Cancerous (malignant) tumours of the liver can be primary cancer – cancer starting in the liver itself or secondary or metastatic cancer which started in another part of the body and has spread to the liver. Here you will be reading about primary cancer of the liver.
FUNCTIONS OF LIVER
The liver is the body’s biggest organ and the primary heat-producing organ. It is encased in a fibrous capsule and separated into lobes. It is located in the right-hand side of the body, in the upper part of the abdomen, and is encircled and protected from harm by the lower ribs.
The liver is a vital organ that serves a variety of tasks. Proteins that circulate in the blood are produced as part of the operation. Some of them aid in the clotting of blood and the prevention of excessive bleeding, while others are necessary for maintaining the body’s fluid balance.
The liver also eliminates injurious waste materials and destroys toxic drugs like alcohol. It performs this by dissolving components that are no longer needed by the body and excreting them in the urine or faeces (bowel motions).
The liver is also performing function of breaking down the carbohydrates (sugars) and fats in food so that the body may absorb them for energy. It stores compounds like glucose and vitamins in order for the body to utilise them when needed. Bile is a substance produced by the liver that breaks down lipids in diet so that they may be absorbed by the gut (intestine).
A tube called the bile duct connects the liver to the first section of the small intestine (duodenum). This duct transports bile from the liver to the intestines.
The liver has a miraculous ability to self-repair. Even if just a tiny portion of it is operational, it may operate normally.
PRIMARY LIVER CANCER
Primary liver cancer is uncommon in the United Kingdom and the rest of the Western world, although it is becoming more common. Each year, around 2500 people in the United Kingdom are diagnosed with this kind of cancer. It is one of the most frequent malignancies in other regions of the world, such as tropical Africa and portions of Asia. It affects twice as many males as it does women.
In total there are two different kinds of primary liver cancer.
• Hepatoma, also known as hepatocellular carcinoma (hcc), is a cancer that develops from the liver’s primary cells (the hepatocytes). This form is normally limited to the liver, however it can spread to other organs on occasion. It is more frequent in men and usually affects those who have cirrhosis, a kind of liver disease. Fibrolamellar hepatoma is an uncommon kind of hepatoma that can emerge in younger persons and is not linked to past liver disease.
• Cholangiocarcinoma, also known as bile duct cancer, is a kind of primary liver cancer that begins in the cells that line the bile ducts. Women are more likely to develop cholangiocarcinoma.
Non-cancerous (benign) primary tumours in the liver do not spread to other regions of the body. They’re generally little and don’t generate any noticeable symptoms. They’re sometimes discovered by accident during operations or inquiries into other issues. They normally do not need to be removed unless they are causing symptoms.
CAUSES OF PRIMARY LIVER CANCER
In the Western world, the majority of persons who acquire hepatoma also have cirrhosis of the liver. This is a fine damage throughout the liver caused by a number of factors including infection and long-term severe alcohol consumption. However, primary liver cancer affects only a small percentage of persons with cirrhosis of the liver.
Infection with either the hepatitis B or the hepatitis C virus can induce liver cancer and cirrhosis, which raises the likelihood of developing hepatoma.
People with haemochromatosis, a rare disorder that generates excessive iron deposits in the body, have an increased risk of getting hepatoma.
A poison called aflatoxin, which is present in mouldy peanuts and grain, is a major cause of hepatoma.
Hepatomas are more prevalent than bile duct tumours (cholangiocarcinomas). Most bile duct cancers have no known aetiology, however they are somewhat more likely to arise in patients who have gastrointestinal diseases that induce inflammation, such as ulcerative colitis. Infection with a parasite known as the liver fluke is suspected to be the cause of many cholangiocarcinomas.
Liver cancer is most common in middle-aged and elderly persons in the Western world, although it can also strike youngsters and young adults on rare occasions.
SIGNS AND SYMPTOMS
There are generally no symptoms in the early stages of primary liver cancer.
• A vague ache in the upper abdomen that might become unpleasant is sometimes noticed. This is caused by liver hypertrophy. The right shoulder might also be painful at times. An enlarged liver stimulates the nerves behind the diaphragm (the sheet of muscle beneath the lungs) that are related to nerves in the right shoulder, causing referred discomfort.
• Feeling of fullness in little food,
• loss of weight, nausea, and
• feelings of weakness and exhaustion (lethargy) are all frequent symptoms.
• Some people may have a high body temperature and a shivering sensation in body.
• Your gender also performs main role as liver cancer of more frequent in man then woman.
• Jaundice: When the bile duct is obstructed, the liver’s bile flows back into the circulatory through blood, causing jaundice. The colour of skin and whiteness of the eyes will become yellow, and the skin can also become irritated or inflammatory. Antihistamine pills or other medications prescribed by your doctor may help to ease the itching. Jaundice can sometimes be relieved on its own. This is accomplished by putting a tiny tube known as a stent into the bile duct to maintain it open and enable regular bile flow into the small intestine.
• Dark-colored urine and pale bowels (Bowel Motion) are other symptoms of jaundice.
• Ascites is a condition in which fluid builds up in the belly and produces swelling.
There may be several possible reasons for this:
• Cancer cells that have spread to the lining of the abdomen might irritate it, causing fluid to accumulate.
• If cancer cells in the liver produce an increase in pressure in the veins that go to the liver, this generates an increase in pressure in the veins that lead to the liver. Because the fluid from the abdomen cannot travel through the liver rapidly enough, it collects in the abdomen.
• The liver may generate less blood protein if it is impaired. This can throw off the body’s fluid balance, causing fluid to accumulate in the tissues, particularly the abdomen.
• Cancer cells obstructing lymphatic flow. The lymphatic system is a system of tiny tubes that runs throughout the body.One of its tasks is to drain excess fluid from the body, which is then passed out in the urine. If some of these channels get clogged, the system will be unable to drain properly, causing fluid to build up.
If ascites develops, a tube can be inserted through the abdominal wall to remove the fluid.
HOW IT IS DIAGNOSED
Typically, you’ll start by seeing your primary care physician, who will assess you and schedule any required tests or x-rays. For these tests, as well as professional advice and treatment, your doctor will recommend you to a hospital specialist.
• A physical examination and blood tests will be performed in the hospital to assess your overall health. You’ll get blood tests called liver function tests as well (LFTs).
• Your doctor may suggest one or more of the following tests for you:
Ultrasound of the liver:
This test creates an image of the liver using sound waves. You will be urged to fast for 4–6 hours before the scan and only consume clear drinks (nothing fizzy or creamy). A gel is applied to your abdomen after you are laying comfortably on your back. The region is then massaged with a tiny device, such as a microphone. A computer converts the sound waves into a visual image. It takes around 15–20 minutes and is absolutely painless.
CT Scan (computerized tomography)
In this scam a succession of x-rays is used to create a three-dimensional image of the inside of the body. The scan is quick and painless, taking around half an hour. It can be used to examine source of a tumour and whether or not it has outranged.
MRI (magnetic resonance imaging) scan
This scan creates a series of cross-sectional images of the inside of the body using magnetism rather than x-rays. You will be requested to lie quite motionless on a sofa inside a metal cylinder for the scan. Although the equipment is rather noisy, the test can last up to an hour and is absolutely painless. If you are claustrophobic, you may feel the machine little uneasy to deal with. Having a friend in the room with you for companionship is frequently beneficial.
The only way to be doubt free of the diagnosis is to draw out some cells or a tiny piece of tissue from the afflicted area and examine it under a microscope. A biopsy is the medical term for this procedure. After a local anaesthetic injection has numbed the region, a small needle is inserted through the skin into the tumour. To ensure that the biopsy is obtained from the correct location, a CT scan or ultrasound may be performed at the same time. You will be required to stay in the hospital for a few hours, if not overnight, following a liver biopsy. This is due to the possibility of bleeding thereafter.
There is a slight chance that cancer will spread along the biopsy needle’s route. You may not need a biopsy if your cancer hasn’t spread yet or if there’s a chance your tumour can be removed.
This is a minor procedure that lets doctors to examine the liver as well as other internal organs in the region. It is performed under general anaesthesia and will result in a brief stay in the hospital.
The doctor will create a tiny cut (incision) in the outside of your abdomen and insert a thin tube carrying a light and a camera (laparoscope). The doctor will be able to examine your liver and collect a small sample of tissue (biopsy) for examination under a microscope while you are under anaesthesia.
Carbon dioxide gas is injected into the abdominal cavity during the procedure, which might induce wind and/or shoulder discomfort for many days. Walking around or sipping peppermint water can help relieve discomfort. You will have one or two sutures in your abdomen after the laparoscopy.
This test helps physicians to observe how the tumour is impacting the liver’s main blood arteries.
A dye is injected through a tiny tube that is placed into an artery in your groin. The dye flows in the arteries, causing them to appear on x-ray. An angiography is performed in the x-ray department in a special room. An MRI scan can sometimes reveal the blood arteries of the liver, eliminating the need for an angiography.
Your doctor will schedule your treatment to a number of factors, including:
• Whether the cancer is primary or secondary;
• age group;
• overall general health;
• The type and length of the cancer;
• Whether it has spread outside the liver; and
• Whether the liver is affected by any other disease, such as cirrhosis.
Don’t be hesitant to ask your doctor or the nurse who is looking after you if you have any queries concerning your treatment. Making a list of questions for your doctor and bringing a close friend or relative with you may frequently assist.
Getting a second medical opinion before making a treatment choice might be reassuring for some people. Most doctors would gladly refer you to another expert for a second opinion if you feel it will be useful.
Surgery is the most powerful diagnosis for primary liver cancer, however it is not always practical due to the tumour’s size or location. Surgery is also not an option if the cancer has expanded beyond the liver. If the liver has been critically damaged by cirrhosis, surgery may not be suggested by doctors. Before undergoing any operation, it is vital to discuss everything in detail with your doctor so that you are entirely informed of what it entails.
Resection of the liver
If only a small portion of the liver is cancerous and the remainder of the liver is healthy, a liver resection may be performed that is to remove the unhealthy liver.
A lobectomy occurs when an entire lobe of the liver is removed during surgery.
The liver has a remarkable ability to self-repair. Even if up to three-quarters of the liver is removed, it will swiftly repair and may be restored to normal size in a few of weeks.
A liver transplant, which involves removing the entire liver and replacing it with one from another person, is another option for treating primary liver cancer, but it can only be used in a few cases when the tumour is small (less than 5cm) or when there are fewer than three tumours, each less than 3cm in size.
The hospital personnel will inform you of what to expect following your procedure. You may be admitted to the intensive care unit until you have recovered completely from the anaesthetic (this usually takes about 24 hours).
If you feel some pain or discomfort following a liver procedure that is alright and need not worry. Painkiller injections will be administered to you on a daily basis for several days following the procedure to prevent and treat discomfort.
Most patients are able to return home 6–12 days following surgery, although they will require pain medication for the next few weeks. It might take up to six weeks before you feel like yourself again.
Tumours with a diameter of less than 5cm (2 inches) are treated with this method. Liquids such as ethanol (ethanol) or acetic acid are injected into the tumour through the skin. Cancer cells are destroyed by the liquids. This operation is frequently performed in the scanning department so that the needle may be guided straight into the tumour using ultrasound. The therapy can be repeated if the tumour develops again.
Laser or radiofrequency (thermal) ablation
The cancer cells are destroyed with a laser or an electrical generator in this therapy. A tiny needle is injected into the tumour’s centre under local anaesthesia. The cancer cells are subsequently heated and destroyed by passing powerful laser light or radio waves via the needle and into the tumour.
Chemotherapy is the treatment of cancer cells with anti-cancer (cytotoxic) medicines. It’s occasionally used to treat non-removable primary liver malignancies.
Chemotherapy medications are generally injected into a vein (intravenously) or directly into the hepatic artery (direct injection) (the blood vessel that takes blood to the liver).
Chemotherapy is normally administered in a single treatment session that lasts a few days. This is followed by a few weeks of rest to allow your body to recuperate from any treatment-related adverse effects. The number of sessions you have will be determined by the type of liver cancer you have and how effectively the medications are working.
Chemotherapy can have unpleasant side effects, but it can also help you feel better by alleviating cancer symptoms. Any negative effects that do occur are typically minor and may easily be managed with medication. Reduced resistance to infection, nausea, a sore mouth, and hair loss are the most common adverse effects
Radiotherapy is the use of high-energy x-rays to kill cancer cells while causing the least amount of harm to healthy cells. Although it is not commonly used to treat hepatomas, it may be utilised to treat cholangiocarcinoma.
The medicines listed below are still being studied in clinical studies. Your cancer expert will be able to discuss if these therapies are appropriate for you and can recommend you to a facility that offers them.
Cryosurgery or cryotherapy is a treatment that involves inserting a device called a cryoprobe into the tumor’s centre during an operation. The probe is then filled with liquid nitrogen. This causes the surrounding region to freeze and the cancer cells to die.
Chemoembolisation- Chemotherapy medications are combined with an oily substance called lipiodol in this treatment. The combination is then injected into the liver by a catheter put through the hepatic artery under local anaesthesia (the main blood vessel carrying blood to the liver). The addition of lipiodol to chemotherapy medications is expected to help them stay in the liver for longer, making the treatment more effective. This procedure can be repeated as needed. It is performed in the x-ray department and generally necessitates a 24-48-hour hospital stay.
You are likely to feel a variety of emotions during your diagnosis and treatment, ranging from shock and disbelief to fear and fury. These feelings can be overpowering and difficult to manage at times. Being able to express them is both natural and necessary. Everyone copes with unpleasant situations in their own manner; some individuals find it beneficial to talk to friends or family, while others prefer to seek advice from others who are not in their situation. Others choose to keep their emotions hidden. There is no right or wrong way to deal, but if you need it, assistance is available.