HEPATIC CANCER
Dra. Echisell Reece Dawkins
Symptoms of Liver Cancer
Many people don’t experience symptoms in the early stages of primary liver cancer. When
symptoms do appear, they may include:
• abdominal discomfort, pain, and tenderness
• yellowing of the skin and the whites of the eyes, which is called jaundice
• white, chalky stools
• nausea
• vomiting
• bruising or bleeding easily
• weakness
• fatigue
The more common benign tumors of the liver include:
• Hemangioma
• Hepatic adenoma
• Focal nodular hyperplasia
• Cysts
• Lipoma
• Fibroma
• Leiomyoma
TYPES
Liver Angiosarcoma
Liver angiosarcoma is a rare form of liver cancer that begins in the blood vessels of the liver. This type of
cancer tends to progress very quickly, so it’s typically diagnosed at a more advanced stage.
Hepatoblastoma
Hepatoblastoma is an extremely rare type of liver cancer. It’s nearly always found in children, especially
those under age 3. With surgery and chemotherapy, the outlook for people with this type of cancer can be
very good. When hepatoblastoma is detected in the early stages, the survival rate is higher than 90 percent.
Hepatocellular carcinoma
Hepatocellular carcinoma (HCC), also known as hepatoma, is the
most common type of liver cancer, accounting for 75 percent of all
liver cancers. This condition develops in the hepatocytes, which
are the predominant liver cells. It can spread from the liver to
other parts of the body, such as the pancreas, intestines, and
stomach. HCC is much more likely to occur in people who have
severe liver damage due to alcohol abuse.
Cholangiocarcinoma
more commonly known as bile duct cancer, develops in the small, tube-like bile
ducts in the liver. These ducts carry bile to the gallbladder to help with digestion.
Bile duct cancer accounts for approximately 10 to 20 percent of all liver cancers.
When the cancer begins in the section of the ducts inside the liver, it’s called
intrahepatic bile duct cancer. When the cancer begins in the section of the ducts
outside the liver, it’s called extrahepatic bile duct cancer.
DIAGNOSIS
Diagnostic tests and procedures for liver cancer include the following:
• Liver function tests help your doctor determine the health of your liver by measuring levels of
proteins, liver enzymes, and bilirubin in your blood.
• The presence of alpha-fetoprotein(AFP) in the blood can be a sign of liver cancer. This protein is
usually only produced in the liver and yolk sac of babies before they’re born. AFP production
normally stops after birth.
• Abdominal CT or MRI scans produce detailed images of the liver and other organs in the abdomen.
They can allow your doctor to pinpoint where a tumor is developing, determine its size, and assess
whether it has spread to other organs.
LIVER BIOPSY
diagnostic test available is a liver biopsy. A liver biopsy involves
removing a small piece of liver tissue. It’s always done using
anesthesia to prevent you from feeling any pain during the procedure.
In most cases, a needle biopsy is performed. During this procedure,
your doctor will insert a thin needle through your abdomen and into
your liver to obtain a tissue sample. The sample is then examined
under a microscope for signs of cancer.
A liver biopsy might also be performed using a laparoscope, which is
a thin, flexible tube with an attached camera. The camera allows your
doctor to see what the liver looks like and to perform a more precise
biopsy. The laparoscope is inserted through a small incision in the
abdomen. If tissue samples from other organs are needed, your
doctor will make a larger incision. This is called a laparotomy.
If liver cancer is found, your doctor will determine the stage of the
cancer. Staging describes the severity or extent of the cancer. It can
help your doctor determine your treatment options and your outlook.
Stage 4 is the most advanced stage of liver cancer.
TREATMENT
Hepatectomy
A hepatectomy is performed to remove either a portion of the liver or all of
the liver. This surgery is usually done when the cancer is confined to the
liver. Over time, the remaining healthy tissue will regrow and replace the
missing part.
Liver Transplant
A liver transplant involves replacing the entire diseased liver with a healthy
liver from a suitable donor. A transplant can only be done if the cancer
hasn’t spread to other organs. Medicines to prevent rejection are given
after the transplant.
Ablation
Ablation involves the use of heat or ethanol injections to destroy the
cancer cells. It’s performed using local anesthesia. This numbs the area to
prevent you from feeling any pain. Ablation can help people who aren’t
candidates for surgery or a transplant.
Chemotherapy
Chemotherapy is an aggressive form of drug therapy that destroys
cancer cells. The medications are injected intravenously, or through a
vein. In most cases, chemotherapy can be given as an outpatient
treatment. Chemotherapy can be effective in treating liver cancer, but
many people experience side effects during treatment, including
vomiting, decreased appetite, and chills. Chemotherapy can also
increase your risk of infection.
Radiation Therapy
Radiation therapy involves the use of high-energy radiation beams to
kill cancer cells. It can be delivered by external beam radiation or by
internal radiation. In external beam radiation, the radiation is aimed at
the abdomen and chest. Internal radiation involves the use of a
catheter to inject tiny radioactive spheres into the hepatic artery. The
radiation then destroys the hepatic artery, a blood vessel that supplies
blood to the liver. This decreases the amount of blood flowing to the
tumor. When the hepatic artery is closed off, the portal vein continues
to nourish the liver.
Radiation Therapy
Radiation therapy involves the use of high-energy radiation beams to
kill cancer cells. It can be delivered by external beam radiation or by
internal radiation. In external beam radiation, the radiation is aimed at
the abdomen and chest. Internal radiation involves the use of a catheter
to inject tiny radioactive spheres into the hepatic artery. The radiation
then destroys the hepatic artery, a blood vessel that supplies blood to
the liver. This decreases the amount of blood flowing to the tumor.
When the hepatic artery is closed off, the portal vein continues to
nourish the liver.
Targeted Therapy
Targeted therapy involves the use of medications that are designed to
hit cancer cells where they’re vulnerable. They decrease tumor growth
and help shut down blood supply to the tumor. Sorafenib (Nexavar) has
been approved as targeted therapy for people with liver cancer.
Targeted therapy can be helpful for people who aren’t candidates for a
hepatectomy or liver transplant. However, targeted therapy can have
significant side effects.
Embolization and Chemoembolization
Embolization and chemoembolization are surgical
procedures. They’re done to block off the hepatic artery.
Your doctor will use small sponges or other particles to do
this. This reduces the amount of blood flowing to the
tumor. In chemoembolization, your doctor injects
chemotherapy drugs into the hepatic artery before the
particles are injected. The blockage created keeps the
chemotherapy medications in the liver for a longer period.
