Conquering Liver Cancer: Your Journey to Recovery Starts Here

• Primary liver cancer
• Secondary liver cancer – (liver metastases)

The liver is one of the largest organs of the human body. It is located just under your rib cage on the right side, on top of your stomach.

The liver performs many tasks which are essential for the normal functioning of the body such as purifying the blood, processing nutrients, making blood clotting factors, and preventing infection. 

Several types of primary cancer can form in the liver.

Hepatocellular carcinoma (HCC) begins in the main type of liver cell (hepatocyte) and is the most common type of primary liver cancer. It occurs most often in people with chronic liver diseases, such as cirrhosis caused by hepatitis B or hepatitis C infection.

Intrahepatic cholangiocarcinoma (ICC) is a rare cancer that develops in the cells within the bile ducts; both inside and outside the liver. This condition occurs slightly more often in males than females and usually affects people who are between 50-70 years old.

Hepatoblastoma is a very rare liver cancer which usually affects children less than 3 to 4 years of age. 

Primary liver cancer is the sixth most commonly diagnosed cancer and the fourth leading cause of cancer mortality worldwide. Cancer that spreads to the liver from elsewhere in the body (metastatic cancer) is more common than primary liver cancer.

• Unintended weight loss
• Loss of appetite
• Abdominal pain
• Nausea and vomiting
• General weakness and fatigue
• Abdominal swelling
• Yellow discoloration of the skin and whites of the eyes (jaundice) White, chalky stools
• Itching

Liver cancer occurs when liver cells develop mutations in their DNA leading to an uncontrolled and disordered division of cells to form a mass or tumour.

In some cases the cause of liver cancer is known, such as with chronic hepatitis infections. But liver cancer can occur with no clear cause underlying disease.

Some factors which appear to increase the risk of liver cancer have been identified. These include:

• Chronic infection with the hepatitis B virus (HBV) or hepatitis C virus (HCV)
• Liver Cirrhosis – scarring of liver tissue due to liver disease
• Certain inherited liver diseases such as haemochromatosis and Wilson’s disease.
• Diabetes
• Nonalcoholic fatty liver disease – accumulation of fat in the liver
• Exposure to aflatoxins that grow on crops such as grains and nuts that are stored poorly.
• Excessive alcohol consumption

A combination of diagnostic tests may be required, such as:

• Imaging tests, such abdominal ultrasound, MRI or CT scan, may reveal an abnormal growth or tumour in the liver
• Biopsy – removing a sample of tissue from the liver to examine under the microscope in a laboratory, may be done during endoscopic ultrasound.
• Blood tests – to check for abnormalities of liver function or specific proteins (tumour markers) shed by liver cancer cells
  These tests are usually performed if a patient has symptoms of liver cancer, although blood tests and abdominal ultrasound may be recommended to screen those with a higher risk of liver cancer.

If your doctor confirms a diagnosis of liver cancer, additional tests may be required to determine the extent (stage) of the cancer and develop the most appropriate treatment plan. 

Treatment options depend on the type, location and stage of the cancer. Options may include surgery, chemotherapy, radiation therapy or a combination of these. In general, the earlier a cancer is detected, the better the prognosis.

Surgical options to treat liver cancer include:

• Removal of the tumour and a small portion of healthy liver tissue that surrounds it may be an option for small tumours where liver function is good. In suitable cases, minimally invasive laparoscopic surgery can significantly reduce recovery time. Laparoscopic surgery is done through a thin, lighted tube with a camera on its tip (a laparoscope) which is inserted through a tiny abdominal incision.
• Liver transplant surgery to remove the diseased liver and replace it with a healthy liver from a donor may be an option in otherwise healthy people whose liver cancer hasn’t spread beyond the liver.

Localised treatments for liver cancer are administered directly to the cancer cells or the area surrounding the cancer cells. Some treatments use image-guided techniques (interventional radiology). Localised treatments may be recommended for people who can’t undergo surgery:

• Radiofrequency ablation – uses an electric current to heat and destroy cancer cells. Thin needles are inserted into small incisions in the abdomen, using an imaging test as a guide.
• Cryoablation – uses extreme cold to destroy cancer cells. An instrument (cryoprobe) containing liquid nitrogen is placed directly onto the liver tumours, guided by ultrasound images.
• Alcohol injection –  pure alcohol is injected directly into tumours causing the tumour cells to die.
• Chemoembolization – chemotherapy (anti-cancer) drugs are injected directly to the liver.

• Radioembolization – tiny glass spheres containing radiation are injected directly into the liver.

Radiation therapy – uses high-energy beams to destroy cancer cells. Doctors carefully direct the energy to the liver, while sparing the surrounding healthy tissue.

Chemotherapy drugs may be either injected or taken orally to help kill cancer cells.

Radiation therapy or chemotherapy may be used when surgery is not an option to help control symptoms. They may also be used before surgery to help shrink a tumor, or after surgery to reduce the risk of recurrence.

Targeted drug therapies – target specific weaknesses present within cancer cells, causing the cancer cells to die. Some targeted therapies only work in people whose cancer cells have certain genetic mutations.

Immunotherapy uses your immune system to fight cancer by interfering with proteins produced by cancer cells which prevent them from being attacked by the body’s immune system. Immunotherapy treatments are generally reserved for people with advanced liver cancer.

Supportive (palliative) care

For advanced liver cancer that is not amenable to surgery, chemotherapy orradiotherapy, treatment may focus on symptom relief and improving quality of life.Palliative care may also be provided to complement other treatments.

Finding out about a cancer diagnosis can cause stress and worry. Here are some ways that may help you cope and get the right treatment and support:

• Educate yourself about your cancer to help you make decisions about your care. Share any questions or concerns with your specialist doctor, who will be able to advise you about the details of your cancer and your

treatment options. They will also be able to recommend trusted sources of further information.

• Build a support network of trusted friends and family who can help you with practical tasks or provide a listening ear. If stress, anxiety or depression are causing significant problems in your daily life, talk to your doctor who may recommend professional counselling.
• Consider joining a support group specifically for liver cancer to connect with others who are going through similar experiences. Ask your doctor for information on liver cancer support groups in your area or online.

Not all liver cancer can be prevented, but you can reduce your risk for some known causes of liver cancer:

• Drink alcohol in moderation, if at all.
• Maintain a healthy weight and get regular exercise. If you need to lose weight, aim for a slow, steady weight loss.
• Get vaccinated against hepatitis B.
• Reduce your risk of hepatitis B and C infection by avoiding sexually transmitted diseases, intravenous drug use and piercings or tattoos from shops that are not well regulated with sterilisation protocols.
• If you are at risk of hepatitis B or C infection seek prompt assessment and treatment if required.
• Ask your doctor about liver cancer screening if you have conditions which increase your risk, such as hepatitis B or C, or liver cirrhosis.

Remember: 

Early detection can improve treatment outcomes. Consult your doctor if you experience unexplained symptoms or conditions that put you at a higher risk of liver cancer.