What does the liver do?
The liver is the second largest organ in the body and filters or detoxifies nearly 1,500 liters of blood daily, removing fats, metabolic byproducts, chemicals, environmental toxins, drugs and alcohol from the blood. The liver is also responsible for storing energy (in the form of glycogen) and fats, breaking down red blood cells and synthesizing proteins in the blood plasma. In addition, the liver synthesizes and secretes bile, which is stored in the gallbladder and released into the small intestine when a person eats. Bile plays an important role in the digestion of fats and the absorption of nutrients and vitamins, such as vitamins A and D.
Unlike most body tissues, liver tissue can regenerate, but this ability depends on the overall health of the organ. This is an important fact for patients planning to undergo hepatectomy. Liver tissue can regenerate and assist the blood filtering organ to regain its working structure, but it will not become the fully functional liver it was initially.
What is liver cancer?
Cancer: also known as malignancy, is an abnormal growth (unrestricted, endless proliferation) and division of cells; it can originate from almost any body part, organ or tissue. Cancer that grows in the liver is called hepatocellular carcinoma, which is divided into primary and secondary hepatocellular carcinoma. Hepatocellular carcinoma is a serious group of diseases that may not show symptoms until it has progressed to an advanced stage. Similar to most cancers, early detection is an important factor in improving potential outcomes and treatment options for liver cancer. In the early stages of the disease, treatment focuses on treating the tumor radically and slowing the growth of the cancer. In later stages of the disease, treatment focuses on managing pain and symptoms, thereby improving quality of life.
Symptoms and diagnosis.
Symptoms.
Hepatocellular carcinoma often does not show any symptoms until the disease is in an advanced stage. This makes early detection more difficult. Symptoms that can occur with liver cancer include
Weight loss.
Loss of appetite.
A feeling of fullness even after eating small amounts of food.
Pain or swelling near the liver (upper right abdomen) or near the right shoulder blade.
Nausea.
Persistent stomach pain.
Accumulation of fluid in the abdominal cavity (ascites).
Yellow coloring of the skin and eyes (jaundice).
Tremor, confusion or disorientation (encephalopathy).
Progressive weakness.
High fever.
Patients with 1 or more risk factors for hepatocellular carcinoma and those with any of the above symptoms must be seen immediately. If a patient is at risk of developing liver disease or liver cancer, he or she must be evaluated and treated immediately so as to ensure a better outcome and health for the patient.
Diagnosis
Only trained physicians can medically assess liver cancer, evaluate test results, make a diagnosis, and provide treatment recommendations based on the diagnosis.
The diagnosis of liver cancer includes risk factor assessment, physical examination, blood tests, ultrasound, computerized tomography (CT) scan, magnetic resonance imaging (MRI), and tissue biopsy. These exams, scans and tests evaluate changes in the size or shape of the liver or adjacent organs, detect the presence of tumors, determine abnormal blood chemistry results that may indicate liver insufficiency, and look for tumors in the body.
The doctor decides which tests and exams are appropriate for each case based on symptoms, risk factors, other test results and best medical practice.
Staging of hepatocellular liver cancer.
Staging describes the extent and severity of the cancer. Staging is based on the size and number of tumors, their location, and whether they have spread (metastasized) to lymph nodes or other parts of the body. Staging is related to the choice of cancer treatment options and prognosis. The development and prognosis of hepatocellular liver cancer are closely related to hepatitis cirrhosis, so its clinical staging includes liver function factors in addition to tumor factors. The following describes the most common clinical staging of hepatocellular liver cancer: BCLC staging, which mainly includes four categories of prognostic factors (1) general status of the patient (2) status of the tumor (3) status of liver function (4) available treatment options.
Barcelona Clinical Staging System for Liver Cancer (BCLC)
BCLC Staging
Behavioral status
Tumor status
Liver function status
Treatment
0 (earliest stage)
0
Single ≤ 50px
Normal bilirubin, no portal hypertension
Hepatectomy
A (early stage)
A1
0
Single ≤ 125px
normal bilirubin, no portal hypertension
Hepatectomy
A2
0
Single ≤125px
normal bilirubin, with portal hypertension
LT/PEI/RF
A3
0
Single ≤125px
abnormal bilirubin with portal hypertension
LT/PEI/RF
A4
0
All three tumors ≤75px
Child-Pugh A-B
LT/PEI/RF
B (mid-stage)
0
Multiple or single >125px
Child-Pugh A-B
TACE
C (late stage)
1-2
Vascular invasion or metastasis
Child-Pugh A-B
New drug therapy
D (end-stage)
3-4
Any tumor
Child-Pugh C
Symptomatic treatment
Stages A and B: all criteria performed; Stage C: at least one criterion, PST: 1-2 or vascular invasion/extrahepatic metastases
Stage D: at least one criterion, PST: 3-4 or Child-Pugh C
Behavioral status score.
PS 0: normal activity; PS 1: symptomatic but barely interfering with bedtime activities; PS 2: less than 50% daytime bedtime; PS 3: more than 50% daytime bedtime; PS 4: completely bedridden
Potential treatment options
—— Each person is unique and each cancer is unique
There is no one treatment or treatment plan that works for every patient or for every cancer. Patients can only decide the most appropriate treatment or combination of treatments for their unique condition by working closely with their physician.
Factors in the treatment of liver cancer
The recommended treatment for liver cancer depends on.
The patient’s age, general health, physiology and previous condition
Number of tumors and degree of invasion of other tissues (stage)
The degree of liver damage or liver insufficiency
The site of the tumor and proximity to large blood vessels, bile ducts, or other organs
Type of cancer, including primary or secondary
Degree of similarity of the cancer cells to surrounding tissues (staging)
Patient preference
Treatment strategy
Radical treatment for liver cancer includes
Surgical removal of the cancerous tissue
Use of thermal or chemical ablation, such as radiofrequency ablation, microwave ablation, laser ablation, alcohol ablation
Liver transplantation
Palliative treatment for liver cancer includes
Interventional embolization
Use of drugs or other chemicals to destroy the cancerous tissue
Others: radiotherapy, immunotherapy, etc.
Many treatment plans are available to attack the cancer using multiple therapies that can be individualized based on unique physiology, condition and patient preference.
Surgical resection
If liver cancer is detected early enough and the rest of the liver is healthy or only has early cirrhosis, the surgeon may remove the part of the liver that contains the cancer. This is called a surgical resection or partial hepatectomy. The surgery removes the tumor and the visually normal margin of liver tissue surrounding the tumor; this helps ensure that all cancer cells are removed.
Reasons why some patients may not be candidates for surgical resection (contraindications)
Only 8 to 27% of patients with hepatocellular carcinoma are candidates for surgical resection. Involving multiple tumors, tumors too close to large blood vessels, or cancer growing outside the liver are not good cases for hepatic resection. However, even in these patients, hepatectomy may be considered to slow the growth of the cancer and extend life or to help control symptoms (palliative care). Treatment plans often combine hepatectomy with other treatments, such as local ablation.
Local ablation
Ablation is the administration of heat, cold, chemistry and/or electricity directly in the tumor, resulting in the death of cells in the diseased tissue. The tissue destroyed by ablation does not need to be removed, but gradually shrinks and becomes scar tissue.
Ablation is indicated for the treatment of primary and secondary liver cancer. It is often used in combination with other therapies, such as regional or systemic chemotherapy, hepatectomy or TACE. The reason for this is that the combination therapy provides local control of tumor growth and prevents systemic spread of the disease. If the tumor cannot be safely removed given its size or proximity to large blood vessels or organs, physicians may use ablation to shrink the tumor and thereby control symptoms (palliative care). Ablation can also successfully slow the progression of liver tumor growth, thus helping patients awaiting liver transplantation.
In some cases, ablation is performed through a small incision in the skin (percutaneous) in a minimally invasive procedure requiring only local anesthesia + intravenous analgesia. To guide during the operation, the physician may use laparoscopy (tiny TV cameras on the overlapping tubes), ultrasound, etc. to guide.
The antenna or electrode is inserted directly into the liver tumor. After placing the antenna or electrode, the physician may ablate the tumor using microwave or radiofrequency energy. The ablated tumor remains in the organ and gradually shrinks over time. The ablation area is monitored by the physician.
Depending on the size, number and location of the tumors, ablation can be used multiple times on multiple tumors or areas within the same session or over a period of time. After completing treatment, ablation may also be used to treat recurrent tumors.
The most commonly used thermal ablation treatments for the treatment of liver cancer are radiofrequency ablation and microwave ablation. Radiofrequency ablation is a minimally invasive cancer treatment that uses high-frequency electrical waves to generate heat and kill cancer cells and healthy cells at the edge of the tumor, thereby preventing cancer recurrence. The doctor inserts electrodes directly into the diseased tissue under the guidance of ultrasound and other imaging. Afterwards, the doctor activates the electrodes and sends an electric current into the tissue. Heat is generated and the cells are brought to a temperature at which they can be killed, and ablation of individual tumors often takes 10 – 25 minutes.
Survival rates for patients with hepatocellular carcinoma who undergo radiofrequency ablation are similar to those of patients who undergo surgical resection. Overall survival rates for recurrent hepatocellular carcinoma at 1, 2, 3 and 4 years after radiofrequency ablation and surgery were 95.8%, 82.1%, 71.4%, 67.9% and 93.3%, 82.3%, 73.4% and 64.0%, respectively. Higher survival rates were achieved for primary liver cancer.
Risk and prevention
Genetic, environmental, viral and behavioral factors can contribute to the transformation of healthy cells into cancer cells.
The liver has the ability to regenerate. People can survive with 30% of their healthy liver preserved, while patients with cirrhosis can survive with 50% of their liver preserved. Reducing risk factors can help improve liver health. Even in people with progressive liver disease or liver cancer, treatment and lifestyle changes can improve their quality of life.
If early stage liver cancer is detected, the cancer is small and confined to the liver. These are important factors in determining treatment options and prognosis. This means that screening and early detection are of key importance. Any patient presenting with liver disease or risk factors for liver cancer must consult a physician so that a prevention plan can be developed. Any patient presenting with symptoms of liver cancer must be seen immediately.
Risk Factors for Primary Liver Cancer
These risk factors can increase a patient’s likelihood of developing primary liver cancer.
. Chronic hepatitis, hepatitis B or C
. Cirrhosis of the liver
. Heavy alcohol consumption
. Unhealthy diet and lifestyle habits
. Diabetes
. Use of anabolic hormones or androgens
. Exposure to arsenic, such as in drinking water
. Exposure to specific industrial chemicals in the plastics industry .
. Aflatoxin – a carcinogenic substance produced by fungi that can sometimes contaminate peanuts, corn, grains and dried fruits, mainly in developing countries where the food supply is not adequately regulated
. Specific genetic disorders such as hemochromatosis, which can lead to cirrhosis of the liver
About the patient’s family and caregivers
It is not only the patient diagnosed with liver cancer who is affected by it, but also the family and friends who provide support. They have many roles to play.
. Providing emotional support and confidence in treatment through talking, listening and encouraging
. Assisting with daily tasks such as cleaning, shopping, meal preparation or personal care
. Assist with transportation to doctor’s appointments, shopping or pharmacies
. Coordination of services, including home care or home meals
. Overseeing the implementation of patient treatments and tests
Many families and caregivers experience stress, depression and fear when helping others during the disease process and treatment, including.
. Frequent feelings of sadness or emptiness
. Difficulty making decisions
. Difficulty sleeping or sleeping too much .
. Fatigue or drowsiness .
. Frequent pain or pain unrelated to illness or injury .
. Fear of
. Loss of appetite or overeating
Self-care is key
Many families and caregivers put all their energy into caring for their patients at the expense of themselves. Caregivers need to be balanced, which involves.
. Proper understanding of the disease and maintaining emotional stability
. Assigning tasks to other family members or friends
. Take personal rest and replenish energy .
. Exercise regularly .
. Eat a balanced and nutritious diet .
. Pay attention to the feelings of others and communicate with support staff .
. Use relaxation techniques, such as yoga, massage or meditation
. Engage in enjoyable activities and hobbies
. Avoid dwelling on past mistakes
. Participate in support groups