In 2023, over 3000 individuals received a diagnosis of liver cancer, with an average age of 69 years at diagnosis. Globally, liver cancer ranks as the sixth most prevalent cancer and the third leading cause of cancer-related deaths. The year 2020 witnessed a staggering 900,000 new cases of liver cancer worldwide, underscoring its profound impact.
Notably, there are gender disparities in liver cancer incidence, with men ranking fifth in prevalence and women ninth. This data emphasizes the significant burden posed by liver cancer on public health systems and the urgent need for effective prevention and treatment strategies.
Liver Cancer Definition
Liver cancer is cancer that originates in the liver itself. Unlike cancers that begin elsewhere and spread to the liver, liver cancer specifically starts within the liver. The liver, positioned beneath the right lung and tucked under the ribcage, is a vital organ with numerous crucial roles, such as detoxifying the body by eliminating harmful substances.
What Causes Liver Cancer?
Liver cancer can be triggered by various risk factors, although not everyone exposed to these factors will develop the disease. Some individuals may develop liver cancer without apparent risk factors. Here are the common causes associated with liver cancer:
Hepatitis B Virus (HBV) Infection
HBV spreads through blood, semen, or other body fluids. It can be transmitted from mother to child during childbirth, through sexual contact, or via shared needles used for drug injection. HBV infection can inflame the liver, leading to cancer. Routine vaccination in infancy is lowering HBV infection rates, although it remains the primary cause of liver cancer in Asia and Africa.
Hepatitis C Virus (HCV) Infection
HCV spreads through blood, primarily through shared needles for drug injection or, less frequently, through sexual contact. Historically, it was transmitted through blood transfusions or organ transplants, but screening of donated blood has substantially reduced this risk. Chronic HCV infection can cause cirrhosis, increasing the risk of liver cancer. It’s the primary cause of liver cancer in North America, Europe, and Japan.
Cirrhosis
Liver cancer risk rises with cirrhosis, a condition where healthy liver tissue is replaced by scar tissue, impairing liver function. Chronic alcoholism and hepatitis infections commonly cause cirrhosis. Those with HCV-related cirrhosis face a higher liver cancer risk than those with cirrhosis due to HBV or alcohol use.
Heavy Alcohol Use
Chronic heavy alcohol consumption can cause cirrhosis, elevating liver cancer risk. Even without cirrhosis, heavy alcohol users are at increased risk. Those with cirrhosis from heavy alcohol use are ten times more likely to develop liver cancer than non-cirrhotic heavy drinkers. Studies also suggest higher liver cancer risk in individuals with HBV or HCV infection who heavily consume alcohol.
Aflatoxin B1
Consuming foods contaminated with aflatoxin B1, a toxin from fungus found on stored corn and nuts in hot, humid areas, can heighten liver cancer risk. This risk is particularly prevalent in sub-Saharan Africa, Southeast Asia, and China.
Nonalcoholic Steatohepatitis (NASH)
NASH, the most severe form of nonalcoholic fatty liver disease, can lead to cirrhosis and subsequently liver cancer. It’s characterized by excessive fat accumulation in the liver, which can induce inflammation and liver cell damage. Even individuals with NASH but without cirrhosis face liver cancer risk.
Cigarette Smoking
Smoking cigarettes is associated with increased liver cancer risk, with higher risks linked to greater daily cigarette consumption and prolonged smoking duration.
Other Conditions
Certain rare medical and genetic conditions, such as untreated hereditary hemochromatosis, alpha-1 antitrypsin deficiency, glycogen storage disease, porphyria cutanea tarda, and Wilson disease, can also heighten liver cancer risk.
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Types of Liver Cancer?
Here are the different types of Liver Cancer:
Hepatocellular Carcinoma (HCC)
Arising from hepatocytes, the main liver cells, HCC is closely associated with cirrhosis and common liver-related factors like viral infections or alcohol abuse. It’s more prevalent in men and increases with age.
Fibrolamellar Carcinoma
Rare and typically affecting younger individuals, fibrolamellar carcinoma differs from other liver cancers by not showing elevated levels of alpha-fetoprotein (AFP) in the blood. It’s not usually linked to cirrhosis or viral infections.
Bile Duct Cancer (Cholangiocarcinoma)
Targeting the bile ducts, which aid in fat digestion, cholangiocarcinoma can be extrahepatic (outside the liver) or intrahepatic (within the liver). It’s rare but necessitates accurate classification for proper diagnosis and treatment.
Angiosarcoma
An uncommon soft tissue sarcoma originating in the liver’s blood vessels, angiosarcoma primarily affects the elderly. Its rarity requires specialized attention for understanding and treatment.
Hepatoblastoma
Exceptionally rare and mostly impacting young children, hepatoblastoma underscores the need for tailored research and treatments for pediatric cases.
Symptoms of Liver Cancer
In the early stages, liver cancer may not present noticeable symptoms. However, as the disease progresses, symptoms may include:
Abdominal Discomfort: Pain or a noticeable lump below the rib cage, on the right side of the abdomen, or pain near the right shoulder.
Jaundice: Yellowing of the skin and eyes, a characteristic sign of liver dysfunction.
Unexplained Weight Loss: Significant weight loss without changes in diet or physical activity.
Nausea and Loss of Appetite: Persistent feelings of nausea and a reduced desire to eat.
Fatigue: Feeling unusually tired or weak, even with sufficient rest.
Dark-Colored Urine: Urine may appear darker than usual due to changes in liver function.
Stages of Liver Cancer
Liver cancer is categorized into four stages to guide treatment decisions and determine prognosis:
Stage 1: The tumor is confined to the liver and has not spread to other organs or tissues.
Stage 2: Multiple small tumors are present within the liver, or there is one larger tumor that has invaded a nearby blood vessel.
Stage 3: Multiple large tumors are detected, or one tumor has extended into a major blood vessel.
Stage 4: The cancer has metastasized, spreading to distant organs or tissues beyond the liver.
Upon diagnosis and staging of liver cancer by a healthcare professional, appropriate treatment measures will be initiated.
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Liver Cancer Treatment
Liver cancer treatment options vary depending on the type and stage of the cancer. Here’s an explanation main treatments available:
Surgery
- Partial Hepatectomy: This surgical procedure involves removing the part of the liver affected by cancer while preserving the healthy portion. It’s a common treatment for localized liver cancers, particularly when the tumor is confined to one area of the liver and can be safely removed without compromising liver function.
- Liver Transplant: In cases where the cancer has spread extensively throughout the liver or when the liver is severely damaged by cirrhosis, a liver transplant may be recommended. This involves replacing the entire liver with a healthy liver from a deceased or living donor. Liver transplant is often considered for individuals with early-stage liver cancer who meet specific criteria and have no other viable treatment options.
Tumor Ablation
Tumor ablation techniques use various methods to destroy cancer cells within the liver, particularly for small tumors that are not suitable for surgical removal. Common approaches include:
- Radiofrequency Ablation (RFA): This procedure uses high-frequency electrical currents to heat and destroy cancer cells. A needle-like probe is inserted directly into the tumor, and the heat generated by the radiofrequency energy kills the cancerous tissue.
- Microwave Ablation: Similar to RFA, microwave ablation uses electromagnetic waves to generate heat and destroy cancer cells. It may offer advantages in terms of larger tumor volumes and faster treatment times compared to RFA.
- Alcohol Injection: Pure alcohol is injected directly into the tumor, causing dehydration and destruction of cancer cells. This method is typically used for small tumors and is less commonly performed than other ablation techniques.
- Cryotherapy: Cryotherapy involves freezing and killing cancer cells using extremely cold temperatures. A probe is inserted into the tumor, and liquid nitrogen or argon gas is circulated to freeze the tissue. Cryotherapy may be used for small liver tumors and is often considered when other treatments are not feasible.
Chemotherapy
- Systemic Chemotherapy: This treatment uses powerful anti-cancer drugs that circulate throughout the body via the bloodstream to target cancer cells wherever they may be. While systemic chemotherapy is less commonly used as a primary treatment for liver cancer, it may be employed after other interventions or for palliative care to relieve symptoms and slow disease progression.
- Chemoembolization (TACE): Transarterial chemoembolization (TACE) is a localized treatment that delivers chemotherapy drugs directly into the blood vessels feeding the liver tumor. By blocking the blood supply to the tumor while simultaneously administering chemotherapy, TACE aims to kill cancer cells while minimizing systemic side effects. It’s often utilized for primary liver cancer, particularly for individuals who are not candidates for surgery or ablation.
Biological Therapy (Immunotherapy)
Immunotherapy harnesses the body’s immune system to recognize and attack cancer cells. It works by stimulating the immune system or by introducing substances that target specific molecules on cancer cells, known as immune checkpoint inhibitors. Immunotherapy can be used alone or in combination with other treatments for both primary and secondary liver cancers. It is increasingly being explored as a promising treatment option, particularly for advanced or recurrent liver cancer cases.
Selective Internal Radiation Therapy (SIRT)
SIRT, also known as radioembolization, is a minimally invasive procedure that delivers high doses of radiation directly to liver tumors using tiny radioactive beads. These beads are injected into the blood vessels supplying the tumor, where they become lodged, emitting radiation to destroy cancer cells. SIRT is often considered for individuals with liver cancer who are not candidates for surgery or have tumors that cannot be treated with other methods.
Endoscopic Stent Placement
When liver cancer obstructs the bile ducts, leading to bile accumulation and jaundice, endoscopic stent placement may be performed to alleviate symptoms. During this procedure, a thin tube (stent) is inserted into the bile duct to keep it open, allowing bile to flow freely and relieving jaundice. While stent placement does not treat the underlying cancer, it can improve quality of life and may be combined with other treatments for comprehensive care.
Palliative Care
Palliative care focuses on improving the quality of life for individuals with advanced or metastatic liver cancer by managing symptoms and providing support. Palliative treatments may include radiation therapy to relieve pain or other symptoms, chemotherapy to slow disease progression, or various drug therapies to alleviate discomfort and improve overall well-being. Palliative care is an essential component of comprehensive cancer care, addressing physical, emotional, and psychosocial needs throughout the disease course.
Also Read: Liver Cancer Treatment & Its Cost in India
Survival Rates for Liver Cancer
Healthcare advancements have improved life expectancy for individuals with liver cancer, although it remains a serious condition. Statistics reveal that among those treated for early-stage hepatocellular carcinoma (HCC) liver cancer, approximately 35% survive beyond five years post-diagnosis. For cases where HCC has spread to nearby tissues or organs, the five-year survival rate stands at about 12%. In more advanced stages where HCC has metastasized further, the five-year survival rate drops to around 3%.
In the case of intrahepatic bile (IHC) duct cancer, survival rates vary. For bile duct cancer confined within the liver, the five-year survival rate is approximately 24%. If the cancer has spread to nearby lymph nodes, the survival rate decreases to about 9%. When the cancer has metastasized extensively, the five-year survival rate further decreases to approximately 2%. These figures underscore the challenges and complexities of treating liver cancer across its various stages.
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