Management of liver Cancer .
What is liver cancer?
Liver cancer is a life-threatening illness and one of the fastest-growing cancer types in the United States. There are two kinds of liver cancer: primary and secondary. Primary cancer starts in your liver. Secondary cancer spreads to your liver from another part of your body. This article is an overview of primary liver cancer.
Like many kinds of cancer, healthcare providers can do more to treat liver cancer during the disease’s early stage. Unlike many kinds of cancer, healthcare providers have a good idea of what increases someone’s risk of developing liver cancer. With that in mind, healthcare providers are intent on identifying who may be at increased risk so they can catch and treat primary liver cancer as early as possible.
Is liver cancer a common disease?
No, it’s not common, but liver cancer cases are steadily increasing. Healthcare providers estimate about 1% of all men and women in the United States will be diagnosed with a form of liver cancer during their lifetime.
There are three kinds of primary liver cancer:
Hepatocellular carcinoma (HCC): This is the most common form of liver cancer, representing nearly all liver cancer cases.
Intrahepatic cancer (IHC): This is a form of cholangiocarcinoma. IHC is cancer in your liver’s bile ducts. It represents about 10% to 20% of all primary liver cancer cases.
Angiosarcoma: This type is very rare, representing about 1% of all primary liver cancer cases. This cancer begins in the lining of blood cells in your liver. (Angiosarcoma may also affect other organs.)
Overall, HCC and IHC represent about 2% of all new estimated cancer cases in the United States, and 5% of all new cancer deaths. Healthcare providers often diagnose and treat HCC and IHC the same way.
Who’s affected by liver cancer?
HCC and IHC affect more men than women and are most often diagnosed between the ages of 55 and 64. People whose race includes Asian/Pacific Islander, Hispanic or American Indian/Alaskan Indian are more likely to develop primary liver cancer than people who are Black or white.
How does liver cancer affect my body?
Your liver is the largest organ in your body, helping you digest your food. It’s also one of the most important organs, as no one can live without their liver. Some of the essential tasks your liver manages include:
Collects and filters blood flowing from your intestines.
Processes and stores nutrients that your intestines absorb.
Changes some nutrients into energy or substances that your body needs to build tissue.
Makes bile, a fluid that helps digest fat.
Digests and stores other nutrients from food like sugar, which makes energy.
Makes substances that help your blood to clot.
Liver cancer symptoms
Symptoms of liver cancer may not be noticeable until the disease has progressed to an advanced stage.
Liver cancer symptoms may include:
Discomfort in the upper abdomen on the right side, where the liver is located
Abdominal swelling
Hard lump on the right side just below the rib cage
Back pain or pain near the right shoulder blade
Jaundice (yellowing of the skin and whites of the eyes)
Easy bruising or bleeding
Fatigue
Nausea and vomiting
Issues with eating: Not having an appetite, feeling full after a small meal, or losing weight with no known reason
Pale bowel movements or dark urine
Learn more about liver cancer symptoms.
Types of liver cancer
Liver cancer is primary or secondary. Primary liver cancer begins in the liver. Secondary liver cancer is metastatic, meaning it started somewhere else and moved into the liver. For example, lung cancer that spreads to the liver is still called lung cancer, and doctors may treat the cancer in the liver as part of a lung cancer treatment plan. In the United States, secondary liver cancer is more common than primary liver cancer.
Hepatocellular carcinoma (HCC), typically related to cirrhosis or chronic liver damage, is the most common form of primary liver cancer. The liver is mostly made up of blood vessels, and this is where cancer usually starts. This cancer may develop as one large tumor, but it’s more common for multiple small tumors to form throughout the liver.
Other types of primary liver cancer include:
Cholangiocarcinoma (bile duct cancer) forms in bile ducts inside or near the liver. About 10-20 percent of primary liver cancers are cholangiocarcinomas.
Angiosarcoma and hemangiosarcoma are rare, fast-moving cancers that affect the thin layer of cells that line blood vessel walls in the liver.
Hepatoblastoma is a childhood cancer that affects fetal liver cells.
What are the risk factors for liver cancer?
A person may be at higher risk for liver cancer if one or more of these risk factors below apply.
Long-term hepatitis B or C infections: Hepatitis infections are the strongest risk factor for liver cancer. These viruses are spread through unprotected sex, during childbirth from a mother with hepatitis to a child, through infected needles, or from contact with infected blood.
Cirrhosis: When the liver is damaged, normal tissue is replaced by scar tissue, called cirrhosis, preventing the liver from functioning normally. This typically occurs from heavy alcohol use.
Hereditary hemochromatosis: This metabolic disease, passed down family lines, causes over-absorption and buildup of iron in the liver and body.
Primary biliary cirrhosis: This autoimmune disease affects the bile ducts in the liver.
Ethnicity and gender: Asian-Americans and Pacific Islanders have the highest rates of liver cancer in the United States. Overall, men are more often diagnosed than women.
Other factors such as obesity and cigarette use.
Blood tests or an ultrasound may help catch cancer early, when it’s most treatable. For those with a higher risk for liver cancer, doctors may recommend regular screeni.
Surgical Treatment of Hepatocellular Carcinoma
For patients who are healthy enough to undergo surgery and who have early-stage cancer confined to the liver, treatment typically consists of surgical resection of the cancer or liver transplantation.
Resection: Resection refers to surgical removal of the cancer and some surrounding normal tissue. This is often the treatment of choice in patients without cirrhosis. Although resection is potentially curative, an estimated 70% of patients will develop a cancer recurrence during the first five years after treatment. Furthermore, resection is only possible when the remaining part of the liver is healthy enough to function on its own after surgery. For many patients with cirrhosis or other liver disease, this will not be the case and other treatment options will need to be considered.1
Liver transplantation: For selected patients who have cancer that is confined to the liver but cannot be surgically resected, liver transplantation may be an option. A benefit of liver transplantation is that it treats not only the cancer but also any underlying liver disease such as cirrhosis. Because the number of donor livers is limited, however, liver transplantation is generally reserved for those patients who are expected to have the best survival and the lowest risk of recurrence after transplantation. According to the commonly used “Milan criteria,” for example, transplant candidates should have a single liver nodule that measures no more than 5 cm or two or three nodules that measure no more than 3 cm each. These criteria are fairly restrictive, and the question of whether and how to expand the criteria to include more patients is currently being evaluated.
Non-surgical Liver Directed Therapy
Even when the cancer is confined to the liver, not all patients will be candidates for surgery. Fortunately, there are several non-surgical treatments available for the management of liver cancers and tumors.
Ablation: Ablation refers to the destruction of the tumor using techniques such as injection of alcohol into the tumor (percutaneous ethanol injection) or use of electrical energy and heat (radiofrequency ablation). Ablation tends to be most effective when tumors are small and limited in number.3
Chemoembolization: Cancers rely on an adequate blood supply in order to grow and survive. The blood supply to cancers in the liver is provided primarily via the hepatic artery. In the process of transarterial chemoembolization (TACE), chemotherapy is injected into the branch of the hepatic artery that supplies the cancer allowing the chemotherapy to concentrate in that area. In addition, the hepatic artery is blocked (embolized) in order to reduce blood supply to the cancer and further prevent its growth. This procedure is not curative, but it can improve survival. In general, patients must have adequate blood flow through the portal vein (the other main blood supply to the liver) in order to undergo TACE.4,5.
Systemic Therapy: Precision Cancer Medicine and Chemotherapy
Systemic therapy is any treatment directed at destroying cancer cells throughout the body, and may include chemotherapy, precision cancer medicines, or immunotherapy. Most patients with advanced cancers will be treated with systemic therapy in order to attack cancer cells throughout the body. The goal of administering systemic therapy is to reduce the risk of cancer recurrence, relieve symptoms, delay cancer progression and prolong survival. Systemic therapy is typically delivered by a medical oncologist and may include one or a combination of medications.1
Precision Cancer Medicines & Immunotherapy
In recent years the greatest progress in the management of liver cancer treatment is the development of effective precision cancer medicines and immunotherapy. Precision cancer medicine utilizes molecular diagnostic testing, including DNA sequencing, to identify cancer-driving abnormalities in a cancer’s genome. Once a genetic abnormality is identified, a specific targeted therapy can be designed to attack a specific mutation or other cancer-related change in the DNA programming of the cancer cells. Precision cancer medicine uses targeted drugs and immunotherapies engineered to directly attack the cancer cells with specific abnormalities, leaving normal cells largely unharmed.4,5.
Checkpoint Inhibitor Immunotherapy
Checkpoint inhibitors are a novel precision cancer immunotherapy that helps to restore the body’s immune system in fighting cancer by releasing checkpoints that cancer uses to shut down the immune system. PD-1 and PD -L1 are proteins that inhibit certain immune responses, allowing cancer cells to evade an attack by the body’s immune cells. Checkpoint inhibitor drugs that block the PD-1 pathway enhance the ability of the immune system to fight cancer. By blocking the binding of the PD-L1 ligand these drugs restore an immune cells’ ability to recognize and fight the liver cancer cells. There are several checkpoint inhibitors available and when used alone to treat HCC are unimpressive but when used in combination have become a new standard of care.
Keywords
Liver management.
Risk factor liver.
Symptoms liver.
Reported By: SM and GM Management Group's.
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