Liver Cancer- Understanding its leading causes and Treatment

Dr.Parveen Jain, 3 mins read

Liver cancer is an intrusive disease that arises from the various cells in the liver. When these cancer cells multiply rapidly and do not leave space for the normal cells then it causes Neoplasms (tumors) to form. These cancer cells spread to the other body parts through lymph nodes and blood. But with appropriate and effective treatment, we can fight and cure it.

Origin of Liver Cancer:

• Hepatocellular Carcinoma (HCC): This is the primary and most prevalent form of Liver cancer. It arises from the liver cells called hepatocytes. The majority of HCCs occur in patients with background chronic liver disease because of any cause like Hepatitis B, Hepatitis C, Alcoholism, and Non-alcoholic fatty liver disease. 
• Intrahepatic Cholangiocarcinoma (IHCC): Cholangiocarcinoma is a type of cancer arising from the cells lining the bile ducts. Cholangiocarcinoma is of 2 types depending on the location of the tumor. Intrahepatic cholangiocarcinoma is found inside the liver whereas extrahepatic cholangiocarcinoma is found outside the liver. 
• Hepatoblastoma: It is a rare tumor that originates from the liver. It primarily affects children < 5 years old but can also occur in adults. Boys are more commonly affected than girls. The exact cause is unknown but it is sometimes associated with genetic syndromes like Beckwith-Wiedemann syndrome or FAP syndrome. 

Causes of Liver Cancer:

The majority of liver cancer develops in the setting of chronic liver disease. The exact etiology of chronic liver disease may not be known but some of the common causes are Chronic hepatitis B or C, Obesity, Alcohol Consumption, non-alcoholic fatty liver disease (NAFLD), certain toxins like aflatoxins, certain genetic conditions like hereditary hemochromatosis, tyrosinemia, alpha-1-antitrypsin deficiency, porphyria cutanea tarda, etc. 

Risk Factors for Hepatocellular carcinoma (HCC):

Multiple risk factors have been identified:

• Cirrhosis due to any cause
• Chronic Hepatitis B: HCC can develop with or without the development of cirrhosis.
• Chronic Hepatitis C: the majority of Hepatitic C-related HCC develops in the setting of cirrhosis. 
• Environmental Toxins: like Aflatoxin B1, betel nut chewing, Iron overload states (without genetic susceptibility)
• Lifestyle factors: Alcohol consumption, Tobacco 
• Metabolic Factors: Non-alcoholic fatty liver disease, Diabetes Mellitus, Obesity
• Genetic susceptibility: Hereditary hemochromatosis, Alpha-1 antitrypsin deficiency, acute intermittent porphyria

Protective Factors for Hepatocellular carcinoma (HCC):

There are multiple protective factors:

• Hepatitis B vaccination: can prevent most of Hepatitis B related HCC 
• Treatment of Viral hepatitis: HBV treatment/HCV treatment
• Lifestyle factors: Coffee, Diet rich in omega-3 fatty acids & vegetables, Physical activity          

Stages of hepatocellular carcinoma: 

• Stage I: Solitary tumor up to 2cm in size or solitary tumor >2 cm but without vascular invasion. 
• Stage II: Solitary tumor > 2cm in size with vascular invasion or there are multiple tumors but none more than 5 cm.
• Stage III A: Multiple tumors with at least 1 tumor > 5cms in size. 
• Stage III B: solitary or multiple tumors of any size but with involvement of a branch of the portal vein or hepatic vein or tumor (s) with direct invasion of adjacent organs other than the gallbladder or with perforation of visceral peritoneum. 
• Stage IV A: At this stage of liver cancer, size, composition, and number are growing gradually but cancer has spread into the regional lymph nodes.
• Stage IV B: Tumor has spread to non-regional lymph nodes or distant organs. 

Liver Cancer Symptoms: 

The majority of HCC develops in the setting of chronic liver disease. There are many clinical presentations of HCC. These are:

• Asymptomatic: Many patients with chronic liver disease are under surveillance for HCC. In these patients, the majority of HCCs are detected in an early stage when they do not have any symptoms. 
• Liver decompensation: In patients with chronic liver disease with HCC, a patient may present with signs and symptoms related to liver decompensation like the development of ascites, confusional state, upper gastrointestinal bleeding, and jaundice. 
• In advanced disease patient usually presents with loss of appetite, weight loss, early satiety, and abdominal distension and pain. 
• Some patients present with features related to the spread of disease to other organs like bony pains, increase in calcium levels, breathlessness (if fluid in lungs or spread to lungs)

How to prevent Liver Cancer?

Prevention of HCC involves prevention strategies at multiple levels. 

Primary prevention strategies: Mainly focus on cutting down the risk factors associated with chronic liver disease. These are 

• Universal Hepatitis B vaccination
• Safe blood practices
• Lifestyle modifications like abstinence from alcohol & tobacco; weight loss and regular exercise. 

Secondary prevention strategies: Involves effective antiviral treatment of HBV/HCV to prevent the occurrence of chronic liver disease and prevent progression to HCC. 

Tertiary prevention strategies: Focus on the active treatment of HCC to prevent its recurrence. 

Liver Cancer Treatment:

The most important factors considered before making a treatment plan for HCC are the liver functions and stage of HCC. Depending on these assessments, the various modalities are:

Partial hepatectomy: This surgery is considered in those patients with good liver functions and has liver limited disease with no vascular invasion. In this surgery tumor along with part of the normal liver is removed. 

Liver Transplants: A liver transplant is considered where the disease is limited to the liver but partial hepatectomy is not feasible due to the tumor's location, size, or inadequate expected residual liver functions. A liver transplant will not only treat the disease but also chances of second new cancers reduced and the new liver will function normally. There is a lot to prepare and plan when you are considering a liver transplant as an option. You must consult with a doctor and must take health checkups to see that your body is ready for the treatment. 

Ablation Procedures: This is one of the efficacious procedures as it consists of radiofrequency ablation where a thin-needle-like probe is inserted in the tumor and then high-energy radio waves are passed through the tip of the probe through the skin into the tumor and eradicate the tumor cells. 

Radiation Therapy: Radiation therapy is a therapy in which high doses of radiation are passed intensively to destroy the cancer cells from the liver. It is also known as radiotherapy. 

Targeted Therapy: These drugs can target the molecular changes which have happened in cancer cells. They work differently from chemotherapy drugs. These drugs mostly are given orally but can be injected sometimes. Like chemotherapy, these drugs enter the blood, circulate and reach almost all parts of the body. Conventional chemotherapy drugs are not very effective in HCC and usually, HCC is treated with targeted therapy or their combination with immunotherapy. 

Immunotherapy: Immune system works efficiently to destroy the cancer cells and at the same time doesn’t attack the normal cells with the help of checkpoint proteins. These checkpoints need to be turned on for an immune response to occur. Cancer cells use these checkpoints for avoiding immune system attacks. Immunotherapy agents block PD-1 and PD-L1 interaction to keep the checkpoints in an ‘on’ state. These are drugs that are injected and they also circulate everywhere in the body. These drugs are used either alone or in combination with targeted therapies to treat HCC.   

Chemotherapy: Chemotherapy is a drug that destroys very fast-growing cells like cancer cells and a few of the normal cells of the body like blood cells and mucosal cells. Chemotherapy is not very effective in HCC. However, they may be used in HCCs that have not responded to other types of therapies. 

If you have any queries related to liver cancer and its treatment, book an appointment with Aakash Healthcare and get consulted by some of the best liver cancer doctors in Delhi.

Also, Read: How Does Smoking Cause Cancer?