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Cancer |
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CANCER : Liver
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The liver is the largest organ in the body, and the main heat-producing organ. It is surrounded by a fibrous capsule and is divided into sections called lobes. The liver is connected to the first part of the small bowel (duodenum) by a tube called the bile duct. This duct takes the bile produced by the liver to the intestine.
The liver is an extremely important organ that has many functions. This includes producing proteins that circulate in the blood. The liver also destroys harmful substances such as alcohol and gets rid of waste products. The liver is also responsible for breaking down food containing carbohydrates (sugars) and fats, so that they can be used by the body for energy. It stores substances such as glucose and vitamins so that they can be used by the body when needed. The liver also produces bile, a substance which breaks down the fats in food so that they can be absorbed from the bowel (intestine). The liver has an amazing ability to repair itself. It can function normally even if only a small part of it is in working order.
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LIVER CANCER
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The tumours of the liver could either be primary -- starting itself from liver or secondary / metastatic due to cancer in other part of the body.
Primary liver cancer has a rising incidence in Asia and Africa, even in younger age groups. It is twice as common in men as in women. There are two different types of primary liver cancer:
- Hepatoma or hepatocellular carcinoma (HCC) arises from the main cells of the liver (the hepatocytes). This type is usually confined to the liver, although occasionally it spreads to other organs. It is more common in men and occurs mostly in people with a liver disease called cirrhosis. There is also a rarer sub-type of hepatoma called fibrolamellar hepatoma, which may occur in younger people and is not related to previous liver disease.
- Cholangiocarcinoma or bile duct cancer is so called because it starts in the cells lining the bile ducts. Cholangiocarcinoma is more common in women.
Some primary tumours in the liver are non-cancerous (benign) and do not spread to other parts of the body. They are usually small and may cause no symptoms. |
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Causes of Primary Liver Cancer |
Many people who develop hepatoma usually also have a condition called cirrhosis of the liver. This is a fine scarring throughout the liver which is due to a variety of causes including infection and heavy alcohol drinking over a long period of time. However, not all people who have cirrhosis of the liver develop primary liver cancer.
Infection with either the hepatitis B or hepatitis C virus can lead to liver cancer and can also be the cause of cirrhosis, which increases the risk of developing hepatoma.
People who have a rare condition called haemochromatosis, which causes excess deposits of iron in the body, have a higher chance of developing hepatoma.
In Africa and Asia a poison called aflatoxin, found in mouldy peanuts and grain, has also been attributed as a major cause of hepatoma.
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| Bile duct cancers (cholangiocarcinomas) are less common than hepatomas. The cause of most bile duct cancers is unknown, but they are slightly more likely to occur in people with conditions which cause inflammation of the bowel, such as ulcerative colitis. In Africa and Asia, infection with a parasite known as the liver fluke is thought to cause many cholangiocarcinomas. |
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Diagnostic Tests
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Liver Function tests and tumour markers
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Liver ultrasound
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CT (computerised tomography) scan
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MRI (magnetic resonance imaging) scan
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Liver biopsy
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Hepatic angiogram
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PET CT scan: PET imaging with F-18 FDG has proven useful in differentiating malignant tumors from benign lesions on the basis of differences in their metabolic activity, in detecting malignant recurrence, evaluating tumor stage, and monitoring therapy for various malignant neoplasms . However, it is of limited value in primary liver cancer (Hepatoma/hepatocellular carcinoma). Approximately one third of primary liver cancers do not accumulate F-18 FDG and will provide false-negative on F-18 FDG PET scan. Therefore, F-18 FDG PET is not a screening tool to detect small liver cancer in patients at risk and in these patients it does not provide any information regarding intra-hepatic or distant disease. Therefore, ideal choice is a combined C-11 Acetate and F-18 FDG PET scan. C-11 Acetate detects well differentiated primary liver cancer, while F-18 FDG is helpful in detecting poorly differentiated liver cancer. In this region, ours is the only facility providing dual-istope PET CT scan for liver cancer. |
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Staging |
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| Stage 1 |
The cancer is no bigger than 2cm in size and has not begun to spread.
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| Stage 2 |
The cancer is affecting blood vessels in the liver, or there is more than one tumour in the liver.
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| Stage 3A |
The cancer is bigger than 5cm in size or has spread to the blood vessels near the liver.
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| Stage 3B |
The cancer has spread to nearby organs, such as the bowel or the stomach, but has not spread to the lymph nodes.
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| Stage 3C |
The cancer can be of any size and has spread to nearby lymph nodes.
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| Stage 4 |
The cancer has spread to parts of the body further away from the liver, such as the lungs. |
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| If the cancer comes back after initial treatment this is known as recurrent cancer. |
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Treatment |
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The choice of treatment depends upon various factors:
- Whether the cancer is a primary or secondary liver cancer
- Age
- General health
- Type, size and stage of the cancer
- Whether liver is affected by any other disease, such as cirrhosis.
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Surgery |
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Surgery is the most effective treatment for primary liver cancer, but this is not always possible due to the size or position of the tumour. It is also not possible to operate if the cancer has spread beyond the liver. If the liver is severely damaged by cirrhosis it may not be safe to have surgery.
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Liver resection |
If only certain areas of the liver are affected by the cancer and the rest of the liver is healthy, it may be possible to have an operation to remove the affected part: this is called a liver resection.
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Lobectomy |
If the operation removes a whole lobe of the liver, it is called a lobectomy.
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Liver transplant |
Removing the whole liver and replacing it with a liver from another person is another possible form of treatment for primary liver cancer, but can only be done in selected cases.
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Tumour ablation |
| This type of treatment is used for tumours less than 5cm in diameter. Liquids such as alcohol (ethanol) or acetic acid are injected through the skin and into the tumour. The liquids destroy the cancer cells. If the tumour grows again, the treatment can be repeated. |
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Laser or radiofrequency (thermal) ablation |
This treatment uses a laser or electrical generator to destroy the cancer cells. Under local anaesthetic, a fine needle is inserted into the centre of the tumour. Powerful laser light or radio waves are then passed through the needle and into the tumour; these heat the cancer cells and destroy them.
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Chemotherapy |
Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. It is sometimes used to treat primary liver cancers that cannot be removed.
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Radiotherapy |
| Radiotherapy is the use of high-energy x-rays to destroy cancer cells, while doing as little harm as possible to normal cells. It is not usually used to treat hepatomas, but it may be used to treat cholangiocarcinoma. |
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Other treatments |
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| Cryosurgery or cryotherapy |
In cryotherapy treatment a device called a cryoprobe is inserted into the centre of the tumour during an operation. Liquid nitrogen is then passed through the probe. This freezes the surrounding area and destroys the cancer cells.
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| Chemoembolisation |
This treatment involves mixing chemotherapy drugs with an oily substance called lipiodol. Under local anaesthetic the mixture is then injected into the liver through a tube inserted into the hepatic artery (the main blood vessel carrying blood to the liver). It is thought that adding lipiodol to the chemotherapy drugs helps them to remain in the liver for longer, and makes the treatment more effective. This treatment can be repeated several times. It is carried out in the x-ray department and you would usually need to stay in hospital for 24–48 hours.
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| Yttrium-90 Microsphere Radioembolization; |
Yttrium-90 microsphere radioembolization is an FDA approved, non-surgical procedure used to treat inoperable liver cancer. This innovative procedure delivers targeted, internal radiation therapy directly to the tumour. With yttrium-90 microsphere radioembolization, a catheter is inserted through a tiny incision in the groin and threaded through the arteries until it reaches the hepatic artery. The hepatic artery is one of two blood vessels that feed the liver and the one that usually supplies blood to the tumors. Once the catheter is properly placed in the hepatic artery, millions of tiny beads, or microspheres, which contain the radioactive element yttrium-90, are released into the blood stream. These microspheres lodge into the smaller blood vessels that feed the tumor. In addition to preventing blood flow to the tumor, the microspheres emit radiation that helps destroy the cancerous cells. The radiation only penetrates approximately 1/16” of tissue, so very little healthy liver tissue is affected by the radiation.
This method can be used treating both primary and secondary liver cancers.
Your treating doctor will be able to discuss with you all various treatment options in detail, according to your disease.
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