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Liver cancer

Liver cancer

About liver cancer

Liver cancer can be primary or secondary. Cancers which begin in the liver are called primary liver cancer. Cancers which arise in the other parts of the body and spread to liver are called secondary liver cancer or metastasis. Primary liver cancer includes

     
  • Hepatocellular carcinoma(HCC)
  •  
  • Intrahepatic Cholangiocarcinoma (arising from the bile duct inside the liver )

Primary liver cancer (hepatocellular carcinoma) tends to occur in livers damaged byalcohol abuse, or chronic infection with diseases such as hepatitis B and C or rare birth defects. More than half of all people diagnosed with primary liver cancer have cirrhosis

The male : female ratio for HCC in India is 4:1. The age of presentation varies from 40 to 70 years.

Secondary liver cancer or metastasis liver is the most common cancerous condition of liver. It depends on the location of the original cancer. Primary cancers that are most likely to spread to the liver are cancers of the:

  • Colon
  • Rectum
  • Stomach
  •  
  • Esophagus/ Stomach Pancreas 

Even if the primary cancer is removed, liver metastasis can still occur years later. If you’ve had cancer, it’s important to learn the signs of liver metastasis and get regular checkups.

Liver cancer signs and symptoms may include:

  • Jaundice - yellowish discolouration of skin and eyes
  • Abdominal pain - often on the right upper abdomen
  • Loss of weight and appetite
  • Hepatomegaly - enlarged liver, the abdomen may appear swollen
  • Fatigue
  • Nausea and vomiting
  • Back pain
  • General itching
  • Fever
Liver cancer
Liver cancer

Treatment Options

Liver cancer

Treatment options for liver metastasis

 

Surgery

 Agressive surgery to resect these liver metastasis is the best way to cure these patients. Patients with solitary metastasis have a more than 60% 5 year survival. At times , we give chemotherapy to downsize the lesions before embarking on surgery. 

Ablative techniques for liver metastasis  

Radiofrequency ablation(RFA) and Microwave ablation(MWA) for liver metastasiscan be used in cases where surgery is not possible of the lesions are too deep seated.

Chemotherapy

 

Chemotherapy is used to help stop or slow the growth of cancer and relieve symptoms. Chemotherapy may also be used to shrink the cancer so surgery can be done, or it may be given after surgery to lower the risk of the cancer coming back. Chemotherapy is sometimes used along with other treatments such as targeted therapy.

Surgery For Liver Cancers

There are various types of resections for liver tumors .

  • Right or Left hepatectomy- involves removal of the right or left half of the liver. These are major surgeries which need a proper preoperative planning.
  • Extended right/ left hepatectomy- involves removal of more than 60-70 % of the liver. Needs a volumetric assessment to preserve enough liver tissue.. these are the most complex liver surgeries
  • Segmental resection- removal of only one or two segments .
  • Non anatomical resection- usually for liver metastasis.

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Related FAQ's
1. what is cirrhosis? Does it cause liver cancer ?
Cirrhosisis due to do long term injury to the liver. Most common causes are hepatitisand alcohol abuse. Cirrhosis by itself is not a cancer, but increases the riskof liver cancer.
2. Can liver cancer be prevented?
Oncecirrhosis (or scarring of the liver) has set in, it is generally notreversible. Therefore, the best way to prevent liver cancer is to avoid liverdamage by treating any underlying hepatitis and avoiding excess alcohol use.Treating hepatitis B and C promptly also reduces the risk of HCC 
3. What is the survival rate after the surgery for HCC?
Ingeneral survival rates are higher for people who can have surgery to removetheir cancer, regardless of the stage. Overall survival of over 50-70% has beenseen in patients with small resectable tumours who do not have cirrhosis orother health issues. For early stage HCC with cirrhosis who have livertransplant , 5 year survival rate is 60-70%
4. What will be the follow up duration after the treatment?
Youhave to consult your doctor maybe every 3 to 6 months for the first 2 years,then every 6 to 12 months. Then, the longer you’re cancer-free, the less oftenthe visits are needed. After 5 years, they may be done once a year.
5. What are the side e?ects of chemotherapy?
 Side e?ects ofchemotherapy includes nausea, vomitting, hair loss, infection and loss ofappetite. These symptoms will settle down once the patient has completedchemotherapy
6. What are the complications of major liver resection?
 Bile leak, wound infection and intraabdominalcollection. Most of the complications are managed conservatively. In case ofcomplications hospital stay and expense may increase. Morbidity rate of majorliver resection  is 5-10% while themortality is less than 1% in high volume centres. 
7. What is the survival rate in colorectal metastasis after surgery?
 In a solitary and resectable liver metastasisthe survival rate is 60-70%, in a multiple resectable liver metastasis thesurvival rate is 25-30%. This is a very encouraging number and hence metastaticcolorectal and neuroendocrine tumors must be aggressively treated.
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