Liver Cancer: Symptoms, Causes and Treatment

Liver Cancer Symptoms, Causes and Treatment

Advised by Ārija Brīze, oncologist chemotherapist at Riga East Clinical University Hospital.

The liver is not only one of the largest odd organs in our body, but also the main laboratory that constantly "filters" the circulating blood, transforming the nutrients, vitamins and minerals into chemical chemicals that our body can use. The liver has a few hundred different important functions. They activate and inactivate various hormones, synthesize plasma proteins, regulate blood glucose levels, as well as "detoxify" the blood or remove toxins and other chemical wastes. Immobility, overweight, environmental pollution, alcohol consumption and other factors are increasingly threatening liver health, so special attention should be paid to this important organ. The good news is that new, more effective medicines for the treatment of liver diseases are also available in Latvia this year, which ensure longer survival and a better quality of life for liver cancer patients.

Liver - an example of patience and good behavior

The liver is patient - in most cases it does not hurt because it does not have nerve receptors that signal pain. If you have complaints of right-sided pain, these symptoms are more likely to be caused by problems with the gallbladder, inflammation of the bile ducts, or the pancreas. It is precisely because of this "good behavior" of the liver that a person often has no complaints until the malignant changes are already quite serious.

The liver is not only patient, but also "silent" - its tumor characteristics in the early stages are not specific and can be observed in other diseases, as well as indicate various other health problems, so liver cancer is often detected late.

Risk factors of Liver cancer

Liver cancer tends to be primary (develops in the liver) and metastatic (cancer cells enter the liver from other organs primarily affected by tumors, ie they may be metastases of colorectal cancer, neurodendocrine tumors, lung, breast cancer). The most common form is  Metastatic liver cancer than primary liver cancer. Continuous contact of the liver with a large part of the body's blood is to a large extent the reason why metastatic liver cancer is more common. For example, liver metastases develop in about 50% of colorectal cancer patients (in Latvia - more than 1,000 patients per year).

Primary liver cancer is the sixth most common tumor localization in the world, affecting mainly men over the age of 50, and the risk of the disease increases with age. The most common type of primary liver cancer (approximately 90% of cases) is hepatocellular carcinoma or hepatoma (the third most common cause of cancer-related death worldwide), which results from both hepatocytes and biliary epithelial cells.

In terms of statistics, the incidence of liver cancer in Latvia is lower than the world average, but this is largely due to the late detection of the disease - in many cases, a biopsy is not performed to confirm the diagnosis, because treatment is no longer possible due to the patient's condition.

The history of familial diseases, especially metabolic diseases, as well as a number of other diseases, such as: chronic hepatitis B and C, are also important in the development of liver cancer; cirrhosis of the liver, diabetes and hepatic steatosis or fatty hepatosis; iron and copper metabolism disorders or haemochromatosis and Wilson's disease (syndromes characterized by increased accumulation / deposition of iron and copper in various organs, including the liver); harmful habits - smoking and excessive alcohol consumption; long-term use of anabolic (muscle building) steroids; exposure to aflatoxins or carcinogens caused by mold resulting from improper storage on crops - grains, nuts.

In the context of public health safety and reducing the risk of liver cancer, it is important to emphasize two things - hepatitis B vaccination, which prevents hepatitis B virus infection and, consequently, the potential development of chronic inflammation up to the stage of cancer. as well as innovative hepatitis C therapy, which completely "frees" the body from the presence of this virus, preventing the development of liver cirrhosis (available in Latvia since 2017).

Symptoms of liver cancer

The symptoms of liver cancer are basically nonspecific.

Fatigue

One of the first signs of a health problem is fatigue and extreme weakness. When the body fights the disease, the body lacks energy, well-being does not improve even after prolonged rest or sleep.

Appetite disorders

Even after small meals, there may be a feeling of discomfort on the right side and an unpleasant feeling of "fullness". Over time, appetite may decrease or disappear altogether. Over time, this symptom may 'combine' with nausea, vomiting and other indigestion.

Weight loss

As the tumor develops, body weight may decrease.

Itching

Itching or inflammation of the liver can cause itching all over the body.

  

Delta

If the liver is not working properly (due to damage to liver cells or hepatocytes or narrowing of the bile ducts), the levels of the bile pigment bilirubin (a substance produced by the breakdown of hemoglobin) increase. When the pigment exceeds the specified norm, human skin, whites of the eyes and mucous membranes turn yellow.

Enlarged liver

As the tumor grows, the inflammation and also the size of the liver increase - the organ becomes sensitive, causing constant abdominal pain and bloating / increase in size (fluid accumulates in the abdominal cavity, spleen increases). The pain can also radiate to the back.

Diagnosis - not always easy

Liver cancer is often diagnosed by dynamic monitoring of other liver diseases. There are cases when suspicion is caused by abnormal laboratory liver tests, followed by more or less complicated imaging examinations - ultrasonography, computed tomography, magnetic resonance imaging, hepatic vascular angiography (with the use of contrast agents); laparoscopy and biopsy methods are also used to clarify the diagnosis.

It should be emphasized that due to its metastatic nature, radiological recognition of liver cancer is not always easy and simple - it requires a lot of experience and specialization from a radiologist to work with this tumor localization. Therefore, patients with the slightest suspicion of malignant processes in the liver should definitely undergo a diagnostic diagnosis in specialized oncology clinics.

How is liver cancer treated?

Unfortunately, liver cancer is not easily treatable and is one of the least favorable tumor localizations in terms of prognosis. The treatment of liver cancer is complicated and limited by the fact that it most often occurs in patients whose liver is already damaged. This is why it is more difficult for them to tolerate the necessary therapies or procedures - the side effects tend to worsen the liver function even more.

In the case of primary liver cancer, the best solution is surgical treatment. The success of tumor resection is influenced by the size of the tumor, the number of tumors, the involvement of liver "structures" (blood vessels, bile ducts), the extent of intact liver function, the spread of the tumor outside the liver. In addition, surgical techniques have evolved over the past decades, making their use increasingly successful.

However, in the case of liver cancer, surgical treatment is not always possible because it is not possible for the patient's general condition - there is too little healthy liver tissue for the liver to function after extensive surgery; the tumor is too widespread (several small tumors) to be operated on. Radiofrequency ablation can then be used, a minimally invasive method of radiology based on a high-frequency electrical current that is delivered precisely to the tumor, thus destroying it. Stereotaxic radiation therapy (radiosurgery) is also used in the treatment of liver tumors - precise "injection" of a very high dose of ionizing radiation into the tumor, as well as transarterial chemoembolization ("closure" of tumor bleeding arteries with the help of topically administered, special drugs).

New medicines and longer life expectancy

There are also not many new drugs in chemotherapy for liver cancer. One of the most effective - a tyrosine kinase inhibitor - was created more than 10 years ago. Increasingly, new clinical trials are demonstrating its ability to provide survival for more than two years in patients with hepatocellular carcinoma. In the case of primary liver cancer, this is really a lot. And these results are for the so-called "average patient", which means that there are patients who get even significantly better results when they start treatment on time.

In the case of primary liver cancer, we can finally catch up with the rest of the world in first-line therapy, so it is especially important to start treatment at the right time when the greatest benefit to the patient is possible. It is gratifying that the new medicine has been included in the list of reimbursable medicines in Latvia since July 2019 as the first choice medicine for the treatment of hepatocellular carcinoma and several patients are already receiving it by the decision of the Council.

There are currently second- and third-line drugs available in the world for the treatment of liver cancer - tyrosine kinase inhibitors, other targeted drugs and immunotherapy, but they have not yet been reimbursed in Latvia. In any case, oncology is one of the areas of therapy where biopharmaceuticals are entering the fastest and the principles of personalized medicine are being implemented. Therefore, it is to be hoped that survival and quality of life prospects will be further improved in liver cancer patients.