Liver cancer is cancer that begins in the cells of your liver. Your liver is an organ that sits in the upper right portion of your abdomen, beneath your diaphragm and above your stomach.
Several types of cancer can form in the liver. The most common type of liver cancer is hepatocellular carcinoma, which begins in the main type of liver cell (hepatocyte). Other types of liver cancer, such as intrahepatic cholangiocarcinoma.
Cancer that spreads to the liver is more common than cancer that begins in the liver cells. Cancer that begins in another area of the body — such as the colon, lung or breast — and then spreads to the liver is called metastatic cancer or secondary Liver cancer rather than Primary liver cancer.
It is essential to come to this diagnosis before treatment can be started as the treatment for primary and secondary Liver cancer is completely different.
Most of the time cancer in the liver is painless. Some present with jaundice. Some have vague symptoms like loss of weight, loss of appetite, tiredness, fever etc. It is extremely important to be suspicious and get tested at the earliest.
Risk factors
- Cirrhosis
- Chronic viral hepatitis
- Family history of Liver cancer
- Fatty Liver disease
Investigations
- USG abdomen – screening investigation
- CT with IV contrast or MRI with Contrast – investigation of choice
- PET CT not required- only positive 30-40% of times. Will not give any additional benefit.
- Blood tests – Alpha Feto Protein & Ca 19-9 , both tumor markers will aid in diagnosis.
- A liver biopsy is NEVER required to diagnose Liver cancer.
Management
Treatments for primary liver cancer depend on the extent (stage) of the disease as well as your age, overall health and the condition of the liver.
As most of the Liver cancer happens in a cirrhotic back ground, a Liver transplantation is the best treatment and offer very good long-term survival if it falls within certain criteria..
Liver resection is performed for cancers happening in a non-cirrhotic liver
A liver resection, also known as a partial hepatectomy, is a cancer surgery that involves removing cancerous tumors in the liver. Your liver can regenerate itself; therefore, tissue mass removed during surgery may be restored eventually.
A partial hepatectomy can be performed via traditional open surgery or laparoscopically. When appropriate, laparoscopic surgery can offer many advantages including less pain, shorter hospital stays, faster recovery and minimal scarring.
Who is a candidate for a liver resection?
A liver resection is typically considered if you have a single tumor in the liver and it has not spread to the blood vessels. The most common reason for a liver resection is patients who have a single liver cancer tumor that has spread from colon cancer or a primary liver cancer happening in a non-cirrhotic liver
You will be evaluated with scans and blood tests to determine if you are a candidate for a liver resection, the following considerations will be evaluated:
- Stage of cancer – if the tumor is very large or there are multiple tumors, surgical removal is complicated
- Location of cancerous tumors – if the liver tumor is close to a blood vessel, you may need a different treatment such as intra-arterial chemotherapy or chemoembolization
- How much surgery will be needed to remove the entire tumor – only a portion of the liver can be removed to preserve function
- How well the organ is functioning – patients with impaired liver function may not be able to handle a liver resection
- Patients overall health – patients who are not in good health may need a different treatment option.
