Liver Cancer

Liver cancer rarely occurs in a normal liver. Non cancerous tumours are rare. It is common in livers infected with hepatitis B or C viruses and in cirrhotic livers. These do not produce much symptoms until late stages and are picked up on random scans. In more advanced stages it causes pain, jaundice, swelling of abdomen, loss of weight and appetite. Cancers that occur from liver cells are primary liver cancers and those that spread from other organs are secondary liver cancers. The differentiation is important, as the treatment differs widely. The diagnosis is made by ultrasound, MRI or CT scans along with fine needle biopsy. Some of these tumours can produce cancer markers such as Alpha fetoprotein (AFP) or Carcinoembryonic antigen (CEA). These markers are more useful for follow up after treatment than for the diagnosis, when raised. Most primary cancers that are restricted to the liver are best treated surgically irrespective of size, whenever possible. Surgery or liver transplant offers the best shot at survival. Survival after liver transplant is as good (85%) as non tumour patients when the tumour volume or number is low (Milan criteria). Liver cancers can spread outside the liver to the lymph nodes, lungs or locally to the adjacent tissues like diaphragm. More commonly primary cancers are known to grow rapidly through the blood vessel like the portal vein, forming tumour thrombus. Tumours that are not treatable surgically can be treated by chemo-embolization(TACE) or radio-embolization (theraspheres), Ethanol injection (PEI), Radiofrequency ablation(RFA) or by Cryoablation.

Secondary liver tumours are usually treated on the same lines as the primary tumours with the difference that the source of the primary tumour is also treated at the same time, provided the disease has not spread to the lungs and bones. Secondary cancers from primary tumour in colon, ovary or neuroendocrine origin are particularly suited for aggressive surgical removal as it improves survival. Liver transplants are not indicated for secondary liver cancers with the exception of a special group of tumours called neuroendocrine tumors.

Cancer of the Liver.
This National Cancer Institute (NCI) booklet has important information about cancer that begins in the liver. It discusses possible causes, symptoms, diagnosis, and treatment of liver cancer. It also has information to help patients cope with this disease. Information specialists at the NCI's Cancer Information Service at 1-800-4-CANCER can help people with questions about cancer and can send NCI publications.

Symptoms.
Liver cancer is sometimes called a "silent disease" because in an early stage it often does not cause symptoms. But, as the cancer grows, symptoms may include:

• Pain in the upper abdomen on the right side; the pain may extend to the back and shoulder
• Swollen abdomen (bloating)
• Weight loss
• Loss of appetite and feelings of fullness
• Weakness or feeling very tired
• Nausea and vomiting
• Yellow skin and eyes, and dark urine from jaundice
• Fever

These symptoms are not sure signs of liver cancer. Other liver diseases and other health problems can also cause these symptoms. Anyone with these symptoms should see a doctor as soon as possible. Only a doctor can diagnose and treat the problem.

Treatment.
Many people with liver cancer want to take an active part in decisions about their medical care. They want to learn all they can about their disease and their treatment choices. However, the shock and stress that people often feel after a diagnosis of cancer can make it hard for them to think of everything they want to ask the doctor. Often it helps to make a list of questions before an appointment. To help remember what the doctor says, patients may want to take notes or ask whether they may use a tape recorder. Some patients also want to have a family member or friend with them when they talk to the doctor -- to take part in the discussion, to take notes, or just to listen.

At this time, liver cancer can be cured only when it is found at an early stage (before it has spread) and only if the patient is healthy enough to have an operation. However, treatments other than surgery may be able to control the disease and help patients live longer and feel better. When a cure or control of the disease is not possible, some patients and their doctors choose palliative therapy. Palliative therapy aims to improve the quality of a person's life by controlling pain and other problems caused by the disease.

The doctor may refer patients to doctors who specialize in treating cancer, or patients may ask for a referral. Specialists who treat liver cancer include surgeons, transplant surgeons, gastroenterologists, medical oncologists, and radiation oncologists.