Definition: Defining the Meaning of Liver Cancer
Liver cancer or hepatic cancer is a cancer that originates in the liver. 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. Liver tumors are discovered on medical imaging equipment (often by accident) or present themselves symptomatically as an abdominal mass, abdominal pain, yellow skin, nausea or liver dysfunction. The leading causes of liver cancer is cirrhosis due to hepatitis B, hepatitis C, and alcohol.
There are as many is one in ten Asian and Pacific Islander Americans who have chronic Hepatitis B, and most of them are not aware that they are infected. One fourth of the hepatitis carriers will eventually die of liver cancer or liver failure. The two types of liver cancer include metastatic liver cancer that has started in another part of the body, and primary liver cancer that started in the liver itself.
Hepatocellular Carcinoma, or HCC, is the most common form of liver cancer and it is also a malignant form. HCC is not common in Europe and America, but it is one of the top three causes of death from cancer in many African and Asian nations. According to the World Health Organization (WHO), at least 550,000 people die each year from HCC. Around 400,000 of the people who die from HCC live in the Pacific Rim and Southeast Asia. Many people in these nations live life with chronic hepatitis B infections, some from birth and childhood, and this is a cause of eighty-percent of the liver cancers people are experiencing there. The remaining cases are caused by hepatitis C. The greatest health disparity between Caucasian Americans and Asian Americans, according to the Centers for Disease Control and Prevention, is liver cancer. Vaccination for hepatitis B could prevent eighty-percent of these cases of liver cancer in Asian American, as well as Worldwide.
Symptoms of Liver Cancer
The majority of people who get liver cancer seem healthy and show no early signs or symptoms, and for this reason liver cancer is called, 'The Silent Killer.' Liver cancer presents as small lumps that are nearly impossible to feel because of the shielded location of the liver, which is underneath the ribs. A person feels no pain whatsoever until the tumor reaches a very large size; sometimes even very large tumors do not cause pain or symptoms. In the later stages of liver cancer, when tumors are very large and liver function is impaired, a person may experience some pain in the upper right abdomen. They may also lose weight, their appetite, and then finally develop a yellow color to their skin and eyes, as well as some abdominal swelling. Because of the difficulty in diagnosing liver cancer until symptoms develop, the survival rate is quoted as being three to six months. The only effective way to screen for an early diagnosis is to screen people who carry hepatitis B and people with cirrhosis of the liver, as well as people with hepatitis C regularly.
Screening for Liver Cancer
Recognizing that people who have chronic hepatitis B infections and were infected at an early age are at risk for liver cancer is very important. Men who have a family history of liver cancer are at even greater risk. While people who have chronic hepatitis B may develop liver cancer in their teens, the risk for liver cancer increases at age thirty. Regular liver cancer screening for persons who are chronic hepatitis B carriers is highly recommended once they become thirty years old.
Screening for liver cancer consists of a blood test which looks for Alpha-Fetoprotein (AFP) levels, and should be performed every six months. An ultrasound should also be taken twice a year. Both tests must be done because either test alone can miss a liver cancer. For example; the blood test for Alpha-Fetoprotein levels is increased in about sixty to seventy-percent of people with liver cancer, so a blood test alone may not show a true result. An ultrasound is capable of missing twenty-percent of liver cancers that measure two-centimeters; most notably if the images are hard to see in a cirrhotic liver. If a person has cirrhosis of the liver, they will need more frequent screening.
It is important to recognize that API chronically infected with hepatitis B who became infected early in childhood have a high risk of developing liver cancer. The risk is greater for men and those with a family history of liver cancer. Regular liver cancer screening in API hepatitis B carriers, although the role in Caucasian carriers who become infected later in life is controversial. Although API carriers may develop liver cancer early in their teens, data from the US shows that the incidence of liver cancer begins to rise around the age of 30 years. A reasonable approach is to begin regular liver cancer screening for the API hepatitis B carriers starting at 30-40 years of age. This generally consists of a blood test for alpha-fetoprotein (AFP) level every 6 months and an ultrasound of the liver once a year (In Taiwan, ultrasound is recommended twice a year). Either test alone can miss the diagnosis. Alpha-fetoprotein is elevated in only 60-70% of liver cancer so blood testing alone will miss 30-40% of the liver cancers. Ultrasound can miss 20% of liver cancers measuring less than 2 cm, especially when the images are difficult to interpret in cirrhotic livers. Once the patient develops cirrhosis, more frequent screening is generally recommended.
Liver Cancer Evaluation
CT Scans and ultrasounds are two of the main diagnostic tools used in the evaluation of HCC; yet these tools can be too insensitive at times. Sometimes a Biphasic Spiral CT Scan of the entire abdomen is required. The person is given an intravenous bolus of a contrast solution, and the fast spiral scanner is used to scan the liver at the arterial phase. Tumors that are present will typically take in the contrast, allowing even small HCC to be detected; something that could be missed using more conventional CT scan techniques or slower scanners.
Hypervascular lesions which are enhanced at an arterial phase and fade at a venous phase of scanning are characteristic of HCC. Liver tumors that have these characteristics in a person who is a chronic hepatitis B carrier or someone with cirrhosis and associated rising AFP levels over 500 is a person that is already diagnostic of HCC - a biopsy isn't needed. If a person's doctor is unsure of whether or not they have a metastatic liver tumor, a fine needle biopsy might be something to pursue if it can be performed safely. A biopsy of the liver can be dangerous, or even life-threatening due to bleeding if a person has cirrhosis; low platelet count, prolonged clotting time, enlarged blood vessels in conjunction with high pressure can all make the process risky. For the most part, liver lesions are pretty rare in people who have cirrhosis.
Liver cancer treatment presents challenges compared to other forms of cancer because many people have damage from hepatitis to their livers in addition to the cancer; resulting in different degrees of liver failure. The results are that many of these people have a liver in a precarious state, and treatment for liver cancer may do more harm than good. Treating some people with liver cancer presents doctors with the potential that their patient may die from the treatment for liver cancer before the die from the cancer. This presents the doctor with individualized decisions related to each person with liver cancer. The doctor must choose between the benefits of treatment for cancer and the effects it will have on the quality of their patient's life.
Surgical Treatment of Liver Cancer
If a tumor in the liver is small or something that a surgeon calls, 'resectable,' and the patient's liver is in a condition that is seen as being fit for a resection, then surgical intervention to remove the tumor may be an option. A surgery to remove the tumor offers the best chance for long-term survival, and with improved anesthetic management and surgical techniques the risks of mortality has dropped to less than two-five percent. Most people are able to be discharged from the hospital within three or four days. Yet even though a tumor has been removed, a person is still at risk for a recurrence of liver cancer and needs to be followed very closely over a long-term period of time. The first year after a surgery of this kind is when the risk of a recurrence is greatest, and when follow-up is of highest importance.
Forms of Nonsurgical Treatment
People who have liver cancer, but are not surgical candidates, still have options through non-surgical treatments. There are a number of alternative treatment options that are available that can improve the quality of life for people with liver cancer, and are presented to people on an individual basis. Chemotherapy is not very effective with liver cancer; it causes a number of side effects that mar a person's quality of life, and usually doesn't prolong a persons survival. Liver tumors are hypervascular ones; the opportunity to cannulate the tributaries feeding the tumor is unique. There is a form of treatment called, 'Intrahepatic Arterial Chemoemolization,' or, 'Chemo Infusion,' (TACE or TAC) that can be performed on unresectable lesions. The treatment can be performed every four months until the AFP levels have returned to normal, or until there are no more appearances of Hypervascular Lesions. One of the benefits of this form of treatment is that it only requires an overnight stay, purely for observation, and that it is well-tolerated. TACE or TAC treatments have become associated with prolonged patient survival. Another piece of good news that is that people who have gone through TACE or TAC treatments may then go on to become surgical candidates, when they may not have been before.
If a person has a liver that is unresectable, either medically or surgically, they may be a candidate for a liver transplant. In a report by the Asian Liver Center at Stanford University, it was reported that people who had a good response to TACE or TAC treatments also had very good survival rates where liver transplants were concerned. People with more extensive tumors were at higher risk for an early recurrence and death after a liver transplant. People who have had a liver transplant must receive one or both of two things; Hepatitus B Immunoglobulin (HBIG) or Lamivudine, in order to prevent a re-infection of their new liver.
Treating liver cancer is still a difficult process, requiring several disciplines, a good understanding of them, surgery, transplants, radiology, and more. The only effective way to improve the outcome of liver cancer is through early diagnosis of it, and this involves screening of high-risk populations.
Liver Cancer Awareness
The jade, or emerald green, ribbon campaign brings awareness about hepatitis B and liver cancer. The objective of the Jade Ribbon Campaign is to eradicate HBV worldwide, and to reduce the incidence and mortality associated with liver cancer. The Jade Ribbon Campaign (JRC) was launched by the Asian Liver Center (ALC) at Stanford University in May 2001 during Asian Pacific American Heritage Month to help spread awareness internationally about hepatitis B (HBV) and liver cancer in Asian and Pacific Islander (API) communities. October has been declared as liver cancer awareness month
Quick Facts: Liver Cancer Symptoms & Risk Factors
Liver cancer symptoms can include a lump or pain on the right side of your abdomen and yellowing of the skin. However, you may not have symptoms until the cancer is advanced. This makes it harder to treat. Doctors use tests that examine the liver and the blood to diagnose liver cancer. Treatment options include surgery, radiation, chemotherapy, or liver transplantation.
Risk factors for primary liver cancer include;
- Heavy alcohol use
- Obesity and diabetes
- Having hepatitis B or C
- Having cirrhosis, or scarring of the liver
- Having hemochromatosis, an iron storage disease
Statistics: Liver Cancer
- Globally, as of 2010, liver cancer resulted in 754,000 deaths, up from 460,000 in 1990, making it the third leading cause of cancer death after lung and stomach.
- In 2012, it represented 7% of cancer diagnoses in men, the 5th most diagnosed cancer that year. Of these deaths 340,000 were secondary to hepatitis B, 196,000 were secondary to hepatitis C, and 150,000 were secondary to alcohol.
- HCC, the most common form of liver cancer, shows a striking geographical distribution. China has 50% of HCC cases globally, and more than 80% of total cases occur in sub-Saharan Africa or in East-Asia due to hepatitis B virus. Cholangiocarcinoma also has a significant geographical distribution, with Thailand showing the highest rates worldwide due to the presence of liver fluke.