Liver Cancer - Symptoms & Treatment

Liver cancer is an abnormal growth of cells in the liver. Often the abnormal growth is called a tumor. There are 2 types of liver cancer: primary and secondary. Primary liver cancer starts from cells in the liver. The 2 most common forms of primary liver cancer are:

• Hepatoma, which develops in the liver cells
• Cholangiocarcinoma, which develops in the cells lining the bile ducts within the liver.

Primary liver cancer accounts for roughly 2% of all cancers in North America and 10% to 50% of cancers in Africa and parts of Asia. It's most prevalent in men, particularly those over age 60, and the incidence increases with age. Mortality is high.

Most primary liver tumors (90%) originate in the parenchymal cells and are hepatomas (also called hepatocellular carcinomas or primary liver cell carcinomas). Some primary tumors originate in the intrahepatic bile ducts and are known as cholangiomas (also known as cholangiocarcinomas or cholangiocellular carcinomas). Rarer tumors include a mixed-cell type, Kupffer's cell sarcoma, and hepatoblastoma.

The liver is one of the most common sites of metastasis from other primary cancers, particularly melanoma and cancers of the colon, rectum, stomach, pancreas, esophagus, lung, or breast. In North America, metastatic liver cancer is about 20 times more common than primary liver cancer and, after cirrhosis, is the leading cause of fatal hepatic disease. Liver metastasis may occur as a solitary lesion, the first sign of recurrence after a remission.

Causes

The immediate cause is unknown but, in children. it's commonly attributed to congenital factors. Adult liver cancer may result from environmental exposure to carcinogens, including the chemical compound aflatoxin (a mold that grows on rice and peanuts), thorium dioxide (a contrast medium used for liver radiography in the past). Senecio alkaloids and, possibly, androgens and oral estrogens. Another high-risk factor is exposure to the hepatitis B virus.

Whether cirrhosis is a premalignant state or whether alcohol or malnutrition predisposes the liver to hepatomas is unclear.

Signs and Symptoms

Symptoms of liver cancer are:

• pain or discomfort on the right side, especially in the upper belly or around the right shoulder blade
• a hard lump on the right side just below the rib cage
• loss of appetite
• unexplained weight loss
• jaundice (yellowing of the skin and whites of the eyes).

Diagnostic tests 

Liver biopsy by needle or open biopsy reveals cancerous cells. Liver function studies are abnormal, and alpha-fetoprotein levels rise above 500 mcg/ml.

Chest X-rays may rule out metastasis to the lungs. A liver scan may show filling defects. Arteriography may define large tumors.

Electrolyte studies may indicate increased sodium retention (resulting in functional renal failure). hypoglycemia, hypercalcemia, or hypocholesterolemia.

Treatment

Because liver cancer may reach an advanced stage before diagnosis, few hepatic tumors are resectable. A resectable tumor must be solitary and not accompanied by cirrhosis, jaundice, or ascites. Resection is performed by lobectomy or partial hepatectomy.

Radiation therapy may be used alone or with chemotherapy. Chemotherapeutic drugs include fluorouracil, doxorubicin, methotrexate, streptozocin, and lomustine I.V. or regular infusion of fluorouracil or flex­uradine. Both therapies combined produce a better response rate than either therapy used alone. Liver transplantation is an alternative for some patients.

Prevention

You can follow a few simple guidelines, to reduce the risk of liver cancer:

• Avoid excessive alcohol drinking, hepatitis, and anabolic steroids. Excessive drinking is the most common cause of cirrhosis of the liver, which often leads to liver cancer.
• Ensure that you work in a safe environment, compliant with safety regulations.
• Eat small, frequent, well-balanced meals throughout the day.
• Family members should be checked for hepatitis infection. A vaccination is now available to protect against hepatitis B. Children should be vaccinated at the appropriate age. Ask your child's pediatrician.
• Exercise according to your health care provider's recommendations.