Malignant liver tumors can be primary or secondary. Secondary tumors are metastases that occur when the malignant process spreads at stage IV. Colorectal cancer most often metastasizes to the liver. Primary liver cancer develops directly from the tissue of the organ, and there are two types of neoplasms:
- Hepatocellular carcinoma. It comes directly from liver cells.
- Cholangiocarcinoma - its substrate is the cells lining the hepatic ducts that excrete bile.
In fact, these are two completely different tumors, and the only thing they have in common is that they are both initially localized in the liver. Later in this article we will talk about hepatocellular cancer, since this neoplasm is much more common than cholangiocarcinoma.
- Liver cancer symptoms
- Diagnosis of liver cancer
- Liver cancer treatment
- Risk factors for liver cancer
- Prevention of liver cancer
- Popular questions
- Patient reviews
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Causes and risk factors
The exact causes of liver cancer have not yet been established. Most often, a malignant lesion occurs against the background of a long-term inflammatory process in the liver tissue. Most often, the first signs of liver cancer are detected against the background of cirrhosis. In regions where viral hepatitis is widespread, cases of liver cancer are detected much more often. Thus, approximately 25% of all patients with signs of liver cancer are diagnosed with viral hepatitis C, and approximately 40% are chronic carriers of the hepatitis B virus.
Other risk factors that increase the risk of developing liver cancer include:
- poor nutrition leading to obesity;
- drinking large amounts of alcohol;
- long-term use of drugs that have hepatotoxicity (including steroids, oral contraceptives);
- the influence of external factors - toxins that damage liver cells (vinyl chloride, aflatoxins);
- long history of diabetes mellitus;
- Budd-Chiari syndrome (these are episodes of thrombosis in the hepatic veins);
- hereditary pathologies - Wilson's disease, hemochromatosis, tyrosinemia, glycogenosis, alpha-trypsin deficiency, intestinal polyposis.
In some cases, the causes of liver cancer cannot be determined, and the cases are considered idiopathic.
Liver cancer symptoms
The first signs of liver cancer are not specific; they are also possible in many other pathologies of the organ (acute and chronic hepatitis, alveococcosis, cirrhosis, damage to the bile ducts or liver metastases). In the early stages, the pathology may not manifest itself in any way, since the organ has a high reserve. Therefore, liver cancer is often first detected by ultrasound, which is performed for various pathologies of internal organs located near the liver. If the tumor is significant in size, patients may experience the following complaints and manifestations:
- decreased or complete lack of appetite (anorexia);
- decrease in the amount of hemoglobin and red blood cells;
- discomfort, pain in the hypochondrium, closer to the right side or in the upper abdomen;
- nausea, vomiting with bile or food;
- an increase in the size of the abdomen due to the growth of a tumor formation that can be felt through the abdominal wall;
- ascites (growth of the abdomen due to the accumulation of fluid in it);
- weight loss, sometimes very significant (up to several kilograms in a couple of months);
- yellowing of the skin and whites of the eyes (development of jaundice);
- severe skin itching;
- nose bleed;
- stool disorders - alternating constipation or diarrhea;
- change in color of urine (dark) and stool (discoloration);
- expansion of small capillaries under the skin (formation of telangiectasia).
As the tumor grows and disintegrates, general malaise, fever, and weakness may occur.
Nutrition
The patient's condition improves with a special diet. The cooks at the Yusupov Hospital prepare dishes from high-quality products that do not contain nitrates, GMOs or carcinogenic food additives. In case of uncontrolled weight loss, increase daily caloric intake at the expense of protein products. When preparing dishes, preference is given to gentle culinary technologies: boiling, stewing, steaming and grilling, baking in the oven.
The following foods are excluded from the patient's diet:
- store-bought sauces;
- smoked meats and pickles;
- rich broths;
- margarine and other heavy fats;
- fresh baked goods;
- alcoholic drinks;
- strong tea and coffee.
Types of primary liver cancer
There are several classification options for primary liver cancer. There are various types of tumors, which differ in course and prognosis. Experts identify several of the most typical types of primary liver cancer (the tumor is formed from the cells of the organ).
Hepatocellular cancer
is the most common tumor (carcinoma) that occurs in the liver area.
As the name suggests, these tumors form in hepatocytes, which form the basis of liver tissue. The course of hepatocellular cancer is possible in two clinical forms - diffuse
(when a large part of the liver is affected) or
nodular
(one focus is formed - a node or several areas).
A more favorable variant of this cancer is possible - fibrolamellar carcinoma
, with it there are possibilities for more active treatment.
Cholangiocarcinoma
is a malignant tumor that originates in the area of the bile ducts.
Cholangiohepatoma
is a mixed type of tumor in which cancer cells originate both in the area of hepatocytes and in the area of epithelial cells in the bile ducts.
Variants of tumors such as angiosarcomas, mesodermal formations
are lesions that grow from lymphatic capillaries, blood vessels or connective tissue cells.
Possible hepatoblastoma
cystadenocarcinoma
is also identified . It occurs as a result of the degeneration of a benign tumor.
Metastases
Metastases are the main danger of any cancer, since they are almost impossible to stop or prevent their spread.
Metastases of primary liver cancer can spread to the stomach, brain, lungs, esophagus, veins and arteries, heart muscle, blood vessels, bones and spine. Metastases from the liver enter the body in the following ways:
- through lymph flow;
- through the circulatory system;
- through growth beyond the liver and damage to neighboring tissues and organs.
Unfortunately, metastases occur in 40% of liver cancer cases and often affect vital organs, which are subsequently extremely difficult to treat.
Stages of liver cancer
The basis of clinical classification is the TNM system. It is based on the pathological features of the tumor, and its prognosis depends on the stage of liver cancer. Each classification criterion will indicate the presence or absence of certain changes.
- T is the growth and spread of the tumor, the presence of several tumor nodes, the size of the largest of them, as well as the growth of the tumor focus into neighboring areas.
- N - reflects tumor metastasis to nearby (regional) or distant lymph nodes;
- M - indicator reflects metastasis of liver cancer to other organs.
In addition to these criteria, the course of the disease, the features of its treatment and the prognosis of liver cancer are influenced by the presence of fibrosis and the degree of differentiation of tumor cells. The lower the degree of differentiation, the more the cancer cells differ from healthy ones and the more aggressive the cancer. These indicators have an extremely negative impact on survival, regardless of TNM stage.
One of the classification options is based on blood parameters for liver cancer. They determine the functional activity of the liver and the severity of cirrhosis. The assessment is carried out based on the levels of total bilirubin, serum creatinine, and blood coagulation parameters.
Popular questions
How can you prevent liver cancer?
First of all, care must be taken to avoid chronic liver diseases, which can lead to cirrhosis. If it is already present, then it is necessary to take tests for alpha-fetoprotein and perform an ultrasound of the abdominal cavity every six months.
What are the first symptoms of liver cancer?
The first symptoms can develop already at advanced stages, and they can also masquerade as signs of cirrhosis. Therefore, instrumental examination is necessary for early diagnosis. Symptoms most often include jaundice, loss of appetite, pain and heaviness in the right hypochondrium.
Does cirrhosis affect liver cancer treatment?
Yes, and cirrhosis itself can be a more serious problem than cancer, since with severe liver failure, the metabolism of various compounds and the synthesis of many proteins is disrupted, which in itself leads to the development of severe conditions. In addition, cirrhosis may influence the choice of treatment tactics for cancer patients.
Primary liver cancer: diagnosis
All people who are at high risk for developing liver cancer are regularly screened. First of all, doctors look for ultrasound signs
Liver cancer in people suffering from chronic inflammatory processes of the organ have different degrees of cirrhosis. They are advised to perform an ultrasound examination every six months, even in the absence of complaints.
In addition, they are advised to perform laboratory blood tests to determine the tumor marker of primary liver cancer - AFP
(stands for alpha-fetoprotein). With this type of observation, it is possible to identify tumor lesions at an early stage (there are no symptoms or complaints yet), when the cancer can be radically cured. Changes in tests for liver cancer with an increase in AFP typically occur in up to 50-90% of patients. Levels greater than 400 ng/mL may occur in individuals with large tumors or rapidly growing tumors. But a temporary increase in the indicator is possible against the background of cirrhosis or inflammation of hepatocytes. However, high AFP in combination with ultrasound data and MRI of the liver confirms the diagnosis in almost 100% of patients.
Performing a CT
or
MRI with contrast
helps to identify a tumor and clarify its size and location, which is important for drawing up a treatment plan for liver oncology.
If all this data is not enough to make a diagnosis, a percutaneous biopsy
(puncture or aspiration) under ultrasound control. The risk of complications with such diagnostic methods is minimal.
Complications
The uncontrolled course of liver cancer is dangerous due to the occurrence of complications. Their appearance depends on many factors. Possible complications include:
- bleeding from the tumor;
- suppuration of the tumor focus;
- impaired outflow of bile due to compression of the bile ducts;
- circulatory disorders due to compression of the abdominal organs by large tumor sizes;
- ascites.
The listed symptoms require immediate diagnosis and surgical intervention. Without this, death is possible.
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Liver cancer treatment methods
If the diagnosis of liver cancer is confirmed, treatment must be started immediately. It will be long and includes several stages. In addition, depending on the type of tumor, its size and location, several methods are combined. The main method is surgical removal of cancer
– resection of part of the liver or its complete removal with transplantation of a donor organ.
If resection is not possible and there are no suitable donors for transplantation, doctors can use non-resection therapy
- percutaneous ethanol injections, radiofrequency ablation therapy, arterial embolization or chemoembolization of tumor vessels. Traditional treatment of primary liver cancer is also possible - chemotherapy, the use of radiotherapy, targeted drugs or a combination of several techniques.
In the initial stage of liver cancer, surgery will be the main method of treatment. The tumor is resected within healthy tissue. One-stage resection and two-stage surgery with preliminary ligation or embolization of the portal vein are possible.
Contraindications to such an intervention include damage to distant lymph nodes and cancer metastasis. However, if the remaining portion of the liver is not enough for its full functioning, if the functions of the organ are significantly impaired, there are signs of liver failure, the tumor has grown into the hepatic vein, or affects the portal system, doctors resort to alternative methods of therapy.
If the tumor develops against the background of cirrhosis, the only radical treatment method is organ transplantation
. However, the criteria for transplantation are very strict, so such an operation is performed infrequently.
Chemotherapy
for liver cancer it is used infrequently due to its low activity against cancer cells. It is carried out using cytostatic drugs, but the effectiveness does not exceed 20%. When chemotherapy is combined with immunotherapy for liver cancer, toxic side effects may develop (decreased platelet and leukocyte levels). But the tumor can be reduced to a size where it can be removed. Research into the use of new immunotherapy drugs is still ongoing, but they have shown some success.
Radiation therapy
for liver cancer, it is used to a limited extent, since the development of radiation hepatitis and organ failure is possible. It is used for inoperable tumors in the area of the portal vein and the porta hepatis. Modern equipment is used to minimize damage to surrounding healthy tissue.
One of the promising areas is targeted therapy
in oncology for liver cancer. This is a targeted effect on cancer cells without affecting healthy tissue. It is used in stages when surgery is dangerous or impossible; the drugs help reduce the size of the formation.
Forecast
Since liver cancer is often diagnosed at the final stage of the tumor process, the prognosis for recovery is pessimistic in most cases. Palliative therapy is aimed at reducing the severity of symptoms of the disease and alleviating the general condition. In the presence of concomitant pathologies, death occurs 6 months or 1 year after diagnosis. The average life expectancy after the onset of this disease is about 2 years with properly selected effective treatment.
Prevention of liver cancer
Among the main preventive measures are avoidance of alcohol consumption, vaccination against viral hepatitis B, as well as protection against infection with other types of infection. In addition, timely recognition and treatment of liver pathologies, treatment of fatty hepatosis and cirrhosis are important.
The information in this article is provided for reference purposes and does not replace advice from a qualified professional. Don't self-medicate! At the first signs of illness, you should consult a doctor.
