Liver cancer is emerging as one of the fastest spreading cancers in India. India sees about 3-5 new cases of liver Cancer per 1,00,000 people per year. It is however, likely to be grossly under-reported as India does not have any population based data due to the absence of systematic cancer registry in the country. Considering the incidence of Hepatitis B here, the number of liver cancer patients definitely does not reflecting the real picture.
Most patients with liver cancer present when it is too late to offer any curative treatment. However when diagnosed early, there are treatment options available. Early detection always helps in better treatment outcome. High-risk category people should get screened regularly, and see a liver specialist if cancer is diagnosed. Patients with cirrhosis of liver are at high risk and should also be regularly screened for cancer.
What is Liver Cancer?
The liver continuously filters blood that circulates through the body, converting nutrients and drugs absorbed from the digestive tract into ready-to-use chemicals. The liver performs many other important functions, such as removing toxins and other chemical waste products from the blood and readying them for excretion. Because all the blood in the body must pass through it, the liver is unusually accessible to cancer cells travelling in the bloodstream.
The liver can be affected by primary liver cancer, which arises in the liver, or by cancer which forms in other parts of the body and then spreads to the liver. Most liver cancer is secondary or metastatic, meaning it started elsewhere in the body.
Because the liver is made up of several different types of cells, several types of tumours can form there. Some of these are benign (noncancerous), and some are cancerous and can spread to other parts of the body (metastasize).
What Causes Liver Cancer?
Primary liver cancer (hepatocellular carcinoma) tends to occur in livers damaged by birth defects, alcohol abuse, or chronic infection with diseases such as hepatitis B and C, hemochromatosis (a hereditary disease associated with too much iron in the liver), and cirrhosis. Liver cancer may also be linked to obesity and fatty liver disease. The incidence and prevalence of HCC is rising in India, mainly due to the epidemic of non-alcoholic fatty liver disease, and is poised to become the leading cause of cancer in India.
Globally, hepatitis B virus (HBV) is estimated to account for 33% of liver cancer deaths, alcohol for 30%,
hepatitis C virus (HCV) for 21%, and other causes for 16% like smoking, herbicides, chemicals, hormones, thorotrast etc; these relative figures show substantial variation between countries
A person with liver cancer may experience abdominal pain, unexplained weight loss, and fatigue. The symptoms of liver cancer do not usually become apparent until the disease reaches an advanced stage. Liver cancer may cause the following:
- jaundice, where the skin and eyes become yellow
- pain close to the right shoulder blade
- an enlarged liver, spleen, or both
- swelling in the abdomen or fluid build-up
- a full feeling after a small meal
Liver cancer might also cause swollen veins that are visible under the abdominal skin, as well as bruising and bleeding. It can also lead to high levels of calcium and cholesterol and low blood sugar levels.
Surgery that completely removes the tumours is the only way to improve the chance of recovery for people with treatable, early stage liver cancer. Surgical options include the following.
When the tumour is small and occupies a limited section of the liver, a surgeon can remove this part of the organ only to stop the cancer growing and spreading. In this case, a surgeon needs to leave enough healthy tissue after hepatectomy for the liver to function. Only people with otherwise healthy liver function are suitable for hepatectomy. Also, the procedure may not be a viable treatment option if cancer has already spread to other parts of the liver or organs in the body. Many people with liver cancer also have cirrhosis, or scarring of the liver, however.
There are a number of surgical options available to treat liver cancer. Candidates for a liver transplant must have a tumor smaller than 5 centimeters (cm) or several tumors smaller than 3 cm each. Otherwise, the risk of cancer returning is too great to justify a high risk transplant. A successful transplant reduces the risk of cancer returning and restores normal liver function.
However, the immune system may ‘reject’ the new organ, attacking it as a foreign body. There are limited opportunities to carry out transplants. The drugs that suppress the immune system and help the body adjust to a new liver can also leave a person susceptible to severe infections. Occasionally, these drugs may also contribute to the spread of tumors that have already metastasized.
Treatment for incurable tumors
Advanced liver cancer, including where it has spread to other areas of the body, has an extremely low survival rate. However, a cancer care team can take steps to treat the symptoms and slow the growth of the tumor. Treatment options may vary, depending on the type of liver cancer.
- Ablative therapy: A surgeon can use radio waves, electromagnetic waves and heat, or alcohol directly on the tumour to shrink it or prevent its growth. Destroying a tumour by freezing, which is known as cryoablation, may also be possible.
- Radiation therapy: A cancer care team directs radiation at the tumour or tumours, killing a significant number of them. Side effects might include nausea, vomiting, and fatigue.
- Chemotherapy: A medical team injects drugs into the bloodstream or a main blood vessel in the liver to kill cancer cells. In chemoembolization, a doctor surgically or mechanically blocks the blood vessel in conjunction with administering anticancer drugs directly into the tumour.
Can Liver Cancer Be Prevented?
Many liver cancers could be prevented by reducing exposure to known risk factors for this disease.
Avoid and treat hepatitis B and C infections
Worldwide, the most significant risk factor for liver cancer is chronic infection with hepatitis B virus (HBV) and hepatitis C virus (HCV). These viruses can spread from person to person through sharing contaminated needles (such as in drug use) through unprotected sex, and through childbirth, so some liver cancers may be avoided by not sharing needles and by using safer sex practices (such as always using condoms). Universal precautions are intended to prevent parenteral, mucous membrane, and non-intact skin exposures to blood-borne pathogens especially in health care workers. Vaccination against hepatitis B reduces the risk of chronic hepatitis, liver cancer and the WHO recommends hepatitis B vaccination for all children worldwide. People at high risk for HBV or HCV should be tested for these infections so they can be watched for liver disease and treated if needed.
Treatment of chronic HBV and HCV infection can eliminate the virus in many people and may lower the risk of liver cancer. A number of drugs are used to treat chronic HBV and HCV. These drugs reduce the number of viruses in the blood and lessen liver damage. Although the drugs don’t cure the disease, they lower the risk of cirrhosis and may lower the risk of liver cancer, as well.
Limit alcohol and tobacco use
Drinking alcohol can lead to cirrhosis, which in turn, can lead to liver cancer. Not drinking alcohol or drinking in moderation even in patients who already developed alcoholic cirrhosis could help in reducing the development of liver cancer.
Smoking also increases the risk of liver cancer, and not smoking will prevent some of these cancers. If you smoke, quitting will help lower your risk of this cancer, as well as many other cancers and life-threatening diseases.
Stay healthy and stay fit
People who are obese are more likely to have fatty liver disease and diabetes, both of which have been linked to liver cancer. The simplest preventive measures include life style modification, including prevention of obesity and control of metabolic diseases, such as diabetes and non-alcoholic fatty liver disease decreases the incidence of liver cancer.
Treat diseases that increase liver cancer risk
Certain inherited diseases can cause cirrhosis of the liver, increasing a person’s risk for liver cancer. Finding and treating these diseases early in life could lower this risk. For example, all children in families with hemochromatosis should be screened for the disease and treated if they have it. Treatment regularly removes small amounts of blood to lower the amount of excess iron in the body.
As suggested always, don’t fight with the disease after acquiring it but try to prevent it well ahead with small changes in your life style, treating diseases that can cause properly. This is the only option available, don’t ignore.
Article is written by Dr. Sujit C Patnaik, MBBS (Hons), MS (Gen.Surgery), FAIS, FMAS; Consultant Surgical Oncologist, Basavatarakam Indo American Cancer Hospital, Hyderabad