Saturday, July 23, 2011

Cancer of the Liver

Overview, Causes, & Risk Factors

Cancer of the liver occurs when cells in the liver undergo changes that make the cells grow and divide uncontrollably. This is called primary liver cancer. Cancer from other places in the body can also spread to the liver. Cancer that has spread to the liver is called liver metastasis.
What is going on in the body?
The liver is a vital organ that functions to help the body to digest foods by producing substances to aid digestion. Many blood system activities occur in the liver, such as production of clotting factors. The liver also helps filter out certain wastes. The waste products are then eliminated from the body. When the liver is affected by cancer, it can no longer serve these functions.
The liver will begin to fail when a significant portion is replaced by cancerous tissue. Cancer in the liver can also block the elimination of waste products. This causes the waste products to build up in the blood. If untreated, the liver will fail completely and the person will die.
Primary liver cancer can spread to other parts of the body such as the lungs and bones.
What are the causes and risks of the disease?
Someone who has had hepatitis B or hepatitis C may be at higher risk for primary cancer of the liver. An individual who has had cirrhosis of the liver is at much higher risk. There may be other risk factors, such as the use of male and female hormones, for the development of this form of cancer. The relationship of those factors to liver cancer is controversial.

Symptoms & Signs

What are the signs and symptoms of the disease?
The first symptoms of liver cancer can be from the effect of waste products building up in the blood. The skin becomes yellow, a condition called jaundice. The urine may turn dark orange from the level of waste products in the blood. Nausea and vomiting are also common. Significant weight loss usually occurs. As the liver enlarges from cancerous growth, it becomes tender. Fluid, or ascites, can develop in the abdomen. The swelling from this can be painful.

Diagnosis & Tests

How is the disease diagnosed?
When a cancer of the liver is suspected, a liver biopsy is done to piece of tissue from the liver for examination in the laboratory. Specialized x-rays such as CT scans can help define the extent of the cancer in the liver. Liver function tests measure the function of the liver and help define the effect of the cancer or the liver.

Prevention & Expectations

What can be done to prevent the disease?
There is no known way to completely prevent primary liver cancer. It may be helpful to reduce hepatitis B risk with hepatitis B vaccination. Excessive alcohol use can lead to cirrhosis of the liver. Avoiding this may also help reduce the risk of liver cancer.
What are the long-term effects of the disease?
Primary cancer of the liver is fatal within a few months of diagnosis if not effectively treated. Most primary liver cancer is discovered in an advanced stage. In the advanced stage, treatment may not be effective in slowing the growth significantly.
What are the risks to others?
Liver cancer is not contagious, and poses no risks to others.

Treatment & Monitoring

What are the treatments for the disease?
The most common therapies for liver cancer include:
  • surgery, if the cancer is small and does not affect a large part of the liver

  • liver transplant to replace the cancerous liver, if the cancerous area is very small

  • radiation therapy. Small primary liver cancers can occasionally be treated with localized radiation therapy to the tumor. Radiation can not be given to the whole liver.

  • chemotherapy, which can be used with radiation to enhance the effect of the radiation therapy. Chemotherapy alone may be used to reduce the tumor size and to relieve symptoms.

  • an injection of ethanol, which is a form of alcohol, into the liver. Ethanol damages the cancer and may give long-term control.
    What are the side effects of the treatments?
    Side effects varying depending on the treatment.

  • Surgery to remove small tumors requires a period of recovery.

  • Liver transplantation takes an extended recovery period.

  • Localized radiation therapy may be well tolerated. Occasionally, the person experiences nausea and fatigue.

  • Side effects of chemotherapy depend on the type of medication used. The most common side effects are increased fatigue, nausea, and mouth sores. These side effects are usually mild and can be effectively treated.

  • Ethanol can cause pain in the site of the cancer. Sometimes the person has a fever from the damage to the cancer.
    What happens after treatment for the disease?
    A person with primary liver cancer will need to be monitored closely. As the cancer progresses, comfort measures can be offered as symptoms develop.
    How is the disease monitored?
    Some people with liver cancer have a high level of alpha-fetoprotein in their blood. This substance indicates the presence of a tumor. If the person has a high level at diagnosis, blood tests are repeated to check the level. Specialized x-rays, such as abdominal CT scans, also help monitor the disease. Any new or worsening symptoms should be reported to the healthcare provider.

    • Attribution

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    Sources
    Hepatocellular Cancer in Cancer Management: A Multidisciplinary Approach, Bower et al., PRR, 1996, pp.117-124.
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