Understanding liver cancer: A comprehensive guide

In his latest online article, Mr Charles Imber gives us his expert insight to liver cancer. He explains what the early signs and symptoms are, the diagnosis, the treatment, risk factors and the survival rates.

What are the early signs and symptoms of liver cancer?

Hepatocellular carcinoma (HCC), commonly known as liver cancer, ranks as the third leading cause of cancer-related deaths worldwide. Typically, it arises in individuals with pre-existing chronic liver conditions. The early manifestations of liver cancer can differ from person to person, and in its initial stages, the disease may not present any noticeable symptoms.

However, as the illness advances, the following signs and symptoms may become evident:

• Unintended weight loss
•  Loss of appetite
• Abdominal pain or discomfort
•  Nausea and vomiting
• Fatigue and weakness
•  Jaundice - yellowing of the skin and eyes
•  Swelling in the abdomen or legs
•  Enlargement of the liver.
• Easy bruising or bleeding tendencies
• Passage of pale, whitish stools.

How is liver cancer diagnosed, and what are the common diagnostic tests used?

It is important to note that these signs and symptoms can be caused by other conditions as well, so a proper medical evaluation is necessary for an accurate diagnosis.

Diagnosing liver cancer involves several tests and procedures. These may include:

1. Medical history and physical examination: The doctor will ask about symptoms, risk factors, and family history, and conduct a physical examination of the abdomen to check for any abnormalities. You will be asked about risk factors for chronic liver disease including alcohol intake, previous drug abuse, travel and hepatitis

2.  Blood tests: Blood samples are analysed to check liver function and look for tumour markers, such as alpha-fetoprotein (AFP). A full liver screen will be performed including looking at any previous viral infections, autoantibody screens, copper and iron levels in blood. The liver function tests will give a broad assessment of potential chronic liver disease.

3.  Imaging tests: Various imaging techniques, including ultrasound, computed tomography (CT) scan, magnetic resonance imaging (MRI), and positron emission tomography (PET) scan, can help visualize the liver and detect any tumours or abnormalities. HCC has a characteristic appearance on CT scans, which will also detect if cirrhosis of the liver is present or any spread of a potential tumour.

4.  Biopsy: A sample of liver tissue is collected for examination under a microscope to confirm the presence of cancer cells. This is often done using a needle guided by imaging techniques, such as ultrasound or CT scan. This is not always necessary if surgical resection is planned and the radiological findings are clearcut.

What are the treatment options for liver cancer?

Once liver cancer is diagnosed, treatment options depend on several factors, including the stage of cancer, the overall health of the patient, and the available treatment options.

Common treatment approaches for liver cancer include:

1. Surgery: Surgical options include removing the tumour (partial hepatectomy), liver transplant which treats both the cancer and the cirrhotic liver if present, or in some cases, removing only the cancerous part of the liver (local ablation), local ablation of the tumour and surround tissue.

 2. Radiation therapy: This involves using high-energy radiation to kill cancer cells or shrink tumours.

3. Trans arterial chemoembolization (TACE): It involves delivering chemotherapy drugs directly to the tumour through the hepatic artery, followed by blocking the artery to cut off the blood supply to the tumor.

4. SIRT (selective internal radiation therapy) – this can shrink tumours and sometimes act as a bridge to subsequent surgery or other medical therapies.

5. Targeted therapy: These are drugs that target specific abnormalities in cancer cells to inhibit their growth and spread.

6. Immunotherapy: This approach boosts the body's immune system to recognise and attack cancer cells.

7.Palliative care: This focuses on managing symptoms and improving the quality of life for patients with advanced liver cancer.

What are the risk factors and causes of liver cancer?

Several risk factors and causes have been associated with liver cancer, including:

1. Chronic infection with hepatitis B or hepatitis C viruses.

2. Cirrhosis (scarring of the liver), often caused by excessive alcohol consumption or non-alcoholic fatty liver disease

3. Excessive alcohol consumption

4. Obesity

5. Diabetes

6. Aflatoxin exposure (a toxin produced by a fungus that can contaminate certain foods)

7. Smoking

8. Certain inherited liver diseases

What is the survival rate for liver cancer, and how does it vary by stage?

The survival rate for liver cancer varies based on the stage at the time of diagnosis. The overall five-year survival rate for liver cancer is relatively low because it is often diagnosed at an advanced stage. However, the survival rates can improve with early detection and appropriate treatment.

 The survival rates by stage are as follows:

• Stage 0: In situ tumours have a 5-year survival rate of around 31%.

• Stage I: Localised tumours have a 5-year survival rate of about 31%.

• Stage II: Regional spread of tumours has a 5-year survival rate of around 11%.

• Stage III: Distant spread of tumours has a 5-year survival rate of about 3%.

• Stage IV: Metastatic tumours have a 5-year survival rate of less than 3%.

It's important to note that survival rates are statistical averages and individual cases may vary based on various factors. Early detection, prompt treatment, and ongoing medical care can significantly impact a person's prognosis.

Mr Charles Imber is a highly regarded consultant general surgeon with over 30 years of experience. You can book an appointment with Mr Imber today on his Top Doctors profile.