Introduction
The sound of the word ‘cancer’ is quite intimidating. It is considered a harbinger of despair and hopelessness. But, in the present scenario, with all the advances in medicine and technology, many of these cancers are curable and patients can have long term survival.
An Introduction to Liver Cancers
Liver cancer is the sixth most common cancer and fourth leading cause of cancer related deaths in the world. Liver cancers are broadly classified as primary and secondary cancers. The primary liver cancers are ones which originate in liver. The secondary liver cancers are ones which spread from other organs to liver.
Primary Liver Cancers
Hepatocellular carcinoma (HCC) is the commonest primary liver cancer. (Intrahepatic) Cholangiocarcinoma, Fibrolamellar carcinoma, Hepatoblastoma, Angiosarcoma and Epitheloid hemangioendothelioma are other known primary liver cancers, however, not as common as HCC.
Hepatocellular carcinoma (HCC)
HCC is the commonest primary cancer of liver. It is the fifth most common cancer in men and seventh in women. It is the second leading cause of cancer related deaths in the world. It is commonly found in cirrhotic livers, however, may also be seen sometimes in non-cirrhotic livers.
It may not present with significant symptoms, except for dragging pain, in most cases and usually diagnosed on follow up screening tests in cirrhotic patients. In advanced stages, it may present with reduced appetite, significant weight loss, jaundice, or deranged liver enzymes. Bone pains, cachexia, etc. are signs of metastatic HCC.
The diagnosis is suggested by raised levels of Alfa feto protein (AFP) and Protein induced by vitamin K absence-II (PIVKA-II) in blood and imaging tests like abdominal ultrasound. An abdominal CT scan and/or MRI confirms the diagnosis in most cases. Unequivocal cases on CT scan and MRI may occasionally require biopsy to confirm the diagnosis.
The treatment of HCC depends on the stage of disease and functional and structural status of liver. Small tumors in non-cirrhotic and early cirrhotic patients (without portal hypertension) may be resected surgically or ablated (Radio frequency ablation-RFA or microwave ablation-MWA). Larger tumors or tumors in liver cirrhosis patients with portal hypertension may require liver transplantation. Sometimes, bridging therapies in form of Trans-arterial chemoembolization (TACE), Trans-arterial radioembolization (TARE) or ablation treatments in form of RFA or MWA may be required in large tumors or in patients who are waiting for liver transplant. Tumors which have metastasized outside liver may have chemotherapy or immunotherapy as the only available options for palliation.
The survival has improved in recent years in patients with HCC. Although it is still dismal in patients who receive no therapy, patients who receive treatment, are seeing better survival now. Liver transplantation provides the best survival among all treatment modalities for HCC. The 3-year survival in patients who receive no therapy is approximately 10-15%, while it is 78-80% in patients who undergo liver transplantation.
Secondary Liver Cancers
Secondary liver cancers are tumors which originate in other organs and spread to liver. Liver is the commonest site of spread of tumors from other organs. Secondary liver cancers are commonest cancers found in liver. Colorectal cancers are commonest cancers which spread to liver.
Colorectal liver metastases
These are cancers originating in large intestine or rectum and spreading to liver. Liver spread is found in more than half of all the cases of colorectal cancers. The diagnosis is confirmed by colonoscopy, biopsy, tumor markers and imaging tests. The treatment depends on the stage of the tumor, number of lesions in liver, the pattern of spread in liver, the operability of primary tumor and operability of the liver tumors, the quality and the volume of liver which would remain after surgery, and the general fitness of the patient. The treatment options range from surgical resection, chemotherapy, radiotherapy, immunotherapy to liver transplantation. The overall 5-year survival in surgically resectable liver tumors is >50%, which means that more than half of the patients with surgically resectable colorectal liver metastases can survive for more than 5 years with surgery.
Other secondary liver cancers
Cancers like ovarian cancers, neuroendocrine cancers, pancreatic cancers, breast cancers, lung cancers and stomach cancers are also known to spread to liver. The diagnosis of these tumors requires blood tests, USG abdomen, upper GI endoscopy, CT scan and/or MRI and PET scan in some cases. Biopsy may be needed in many cases to confirm the diagnosis. The treatment options range from surgical resection, chemotherapy, radiotherapy, immunotherapy to liver transplantation in some cases.
Conclusion
Liver cancers are of various types. Commonest cancers in liver are colorectal liver metastases. Commonest primary cancer in liver is hepatocellular carcinoma. The diagnosis of liver cancer may not be necessarily, the end of the road. Liver cancers need to be diagnosed and staged in time to receive best possible treatment option. The treatment options are varied and depend on the diagnosis and stage of the cancer. The cure of these cancers is possible, if diagnosed and treated in time.
The above is the management in brief about Liver Cancers. If you have any patient suffering from liver problems, do consult your Liver cancer specialist. To know more, feel free to call +91 6359 602647
