Liver cancer is one of the most common malignancies worldwide, affecting nearly one million individuals. The most common cancer that begins in the liver is called hepatocellular carcinoma; this is associated with several chronic liver diseases, including alcoholic cirrhosis, chronic Hepatitishepatitis B, and Hepatitishepatitis C. Certain metabolic conditions are also associated with HCC, including hemochromatosis, autoimmune hepatitis, and Primary Biliary Cirrhosis.
Studies have found the following risk factors for liver cancer:
Infection with hepatitis B virus (HBV) or hepatitis C virus (HCV): Liver cancer can develop after many years of infection with either of these viruses. Around the world, infection with HBV or HCV is the main cause of liver cancer. HBV and HCV can be passed from person to person through blood (such as by sharing needles) or sexual contact. An infant may catch these viruses from an infected mother. Although HBV and HCV infections are contagious diseases, liver cancer is not. You can’t catch liver cancer from another person.
Heavy alcohol use: Having more than two drinks of alcohol each day for many years increases the risk of liver cancer and certain other cancers. The risk increases with the amount of alcohol that a person drinks.
Aflatoxin: Liver cancer can be caused by aflatoxin, a harmful substance made by certain types of mold. Aflatoxin can form on peanuts, corn, and other nuts and grains. In parts of Asia and Africa, levels of aflatoxin are high. However, the United States has safety measures limiting aflatoxin in the food supply.
Iron storage disease: Liver cancer may develop among people with a disease that causes the body to store too much iron in the liver and other organs.
Cirrhosis: Cirrhosis is a serious disease that develops when liver cells are damaged and replaced with scar tissue. Many exposures cause cirrhosis, including HBV or HCV infection, heavy alcohol use, too much iron stored in the liver, certain drugs, and certain parasites. Almost all cases of liver cancer in the United States occur in people who first had cirrhosis, usually resulting from hepatitis B or C infection, or from heavy alcohol use.
Obesity and diabetes: Studies have shown that obesity and diabetes may be important risk factors for liver cancer.
The more risk factors a person has, the greater the chance that liver cancer will develop. However, many people with known risk factors for liver cancer don’t develop the disease.
Early liver cancer often doesn’t cause symptoms. When the cancer grows larger, people may notice one or more of these common symptoms:
- Pain in the upper abdomen on the right side
- A lump or a feeling of heaviness in the upper abdomen
- Swollen abdomen (bloating)
- Loss of appetite and feelings of fullness
- Weight loss
- Weakness or feeling very tired
- Nausea and vomiting
- Yellow skin and eyes, pale stools, and dark urine from jaundice
These symptoms may be caused by liver cancer or other health problems. If you have any of these symptoms, you should tell your doctor so that problems can be diagnosed and treated as early as possible.
To determine if you are suffering from a GIST tumor, as well as whether it is surgically removable, your surgical oncologist will perform a number of diagnostic tests, including:
- Physical exam and history : An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
- Blood Tests: Many blood tests may be used to check for liver problems. One blood test detects alphafetoprotein(AFP). High AFP levels could be a sign of liver cancer. Other blood tests can show how well the liver is working.
- CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, such as the chest, abdomen, and pelvis, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
- Ultrasound exam: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram. An abdominal ultrasound is done to diagnose liver cancer.
- Chest X-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
- Biopsy: The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. The biopsy may be done after surgery to remove the tumor. If the tumor clearly cannot be removed by surgery, the biopsy may be done using a fine needle to remove cells from the tumor.
- MRI: MRI scans use radio waves and strong magnets instead of X-rays. The energy from the radio waves is absorbed and then released in a pattern formed by the type of tissue and by certain diseases. These scans can help oncologists find the extent of the cancer in the abdomen.
Doctors use a staging system to describe the extent of spread of most types of cancer, including gastrointestinal stromal tumors (GISTs). The most common system used is the TNM system of the American Joint Committee on Cancer (AJCC). This system is based on 4 key pieces of information:
- T describes the size of the primary tumor, measured in centimeters (cm).
- N describes whether the cancer has spread to nearby (regional) lymph nodes (this is very rare for GISTs).
- M indicates whether the cancer has metastasized (spread) to other organs of the body. If a GIST does spread, most often it is within the abdomen, such as to the liver. Less often, it may spread to the lungs and bones.
- The mitotic rate is a measure of how fast the cancer cells are growing and dividing. It is described as either low or high. A low mitotic rate predicts a better outcome.
Numbers or letters appear after T, N, and M to provide more details about each of these factors:
- The numbers 0 through 4 indicate increasing severity.
- The letter X means “cannot be assessed” because the information is not available.
Once the T, N, and M groups have been determined, they are then combined to give an overall stage, using Roman numerals I to IV (1 to 4):
Stage I: T1, N0, M0: There is a single tumor (any size) that has not grown into any blood vessels. The cancer has not spread to nearby lymph nodes or distant sites.
Stage II: T2, N0, M0: Either there is a single tumor (any size) that has grown into blood vessels, OR there are several tumors, and all are 5 cm (2 inches) or less across. The cancer has not spread to nearby lymph nodes or distant sites.
Stage IIIA: T3a, N0, M0: There is more than one tumor, and at least one is larger than 5 cm (2 inches) across. The cancer has not spread to nearby lymph nodes or distant sites.
Stage IIIB: T3b, N0, M0: At least one tumor is growing into a branch of a major vein of the liver (portal vein or hepatic vein). The cancer has not spread to nearby lymph nodes or distant sites.
Stage IIIC: T4, N0, M0: A tumor is growing into a nearby organ (other than the gallbladder), OR a tumor has grown into the outer covering of the liver. The cancer has not spread to nearby lymph nodes or distant sites.
Stage IVA: Any T, N1, M0: Tumors in the liver can be any size or number and they may have grown into blood vessels or nearby organs. The cancer has spread to nearby lymph nodes. The cancer has not spread to distant sites.
Stage IVB: Any T, Any N, M1: The cancer has spread to other parts of the body. (Tumors can be any size or number, and nearby lymph nodes may or may not be involved.)
Liver tumors may be benign or malignant, but most require surgical removal. MedStar Health physicians work closely with patients to develop the best treatment plan for their specific case, which may include the following:
- Surgery: Surgery to remove part of the liver is called partial hepatectomy. This operation is considered for a single tumor that has not grown into blood vessels. It is only an option in patients with good liver function who are healthy enough for surgery.
- Ablation: This procedure involves destroying the liver tumor and the cancer cells with high levels of heat aimed at the tumor. It has minimal side effects.
- Radiofrequency ablation (RFA): This technique uses a heating probe to destroy tumors with an alternating radiofrequency electrical current. It can be performed during open surgery, laparoscopy, or through the skin using X-ray.
- Microwave ablation: This technique is similar to radiofrequency ablation, but uses microwave energy to destroy the tumor instead.
- Resection: Portions of the liver are surgically removed (The liver quickly regenerates, or grows back, to normal size, after this procedure.). This can also be performed laparoscopically
- Radiation therapy: Radiation therapy uses high-energy rays to kill cancer cells. There are different kinds of radiation therapy
- Chemotherapy or other drug therapy: Systemic (whole body) chemotherapy uses anti-cancer drugs that are injected into a vein or given by mouth. These drugs enter the bloodstream and reach all areas of the body, making this treatment potentially useful for cancers that have spread to distant organs. The drugs that have been most effective as systemic chemo in liver cancer are doxorubicin (Adriamycin), 5-fluorouracil, and cisplatin. But even these drugs shrink only a small portion of tumors, and the responses often do not last long. Even with combinations of drugs, in most studies systemic chemo has not helped patients live longer.
- Liver transplant: When it is available, a liver transplant may be the best option for some people with small liver cancers. At this time, liver transplants can be an option for those with tumors that cannot be removed with surgery, either because of the location of the tumors or because the liver is too diseased for the patient to withstand removing part of it.
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