Liver Cancer
Liver cancers can arise primarily in the liver when they are commonly called as hepatomas or hepatocellular carcinomas (HCC) or liver tumours. These commonly arise in livers which are diseased with cirrhosis due to factors like Hepatitis B, Hepatitis C and or alcohol. There are of course other variants like intra hepatic Cholangiocarcinomas and the like. The treatment strategies are based on the severity of underlying liver disease and the location, size, multiplicity and stage of the disease.
The other group commonly known as metastatic tumours arises from other organs like colon, ovaries, breast, kidney etc and if the spread is restricted to the liver and is such that it is resectable then surgery may be the best option available if deemed appropriate by the surgeon.
Aggressive treatment strategies can cure or significantly prolong the life of many patients with liver cancer for which surgery forms the mainstay of treatment.
Patient Presentation
What are the symptoms and signs?
Early stages of cancer can be asymptomatic and may go undetected for months or even years. When symptoms do develop, they are most pronounced as pain.
Pain associated with cancer is a result of several possibilities: invasion or destruction of normal tissue with cancer cells; stretching of internal tissue by tumour growth; pressure of tumor on an organ; blockage of a vital passageway by the tumor; and infection caused by cancer.
Other symptoms may include loss of appetite, loss of weight, fever of unknown origin, limb weakness, sensory loss, or an absence of tendon reflexes in the limb.
Liver cancer, both primary and metastatic, often exhibits symptoms of general malaise as well as pain and tenderness. The discomfort is usually of a moderate degree and most often in the upper or upper right part of the abdomen. In more advanced cases, symptoms of jaundice, a yellowing of the skin and eyes, may also appear.
Frequently, patients with liver tumors are asymptomatic (have no symptoms). The diagnosis is made during an examination as part of a routine follow-up after cancer treatment in case of metastatic tumors. Primary cancers are usually picked up by screening of susceptible group of people.
Remember that diagnostic testing can become quite stressful. Allow yourself as much time as safely possible to learn about the test and to recover from the testing experience.
Staging of Liver Cancer
How do you stage liver cancer?
Each type of cancer has specific staging criteria. In general the different stages can be summarized as follows:
Stage I: Localized and Resectable
Tumor is found in one location of the liver and could be treated surgically.
Stage II: Localized and Possibly Resectable
Primary tumor is found in one or more locations in the liver and may be treated surgically. The decision to surgically treat the disease will depend upon the location, nature of the liver disease and the tumour.
Stage III: Advanced
Cancer has spread to more than one location in the liver and/or to other parts of the body. Frequently requires multiple treatment modalities for maximum benefit.
Stage IV: Disseminated
Cancer involves multiple sites throughout the body. Frequently, surgery is not indicated and chemotherapy is the best option.
This classification system is not standardized across all types of cancer, and each type of cancer has its own interpretation. Consult your surgeon for an exact interpretation of the stages and the letter designators as they apply to your diagnosis.
Imaging
What are the imaging studies for staging liver cancer?
- Ultrasonography
- CT-Scan
- CT- Angiogram
- MRIv
- Endoscopy & Laparoscopy
What other studies are done to assess liver cancer?
- Colonoscopy
- Upper GI Endoscopy
- Laparoscopy
Treatment
What are the treatment options?
Surgery
Chemoembolization
Alcohol Injection
Radiofrequency Ablation
Liver Transplantation
Chemotherapy
Yittrium 90 Treatment