The liver is the largest organs of the body which is located below the right lung and inside the ribcage. The liver performs a variety of functions majorly detoxification, break-down of fats, synthesis of proteins and it also aids in digestion.
Liver cancer is also known as hepatic cancer and it develops liver tissues. Hepatocellular carcinoma (hepatoma or HCC) is the most common type of cancer which affects the liver.
The various types of liver cancer are based on the type of cells that becomes cancerous in it which are as follows:
- Hepatocellular carcinoma (HCC): It is also known as hepatoma. It accounts for 75% of liver cancer. It starts in the main liver cells, known as hepatocellular cells. These mostly result due to infection with hepatitis B or C, or sometimes due to cirrhosis of the liver caused by alcoholism.
- Fibrolamellar HCC: It is a rare type of HCC but it is more responsive to treatment than any other liver cancer.
- Cholangiocarcinoma: It is also known as bile duct cancer occurring in bile ducts that carry bile to the gallbladder. Cholangiocarcinomas account for 10-20 %of liver cancers.
- Angiosarcoma: It is also known as hemangiosarcoma, accounting for about 1 % of liver cancers. Angiosarcomas start in the liver blood vessels. Mostly diagnosed at an advanced stage.
- Secondary liver cancer: It is also known as liver metastasis and it develops when primary cancer from another part of the body spreads to the liver. Most of the liver metastasis originate from colon or colorectal cancer.
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The general liver cancer risk factors are:
- Age: Mostly the onset of liver cancer is 60 + years.
- Gender: Generally men are more likely to develop it than women, in the ratio of 2:1.
- Race and ethnicity: It is highest in Asian Americans and Pacific Islanders.
- Any chronic infection with Hepatitis B virus (HBV) or Hepatitis C virus (HCV) can cause liver cancer. These mostly lead to cirrhosis of the liver. Both hepatitis viruses can spread from by sharing of contaminated needles (like in drug use), or through unprotected sex, or childbirth or through blood transfusion.
- Heavy use of alcohol: Alcohol abuse causes cirrhosis of the liver and leads to liver cancer.
- Smoking: Tobacco increases the risk of liver cancer.
- Anabolic steroids: Mostly used by athletes for strength and muscle mass,.Its long-term usage causes the increased risk of liver cancer.
- Arsenic: Severe exposure to arsenic through drinking water causes risks of liver cancer.
- Aflatoxins: Cancer-causing substance aflatoxins made up of fungus contaminates grains and nuts due to storage of the food in a moist, warm environment, particularly found in the warmer and tropical countries lead to liver cancer risk most specifically in people with HBV or HCV infections.
- Exposure to certain chemicals: Many times exposure to vinyl chloride and thorium dioxide increases the risk of developing angiosarcoma of the liver.
Other conditions which risk causing liver cancer are:
- Cirrhosis of the liver: When liver cells are damaged and replaced by scar tissue. It is caused because of alcohol abuse and chronic HBV or HCV infections, non-alcoholic steatohepatitis (NASH, a fatty liver disease in obese people who may or may not consume alcohol), in some inherited metabolic diseases and autoimmune diseases.
- Metabolic diseases: Some inherited metabolic diseases causing cirrhosis increases the risk of liver cancer. Genetic hemochromatosis, tyrosinemia, alpha-1-antitrypsin deficiency, porphyria cutanea tarda, glycogen storage disease, and Wilson disease though are rare diseases but can damage the liver.
- Diabetes: Diabetes also increases the risk of liver cancer.
Liver cancer symptoms are different for every person and any one of the symptoms can be caused by other, benign conditions. Liver symptoms are:
- Weight loss when is not associated with diet changes.
- Appetite decreases or a feeling of fullness after a small meal.
- Nausea and vomiting.
- General weakness and/or fatigue or ongoing weakness or fatigue.
- Fever but should not be related to other conditions.
- Pain that is occurring in the upper part of the abdomen either on right side or near the right shoulder blade.
- Enlarged liver (hepatomegaly)
- Enlarged spleen
- Abdominal swelling (ascites) or bloating in the abdomen part of the body as a result of the occurrence of a mass form.
- Jaundice, yellowing of the skin and eyes.
These symptoms are being seen in relation to other types of benign liver infections or diseases. Though in case of liver cancer, symptoms will continue to grow and worsen as the disease will advance.
Then there are times when paraneoplastic syndromes can cause symptoms in other parts of the body. These some paraneoplastic syndromes which are related to liver cancer are:
- Hypercalcemia: when there are high blood calcium levels
- Hypoglycemia: when there are low blood sugar levels
- Erythrocytosis: when there is high red blood cell count
- Hypercholesterolemia: when there are high cholesterol levels
- Gynecomastia: when there is breast enlargement
- when the testicles in men shrink.
In order to determine the liver cancer staging American Joint Committee on Cancer (AJCC) devised TNM system which is the widely accepted method. In this method the staging criteria are based on the evaluation of three primary factors which are:
- Tumor (T): It describes the number and size of the original liver tumor formed.
- Lymph Node (N): It shows whether the cancer is present in the regional (nearby) lymph nodes or not.
- Metastasis (M): It refers to where cancer has spread to distant parts of the body.
Numbers ranging from (0-4) or the alphabet X is given to each factor. A higher number shows the increasing severity. For instance, if the T1 score is given it shows a smaller tumor than a T2 score and alphabet X indicates that the information could not be assessed.
Once all the staging by T, N, and M scores have been assigned, one can determine the overall liver cancer stage.
The early stages of liver cancer might go undetected for a longer period of time. Once some symptoms start appearing then some diagnostic tests are performed to detect Liver cancer which are;
- Blood test to detect AFP (alpha-fetoprotein), a type of protein produced by cancerous tumors
- MRI or CT scan
- Biopsy to detect and reveal the tumor (cancerous (malignant) or non-cancerous (benign))