How do I know if I have liver cancer?
Screening for primary liver cancer is not a routine test, but people at high risk for liver cancer may consider it as a routine test. However, studies have not determined whether screening is beneficial for people who are not at high risk for liver cancer.
To diagnose liver cancer, doctors must first rule out other causes of abnormal liver function.
Patients at high risk for liver cancer include those with hemochromatosis, those with chronic hepatitis, and those who abuse alcohol.
Other tests include:
- alpha fetoprotein (AFP) test: AFP is normally present only in the fetus and disappears after birth. Elevated levels of AFP in adults may indicate the development of hepatocellular carcinoma, and 70% of patients with hepatocellular carcinoma have elevated AFP. Increased levels of iron in the blood may also be a tumor marker.
- Ultrasound: This is the initial diagnostic tool and can detect tumors as small as 1 cm. High-resolution CT scans and enhanced MRI scans can be used to diagnose and stage tumors.
- Liver biopsy: Can distinguish between benign and malignant tumors. Sometimes it may be possible to diagnose liver cancer without a liver biopsy, depending on the results of other tests.
- Laparoscopy: A camera and associated instruments are inserted through a small abdominal incision into the abdomen and may be used to find small tumors, determine the extent of cirrhosis, or perform a biopsy, as well as to verify the results of prior tests and perform other procedures.
What are the treatment options for liver cancer?
Hepatocellular carcinoma of any type is difficult to cure. Primary liver cancer is rarely detected early, and early stages are the easiest to treat. Secondary or metastatic liver cancer is difficult to treat because the cancer has spread.
Surgical treatment
The liver has complex vascular and bile duct tissue that makes surgery very difficult. Much of the focus of liver cancer treatment is on making the patient feel better and on surviving as long as possible.
For patients with early-stage liver cancer, the tumor can be surgically removed, and these patients have the best chance of long-term survival. However, most liver cancers are inoperable at the time of diagnosis, often because the cancer has progressed to an advanced stage or the liver damage is so severe that it is difficult to tolerate surgery.
Chemotherapy and ethanol embolization
In some patients, chemotherapy drugs can be injected directly into the liver (chemoembolization) to shrink the tumor and give the patient the possibility of surgical resection. In some cases it is also possible to dispense with chemotherapy drugs and use ethanol instead. In patients in remission, the disease needs to be closely monitored for recurrence.
Cryotherapy and radiofrequency ablation
Cryotherapy and radiofrequency ablation (RFA, which uses radiofrequency current to destroy the tumor) are also used to treat some patients with liver cancer.
Radiation therapy
Radiation therapy is a local treatment using radiation to treat tumors and can be achieved in a variety of ways, but its use is limited by the liver’s low tolerance for radiation. The role of radiotherapy is to relieve extrahepatic symptoms or intrahepatic pain by shrinking the tumor. Radioembolization, on the other hand, is based on the use of certain substances to block the blood supply to the tumor.
Liver transplantation
For some patients with liver cancer and cirrhosis, liver transplantation may also be a treatment option. Although liver transplantation is risky, it gives patients a chance for long-term survival.
Treatment of advanced liver cancer
There is no standard cure for advanced liver cancer. Chemotherapy and low-dose radiation therapy may be able to control the spread of the cancer and relieve pain, but these treatments are limited for liver cancer. Most patients also need medications to relieve pain, relieve nausea, improve appetite, and reduce bloating and swelling in the lower extremities.
Sorafenib (trade name doxorubicin) was the first drug to significantly extend overall survival in patients with advanced liver cancer and is considered the drug of choice for the treatment of these patients.
Patients with advanced liver cancer have the option of participating in clinical trials to try new treatments.