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The liver,
one of the largest organs of the body, has many important
functions that keep a person healthy. It removes harmful
material from the blood, produces enzymes and bile that
help digest food and converts food into substances needed
for life and growth.
Cancer of the liver, which may be primary or secondary
cancer, involves an uncontrolled growth of cells. Primary
cancer arises within the liver and in its early stages
exists only in the liver. Secondary liver cancer, also
called metastatic cancer, originates in another organ,
such as the colon, stomach, pancreas or breast and then
spreads to the liver. Because secondary cancer is present
in at least two organs, the treatment possibilities are
more limited than for primary liver cancer.
Primary liver cancer can affect anyone, but it occurs
most frequently in people with advanced liver disease.
In the United States, the risk is greatest for those with
longstanding hepatitis B, advanced hepatitis C and cirrhosis.
Because hepatitis viruses are so widespread, liver cancer
is the second most common cause of cancer death worldwide.
Certain inherited conditions also predispose a person
to liver cancer, including tyrosinemia in children, a
rare disorder in which the body can't effectively break
down the amino acid tyrosine, and untreated hemochromatosis,
a disorder that causes the body to absorb and store too
much iron, in adults. Common to all these conditions is
chronic liver inflammation and injury.
Signs and Symptoms
Liver cancer is a disease involving uncontrolled growth
of cells within the liver.
Cancer in the liver may be primary or secondary, also
called metastatic. Primary cancer arises within the liver
and in its early stages exists only within the liver.
People who have hepatitis B or C, viral infections of
the liver, or cirrhosis of the liver are more likely than
other people to develop primary liver cancer. At an early
stage primary liver cancer may cause no symptoms at all.
More advanced disease may cause loss of appetite, weight
loss, fever, fatigue and weakness.
Secondary liver cancer is term for cancer that originates
in another organ, such as the colon, stomach, pancreas
and breast and then spreads to the liver. Because secondary
cancer is present in at least two organs, the treatment
possibilities are more limited than for primary liver
cancer. As the cancer grows, pain may develop in the upper
abdomen on the right side and may extend into the back
and shoulder. With advanced disease, the signs of liver
failure appear, which include abdominal swelling and a
feeling of fullness or bloating and jaundice, a condition
in which the skin and the whites of the eyes become yellow
and the urine becomes dark.
Diagnosis
In making a diagnosis of liver cancer, your doctor will
evaluate your medical history and perform a careful physical
examination. Certain tests also will be recommended. For
people at increased risk of developing primary liver cancer,
such as those with chronic viral hepatitis or cirrhosis,
the current recommendation is to have an alpha-fetoprotein
blood test and an ultrasound examination of the liver,
at least annually. While not perfect, these tests increase
the chances of detecting liver cancer at an early stage.
• Certain
blood tests are used to see how well the liver is functioning.
•
X-rays of the chest and abdomen, angiograms or X-rays
of blood vessels; CT scans , or X-rays put together by
computer; and MRIs, or magnetic resonance images, created
by using a magnetic field, may be part of the diagnostic
process.
• If
there is uncertainty about the diagnosis, the presence
of liver cancer may be confirmed with a biopsy. Tissue
from the liver is removed through a needle or during an
operationand checked under a microscope for the presence
of cancer cells. Your doctor also may look at the liver
with an instrument called a laparoscope, which is a small
tube-shaped instrument with a light on one end. For this
procedure, a small cut is made in the abdomen so that
the laparoscope can be inserted. Your doctor may take
a small piece of tissue during the laparoscopy. A pathologist
then examines the tissue under the microscope to see if
cancer cells are present.
Once primary liver cancer is found, more tests
will be performed to determine if cancer cells have spread
to other parts of the body. The following stages are used
for adult primary liver cancer:
•
Localized respectable: Cancer is found in one place in
the liver and can be totally removed in an operation.
•
Localized unrespectable: Cancer is found only in one part
of the liver, but the cancer cannot be totally removed.
•
Advanced: Cancer has spread through much of the liver
or to other parts of the body.
•
Recurrent: Cancer has come back or recurred after it was
treated. It may come back in the liver or in another part
of the body.
Treatment
- Surgery
Surgery is the most common treatment for cancer of the
liver.
- Radiation therapy
Radiation therapy is the use of X-rays or other high-energy
rays to kill cancer cells and shrink tumors. Radiation
comes from a machine outside the body, or external radiation
therapy. Radiation can be used alone or in addition to
surgery and chemotherapy.
- Chemotherapy
Chemotherapy is the use of drugs to kill cancer cells.
Chemotherapy for liver cancer is usually put into the
body by inserting a needle into a vein or artery. This
type of chemotherapy is called a systemic treatment because
the drug enters the bloodstream, travels through the body,
and can kill cancer cells outside the liver. In another
type of chemotherapy called regional chemotherapy, a small
pump containing drugs is placed in the body. The pump
puts drugs directly into the blood vessels, called arteries,
that go to the tumor.
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