Liver Cancer

Liver Cancer

The fourth-most common cancer in the world, liver cancer is characterized by abnormal cell growth in the liver. While the exact cause of the disease is unknown, risk factors include such things as having a chronic liver infection, being male, and having a family history of the disease. Symptoms of liver cancer include jaundice or a lump near the ribs. The cancer must be detected early in order to be treated with surgery.

What Is Liver Cancer?
Liver cancer is a disease in which cancer cells form in the tissues of the liver. It is not a common cancer in the United States; however, it is the fourth-most common cancer in the world.

This article will discuss primary liver cancer, which is cancer that begins in the liver. Primary liver cancer can occur in both adults and children.

The liver is also a location where a lot of other cancers (like breast cancer or colon cancer) will metastasize (spread). When cancer begins in another part of the body and then spreads, it is called metastatic cancer. Cancer that began in the breast but has spread to the liver (or other areas of the body) is called metastatic breast cancer. Likewise, cancer that has spread to the liver but began in the colon is called metastatic colon cancer.

Understanding the Liver
The liver is the largest internal organ in the body. It is found behind the ribs on the right side of the abdomen. The liver has two parts: a right lobe and a smaller left lobe.

The liver has many important functions that keep a person healthy. It removes harmful material from the blood. It makes enzymes and bile that help digest food. It also converts food into substances needed for life and growth.

The liver gets its supply of blood from two vessels. Most of its blood comes from the hepatic portal vein. The rest comes from the hepatic artery.

Most primary liver cancers begin in hepatocytes (liver cells). This type of cancer is called hepatocellular carcinoma or malignant hepatoma.

Children may develop childhood hepatocellular carcinoma or hepatoblastoma.

When liver cancer spreads (metastasizes) outside the liver, the cancer cells tend to spread to nearby lymph nodes and to the bones and lungs. When this happens, the new tumor has the same kind of abnormal cells as the primary tumor in the liver. For example, if it spreads to the bones, the cancer cells in the bones are actually liver cancer cells. The disease is metastatic liver cancer, not bone cancer, and it is treated as liver cancer, not bone cancer. Doctors sometimes call the new tumor "distant" disease.

Similarly, cancer that spreads to the liver from another part of the body is different from primary liver cancer. The cancer cells in the liver are like the cells in the original tumor. When cancer cells spread to the liver from another organ (such as the colon, lung, or breast), doctors may call the tumor in the liver a secondary tumor. In the United States, secondary tumors in the liver are far more common than primary liver tumors.

Liver Cancer (Cont.)

Risk Factors
No one knows the exact cause of liver cancer. Doctors can seldom explain why one person gets this disease and another does not. However, research has shown that people with certain risk factors are more likely than others to develop liver cancer. A risk factor is anything that increases a person's chance of developing a disease.

Researchers have identified the following risk factors associated with liver cancer:

* Having a chronic liver infection (such as hepatitis B or hepatitis C)
* Having cirrhosis
* Eating foods tainted with aflatoxin (poison from a mold that can grow on foods, such as grains and nuts, that have not been stored properly)
* Being male
* Family history of liver cancer
* Age (In the U.S., people over the age of 60 are more likely to have cancer than younger people.).

Screening for Liver Cancer
At this point, a routine, effective screening test for liver cancer has not yet been developed. Research is currently being conducted to look for a liver cancer screening test using ultrasound, computed tomography (CT), or blood tests.

Symptoms
Liver cancer is sometimes called a "silent disease" because there are usually no early liver cancer symptoms. Pain is a symptom of late-stage liver cancer; therefore, it is important not to wait to feel pain before seeing a doctor.

If symptoms of liver cancer are present, they may include the following:

* A hard lump on the right side just below the rib cage
* Discomfort in the upper abdomen on the right side
* Pain around the right shoulder blade
* Unexplained weight loss
* Jaundice (yellowing of the skin and whites of the eyes)
* Unusual tiredness
* Nausea
* Loss of appetite.

These possible symptoms are not sure signs of the disease. Other liver diseases and other health problems can also cause these symptoms. Anyone with these possible symptoms of liver cancer should see a doctor as soon as possible. Only a doctor can diagnose and treat the problem.

Making a Diagnosis
If a person has possible symptoms of liver cancer, the doctor may do a physical exam and ask about the patient's personal and family medical history. The doctor may also recommend additional tests and procedures.

The exams and tests used to make a diagnosis may include the following:

* Blood tests
* CT scan
* Ultrasound
* MRI
* Angiogram
* Laparoscopy
* Biopsy.

Staging Liver Cancer
If a liver cancer diagnosis is made, the doctor needs to know the stage, or extent, of the cancer in order to plan the best liver cancer treatment. Staging is an attempt to find out the size of the tumor, whether the disease has spread, and, if so, to what parts of the body. Careful staging shows whether the tumor can be removed with surgery. This is important, because most liver cancers cannot be removed with surgery.

The doctor may determine the cancer's stage at the time of diagnosis, or the patient may need more tests.

The following stages pertain to adult primary liver cancer:


* Stage I
* Stage II
* Stage III
* Stage IV
* Recurrent.


For adult primary liver cancer, stages are also grouped according to how the cancer may be treated. There are three treatment groups:


* Localized resectable
* Localized and locally advanced unresectable
* Advanced.

Treatment
At this time, liver cancer can be cured only when it is found at an early stage (before it has spread) and only if the patient is healthy enough to have an operation. However, treatment methods for liver cancer other than surgery may be able to control the disease and help patients live longer and feel better.

When a cure or control of the disease is not possible, some patients and their doctors choose palliative therapy. Palliative therapy aims to improve the quality of a person's life by controlling pain and other problems caused by the disease.

Some factors that may influence the treatment for liver cancer include:

* The stage of the cancer (see Stages of Liver Cancer)
* The number, size, and location of tumors
* Whether the cancer has spread outside the liver
* The patient's age
* The patient's general health.

In general, treatments include:

* Surgery (see Liver Cancer Surgery)
* Chemotherapy (see Liver Cancer Chemotherapy)
* Radiation therapy (see Liver Cancer Radiation Therapy)
* Percutaneous ethanol injection.

Choosing the most appropriate treatment is a decision that ideally involves the patient, family, and healthcare team.

Prognosis
A person's prognosis for liver cancer depends on the following:

* The stage of the cancer (the size of the tumor, whether it affects part or all of the liver, or has spread to other places in the body)
* How well the liver is working
* The patient's general health, including whether there is cirrhosis of the liver
* Alpha-fetoprotein (AFP) levels.

Statistics
The American Cancer Society estimates that 18,510 men and women (12,600 men and 5,910 women) will be diagnosed with liver cancer and that 16,200 men and women will die of liver cancer in 2006.

Summary of Key Points on Liver Cancer
The following points are important to remember:

* Primary liver cancer is a disease in which malignant (cancer) cells form in the tissues of the liver
* Having hepatitis or cirrhosis can affect the risk of developing liver cancer
* Possible signs of liver cancer include a lump or pain on the right side
* Tests that examine the liver and the blood are used to detect and diagnose liver cancer
* Certain factors (such as the stage of the cancer and the patient's general health) affect prognosis and treatment options for liver cancer.