Liver Cancer - Symptoms & Treatment

A rare form of cancer, liver cancer (primary and metastatic hepatic carcinoma) has a high mortality It's responsible for roughly 2% of all cancers in the United States and for 10% to 50% in parts of Asia. Liver cancer is most prevalent in men (particularly over age 60); incidence increases with age. It's rapidly fatal, usually within 6 months, from 01 hemorrhage, progressive cachexia, hepatic failure, or metastasis.

Most primary liver tumors (90%) originate in the parenchymal cells and are hepatomas (hepatocellular carcinoma, primary lower-cell carcinoma). Some primary tumors originate in the intrahepatic bile ducts and are known as cholangiomas (cholangiocarcinoma, cholangiocellular carcinoma). Rarer tumors include a mixed-cell type, Kupffer cell sarcoma and hepatoblastomas (which occur almost exclusively in children and are usually resectable and curable).

The liver is one of the most common sites of metastasis from other primary cancers, particularly those of the colon, rectum, stomach, pancreas, esophagus, lung, or breast or melanoma. In the United States, metastatic liver carcinoma occurs over 20 times more often than primary carcinoma and, after cirrhosis, is the leading cause of liver-related death. At times, liver metastasis may appear as a solitary lesion, the first sign of recurrence after a remission

Causes

Although nobody is exactly sure what causes liver cancer, it does tend to arise in those people whose liver has been severely damaged by a condition called cirrhosis (scarring of the liver). Any disease that causes cirrhosis of the liver will increase the risk of you developing liver cancer. Cirrhosis of the liver can be caused by infection with the hepatitis B or C virus and drinking excess alcohol. Hepatitis A does not cause cirrhosis or primary liver cancer.

However, only a small minority of people with cirrhosis of the liver will go on to develop primary liver cancer.

Primary liver cancer tends to affect the middle aged and elderly, but very rarely it can affect children. It is also a lot more common in men than it is in women.

Signs and symptoms

A very early cancer will have little or no symptoms. It will have little or no symptoms because it is too small to cause any. As the cancer enlarges, it will have symptoms. The common symptoms are:

• Pain in the right upper abdominal area. Pain is caused by stretching of the liver's capsule.
• Weight Loss and loss of appetite.
• Breast swelling in males
• Blood clotting problems leading to intestinal bleeding and bruises on the skin.
• Jaundice

Diagnosis

The confirming test for liver cancer is a needle or open biopsy of the liver. Liver cancer is difficult to diagnose in the presence of cirrhosis, but several tests can help identify it:

• Physical examination shows an enlarged, tender liver.
• A liver biopsy shows hepatocellular carcinoma.
• Serum alpha fetoprotein may be elevated.
• There may be a mass shown on abdominal CT scan .
• A liver scan may indicate an abnormality.
• Liver enzymes ( liver function tests ) are elevated.

Treatment

Because liver cancer is often in an advanced stage at diagnosis, few hepatic tumors are resectable. A resectable tumor must be a single tumor in one lobe, without cirrhosis, jaundice, or ascites. Resection is done by lobectomy or partial hepatectomy.

Radiation therapy for unresectable tumors is usually palliative. However, because of the liver's low tolerance for radiation, this therapy hasn't increased survival.

Another method of treatment is chemotherapy with I.V. fluorouracil, methotrexate, streptozocin, lomustine, or doxorubicin or with regional infusion of fluorouracil or floxuridine (catheters are placed directly into the hepatic artery or left brachial artery for continuous infusion for 7 to 21 days, or permanent implantable pumps are used on an outpatient basis for long-term infusion).

Appropriate treatment for liver metastasis may include resection by lobectomy or chemotherapy with mitomycin or fludarabine. (The results are similar to those in hepatoma.) Liver transplantation is now an alternative for some patients.

Prevention

In many cases it's not possible to prevent the spread of cancer from another site to the liver. And it may not always be possible to prevent primary liver cancer. But you can greatly reduce your risk by taking steps to protect yourself from hepatitis B and C, cirrhosis and other liver diseases. Because no vaccine for hepatitis C exists, the following measures also can play a key role in protecting your health:

• Educate yourself and others. Make sure you understand what viral hepatitis is and how it's transmitted.
• Avoid body piercing and tattooing. Needles that may not be properly sterilized can spread the virus.
• Avoid excessive alcohol consumption.
• Avoid medications that may cause liver damage. Your doctor can advise you about these medications, which may include over-the-counter medications as well as prescription drugs. Avoid mixing alcohol and acetaminophen (Tylenol, others) - a combination known to cause liver damage.