Liver Cancer: The Facts

What is it?

The liver is located on the right side of the body, directly under the diaphragm, which is the wall separating the area that contains the lungs from that which contains the stomach and other organs. The liver is divided into sections, often referred to as "lobes." It is also made of many types of different cells. The liver is the largest organ inside the body. It is responsible for secreting enzymes that allow your body to digest foods and absorb nutrients. The liver also helps to rebuild tissues and remove toxic waste from the body.

Liver cancer occurs when the cells of the liver divide uncontrollably and form malignant (or cancerous) tumors. There are many types of liver cancer. The name given to each type depends upon the location of the tumors and the type of cells that are affected.

• Hepatocellular Carcinoma (HCC) - HCC is the most common form of liver cancer. It is found in the hepatocytes, the primary cells of the liver. HCC can begin as a single tumor and spread to other parts of the liver as the tumor grows, or it can begin in different parts of the liver.
  
  
• Cholangiocarcinomas - Cholangiocarcinoma is the name given to cancer that starts in the bile ducts of the liver. The bile ducts are the tubules that transport bile from the liver into the gall bladder. Cholangiocarcinoma is less common than HCC.
  
  
• Angiosarcomas and Hemangaiosarcomas - Both of these cancers are among the most rare and begin in the blood vessels of the liver. These cancers grow rapidly and spread throughout the body often before they are detected.
  
  
• Heptablastoma - This form of liver cancer is often found in smaller children under the age of 4 years. When detected in its earliest stages, the survival rate for Heptablastoma is very high.
  

Who Gets it?

While there is no exact way to determine whether or not a person will develop liver cancer, certain risk factors are associated with it. For instance, people with one or more of the following risk factors have an increased chance of developing liver cancer. This does not mean that a person with one or more of these factors will definitely develop liver cancer, nor does it mean that a person with none of the risk factors will be safe from cancer.

• Gender - Males are more than two times more likely than females to contract liver cancer.
  
  
• Age - For the most part, with the exception of Heptablastoma, liver cancer is found more often in people older than 60 years old.
  
  
• Medical History - People with a history of certain medical conditions and diseases are also more likely to develop liver cancer.
  
  
  • Hepatitis: Both hepatitis B and hepatitis C are viral infections that attack the liver. These infections may never go away and, after many years, often lead to liver cancer. Both viruses are passed through the blood and other bodily fluids. Currently, a vaccine is available for protection against hepatitis B.
    
    
  • Cirrhosis: The primary cause of cirrhosis is excessive alcohol intake. Cirrhosis sufferers have damaged the cells of the liver and their bodies have replaced the liver cells with scar tissue. The scar tissue greatly decreases the effectiveness of the liver.
    
    
  • Aflatoxin: Aflatoxin is created by certain types of mold primarily found in Asia and Africa. It is rare in the United States, as the FDA (Food and Drug Administration) carefully monitors the contents of food in the country.
    
    
  • Vinyl Chloride and Thorium Dioxide: In the past, prolonged exposure to these chemicals could lead to liver cancer. In recent times, however, these chemicals are closely monitored and accidental, dangerous exposure is much more rare.
    

Symptoms

The following is a list of symptoms, or signs, most often associated with liver cancer. If you are experiencing one or more of these symptoms, or are generally concerned about your health, it is important to see your doctor . Only your doctor can determine whether or not you have liver cancer.

• Pain on the right side below the ribs
  
• Swollen or bloated abdomen
  
• Loss of appetite or disinterest in food, or feeling full after very small meals
  
• Tiredness, fatigue, or weakness
  
• Nausea and vomiting
  
• Yellow skin or eyes (Symptoms of jaundice, which indicate poor liver function)
  
• Fever
  

How is it Detected?

• Physical Exam: The first step in diagnosing liver cancer is visiting a doctor for a consultation. The doctor will check for symptoms (see above) and conduct an examination. This procedure is typically non-invasive and not painful. For the most part, it is no different than a regular doctor's visit.
  
  
• Blood Tests: If your doctor thinks that you may be at risk for liver cancer, (s)he may do a series of blood tests to evaluate liver function or to look for the presence of hepatitis B or C. Blood tests require a needle, usually placed in the finger or arm, to collect blood. They can usually be conducted in the doctor's office or at a nearby clinic.
  
  
• Ultrasound: Ultrasound machines generate sound waves that bounce off the organs and create a picture of what these internal organs may look like. Ultrasound pictures can help to detect tumors on the liver. An ultrasound is a painless procedure. The patient will lie on an examining table while the doctor moves a small wand across the abdomen.
  
  
• Computer Tomography (CT): CT Scans are often taken at the hospital. CT scan machines take a series of x-rays of the body. The machine then compiles these pictures to provide the doctor with a detailed image of the internal organs. During the procedure, the patient will need to lie still while the CT machine rotates around the examining table. This procedure will not hurt, but some patients experience discomfort or claustrophobia (fear of small spaces) from lying still under a machine. Sometimes, the doctor may wish to give the patient a dye injection. This is similar to an IV (delivered through a vein in the arm or hand) and will help the machine get a clearer picture.
  
  
• Magnetic Resonance Imaging (MRI): MRI machines use radio waves, magnets and a computer to generate a picture of the internal organs. An MRI is similar to a CT scan, but often takes longer. During an MRI the patient must lie still inside of a narrow tube (about half the size of a full-sized bed). The machine will rotate and make noise while the patient is inside. The machine will not cause any pain. Like in a CT scan. The doctor may wish to provide an intravenous injection to make the image clearer. Some hospitals and MRI facilities now offer larger MRI machines for patients who may be frightened by the small space.
  
  
• Angiogram: This procedure will be done by a doctor in the hospital. During an Angiogram, a catheter, or small tube is inserted into the artery that supplies the liver. A local anesthetic is applied to the body to ease discomfort. Dye is then injected into the blood vessels and x-ray images are taken. The x-ray images show the path of blood through the liver and can indicate the location of the tumor.
  
  
• Laparoscopy: Laparoscopy uses a thin tube with a light on the end (called a laparoscope) to view the internal organs. The laparoscope is inserted into the body through a small incision on the abdomen. This procedure can help the doctor to see tumors on the liver, and it also allows for tissue samples to be taken out of the body and viewed under a microscope. A Laparoscopy is a surgical procedure. The patient will be under anesthesia. It is just like going to sleep for any surgery. The patient will wake up when the procedure is over. Because the laparoscope only needs a small incision, there is only minor discomfort associated with recovery. In most cases, the patient may go home the same day as the procedure.
  
  
• Biopsy: If a tumor is identified, a biopsy will be used to obtain a sample of cells from the tumor. These cells will then be tested and examined under a microscope to determine if they are malignant (cancerous). There are many types of biopsies, and your doctor will decide which kind will work best for you. In some biopsies, the doctor will insert a small needle into the tumor to extract some of the cells. This needle may be guided by a CT or an ultrasound image. The doctor may also remove a section of the tumor through an incision in the abdomen, usually during a laparoscopy. Also, the doctor may choose to perform surgery to remove the entire tumor, as well as some of the tissue surrounding it.
  

IS IT CURABLE?

Liver cancer is difficult to cure due to the fact that it is generally not diagnosed until a later stage. Research is being done on new ways to attack cancer cells that are growing in the liver, including drug therapies and new surgical techniques.

Like most cancers, survivorship dramatically increases with early diagnosis. Report any symptoms to your physician immediately, especially if you are in a high-risk category.

STAGING

After a doctor identifies the presence of liver cancer, usually through a biopsy, the stage of the cancer will be determined. A cancer's stage describes how advanced the cancer has become. Stage 1 is the lowest, least severe type of cancer, while Stages 3 and 4 are far more advanced. Stage 2 liver cancer can involve tumors of any size or more than one tumor but they invade the surrounding blood vessels. The stage of the cancer will tell the doctor how many tumors there are and how far the cancer has spread. The stage of the cancer plays an important role in determining treatment options.

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