also referred to as cirrhosis.People with both hepatitis B or C have a significantly higher risk of developing liver cancer.Some inherited liver diseases, such as hemochromatosis, cause cirrhosis and also increase the risk of liver cancer.

Other risk factors for liver cancer development include:

Diabetes: People with diabetes, especially if they also have hepatitis, or regularly consume a lot of alcohol, are more likely to develop liver cancer.

Family history: If a person's mother, father, brother, or sister has had liver cancer, the person has a higher risk than others of developing the cancer themselves.

Alcohol Intake: Consuming alcohol regularly and in excessive amounts is one of the leading causes of cirrhosis in the U.S.

Long-term exposure to aflatoxins: An aflatoxin is a substance made by a fungus. It can be found in moldy wheat, groundnuts, corn, nuts, soybeans, and peanuts. The risk of liver cancer only increases following long-term exposure. This is less of a problem in industrialized nations.

Low immunity: People with weakened immune systems, such as those with HIV/AIDS have a risk of liver cancer that is five times greater than other healthy individuals.

Obesity: Being obese raises the risk of developing many cancers, including liver cancer.

Smoking: Individuals with hepatitis B or C face a higher risk of liver cancer if they smoke.

Arsenic: People who rely on water wells that contain naturally-occurring levels of the toxin arsenic may eventually have a significantly higher risk of developing several conditions or diseases, including liver cancer.

High-risk individuals for liver cancer should have regular screenings for liver cancer. Liver cancer, if not diagnosed early, is much more difficult to cure. The only way to know whether you have liver cancer early on is through screening because symptoms are either slight or nonexistent.

This includes people with hepatitis B and C, patients with alcohol-related cirrhosis, and those that have cirrhosis as a result of hemochromatosis.

Treatment

For people who have early-stage liver cancer that can be treated, only surgery that removes the tumors completely will lead to a chance of recovery.

Surgical options include the following:

Partial hepatectomy

When the tumor is small and occupies a small part of the liver, that part of the liver can be surgically removed.

Many people with liver cancer have cirrhosis. This means that a hepatectomy needs to leave behind enough healthy tissue for the liver to perform its necessary functions after the procedure.

It may be decided during surgery that this will not be the case, and the procedure may be canceled halfway through if the risk to the patient is deemed to be too great.

Partial hepatectomy is only considered for people with otherwise healthy liver function. This procedure is often not an option, as the cancer has spread to other parts of the liver or other organs in the body.

Liver surgery of this scale can lead to excessive bleeding and blood-clotting issues, as well as infections and pneumonia.

Liver transplant

Candidates for a liver transplant cannot have a tumor larger than 5 cm or several tumors larger than 3 cm. The risk of the cancer returning is too great to justify a procedure as risky as a transplant if the tumor is larger than this.

With a successful transplant, the risk of cancer returning is greatly reduced, and normal function can be restored.

The drugs that suppress the immune system to accommodate a new liver can also lead to serious infections and, on occasion, even the spreading of already metastasized tumors.

Treatment for incurable tumors

Advanced liver cancer, on the other hand, has an extremely low survival rate. However, there are steps to treat cancer symptoms and slow the growth of the tumor.

·         Ablative therapy: Substances are injected directly into the tumor, such as alcohol. Lasers and radio waves can also be used.

·         Radiation therapy: Radiation is directed at the tumor or tumors, killing a significant number of them. Patients may experience nausea, vomiting, and fatigue.

·         Chemotherapy: Medications are injected into the liver to kill cancer cells. In chemoembolization, the blood supply to the tumor is blocked surgically or mechanically, and anti-cancer drugs are administered directly into the tumor.

·         Volunteer for clinical studies: When trials reach the human stage they are called clinical trials. Ask your doctor whether there are any available in which you may be able to take part.

Stereotactic Body Radiotherapy (SBRT) For Liver Cancer : SBRT is latest targeted radiation therapy and new way of treatment for liver cancer. It is ray of hope in hopeless situation like inoperable and advanced cancer and makes patient eligible for liver transplant if rejected for transplant.

SBRT, a treatment with ability to focus a high dose of radiation, delivered with high precision to atumor while sparing the healthy tissues nesrby. Sometimes called ‘radiosurgery’ or Cyberknife’. It is a non invasive therapy .

Treatment options may vary, depending on the type of liver cancer