Liver cancer awareness

Liver cancer is a type of cancer that requires a thorough diagnostic and treatment strategy. Early diagnosis is key to increasing the chances of successful treatment, and surgical options can often provide curative outcomes, especially when used alongside other cancer therapies.

This article provides an expert insight into the nature of liver cancer, its symptoms, and the various treatment pathways available, including surgical interventions.

What is liver cancer?

Liver cancer is a type of cancer that arises when cells grow uncontrollably in the liver. The liver, located in the upper right abdomen, is an organ responsible for many functions, including filtering blood, metabolising nutrients, and producing bile for digestion.

Liver cancer can either be primary or secondary. Primary liver cancer originates in the liver itself, whereas secondary (metastatic) liver cancer starts in another part of the body and subsequently spreads to the liver. Risk factors for liver cancer include chronic hepatitis B or C infections, cirrhosis (scarring of the liver), excessive alcohol consumption, obesity, diabetes, and exposure to certain toxins.

In its early stages, liver cancer can be challenging to detect since it often presents no symptoms. As the cancer progresses, symptoms may appear, including persistent abdominal pain, unexplained weight loss, lack of appetite or feeling full after small meals, jaundice (yellowing of the skin and eyes), fatigue, and general weakness.

What types of surgical procedures are available for liver cancer?

Surgery is one of the main treatment options for liver cancer, especially when the cancer is detected early and is localised to a specific part of the liver. There are two primary surgical procedures for addressing liver cancer.

Partial hepatectomy

A partial hepatectomy involves removing the portion of the liver that contains cancerous cells. This procedure is most effective when the tumour is small, located in a specific area, and the surrounding liver tissue is healthy. The amount of liver removed will depend on the tumour's size and location.

The liver has the unique ability to regenerate, allowing it to regrow to its original size after part of it is removed. For this reason, patients with good liver function and no cirrhosis are typically considered suitable candidates for partial hepatectomy.

Ablation techniques

Ablation techniques are minimally invasive procedures used to destroy cancerous cells without removing any part of the liver.

Common methods include:

• Radiofrequency ablation (RFA): Radio waves are used to generate heat that kill cancer cells.
• Microwave ablation: Microwave energy is used to generate heat that kills cancer cells.
• Cryoablation: Extreme cold is used to freeze and destroy cancer cells.

These procedures may be used alone or in combination with other treatments, particularly for patients who may not be eligible for a full surgical resection. They can effectively control small tumours.

What is a liver transplant, and how can it cure liver cancer?

A liver transplant is a surgical procedure that involves fully replacing a diseased liver with a healthy liver from a donor. This option is generally considered for patients with early-stage liver cancer who meet specific criteria and for whom other forms of treatment, like resection, aren’t viable due to extensive liver damage or cirrhosis.

In cases where a donor organ isn’t available, patients may be placed on a transplant waiting list, during which additional treatments may be employed to control the cancer.

Can liver cancer surgery be combined with other cancer treatments?

Yes, liver cancer surgery can often be combined with other treatments to enhance outcomes, especially in advanced cases or if there is a risk of recurrence.

Chemotherapy or targeted therapy may be used before surgery (neoadjuvant therapy) to shrink tumours, making them easier to remove, or after surgery (adjuvant therapy) to kill any remaining cancer cells.

Immunotherapy is another treatment option that can be combined with surgery for liver cancer. This approach stimulates the immune system to recognise and attack cancer cells, especially for patients with advanced liver cancer.

Radiotherapy, though not commonly used due to the liver’s sensitivity, may be used for cases where the cancer can’t be surgically removed. Advanced techniques, like stereotactic radiotherapy, deliver high doses of radiation precisely to the tumour with minimal impact on health tissue.