Liver tumours and cancers
Primary tumours
Nobody knows exactly what triggers primary
liver cancer. But in the vast majority of cases, it’s a result of
having another condition that has already damaged the organ. The
prime culprit is cirrhosis that can result from excessive
alcohol consumption, viruses such as hepatitis B or C and, in rare
cases, inherited diseases that cause the liver to malfunction.
The scarring caused by cirrhosis can cause
problems with the way the liver works. This increases the risk of a
tumour called hepatocellular carcinoma.
Patients with hepatitis C, or uncontrolled
hepatitis B, are most at risk of developing liver cancer. However,
the tumours can also develop also in patients with cirrhosis
secondary to alcohol abuse or other diseases. Indeed, the
combination of alcohol and other causes of cirrhosis is
particularly dangerous.
This means that a patient who may be unaware
they have a predisposition to cirrhosis and drinks even moderate
amounts of alcohol, is exposed to a much higher risk.
In recent years, doctors have made significant
advances in the management of cirrhosis. Although it still cannot
be cured, it can be controlled better than ever before, so that
survival chances have increased.
But as a result, more patients are developing
hepatocellular carcinomas, says Professor Max Malago. ‘People are
living longer with cirrhosis because of new medical treatments but
they are developing tumours more often.’
‘Primary liver cancer is becoming one of the
leading causes of death just because people live longer with
cirrhosis.’
This makes it crucial that patients with
cirrhosis are regularly monitored for signs of tumours, says
Professor Malago.
They should have their blood regularly checked
for tumour markers such as alpha fetoprotein, or CA-19.9.
However, not all liver tumours produce these markers, so a blood
test on its own is not reliable enough.
That’s why current medical guidelines also
state that an ultrasound check, an easy and sensitive tumour
detector, should be performed frequently on the liver with
cirrhosis to look for signs of malignant growths.
Unfortunately, it seems, some patients still
slip through the net. ‘If you have cirrhosis, it’s absolutely
crucial that you stay under control of a liver specialist and that
you have ultrasound checks and tests for tumour markers,’ says
Professor Malago.
‘Even if your cirrhosis is under control you
still need these checks.’
‘We sometimes see asymptomatic patients coming
in who have tumours up to 10cm in size and we wonder why they were
not diagnosed months or years earlier.’
Cancer Research UK advises any cirrhosis
patient who is concerned by a lack of testing for cancer to take up
the matter with their liver specialist.
It adds: ‘Regular check ups in people with
cirrhosis have been proved to pick up hepatocellular tumours
earlier, when they are smaller and easier to treat.
‘There has been some research to show these
people may live longer, although there is no guarantee of a
cure.’
Secondary tumours
Cancers are named after the original cell
type, from the organ where the malignancy first begins to grow.
So most cases of liver cancer in the UK are
not liver cancer as such but tumours that have spread from other
parts of the body. Cancer cells can break away from their primary
site and travel through the body via the blood or lymphatic system.
Once they lodge in another organ, they can start to grow again.
The liver, as the largest solid organ in the
body and a filter for the bloodstream from the gastro-intestinal
organs, is a favourite ‘camping ground’ for travelling cancer
cells.
One of the major primary sites for these liver
tumours is the colon.
Unhealthy Western diets are a major cause of
colon cancer. And the next stop for many colon cancer cells is the
liver.
Professor Malago says: ‘Cancerous cells from
the colon move into the gut and then go to the liver through the
portal vein.’
Malignant melanomas, the most deadly form of
skin cancer, are also a common source of secondary liver
cancer.
The best treatments
Modern treatments, such as those provided at
The London Clinic, can provide a range of options for the primary
and secondary liver tumour patient.
- Resection – this is where
the cancer and the surrounding tissue is removed. It is
normally
only done if the cancer is relatively
small and is not tangled up with any major blood vessels
- Lobectomy and Segmentectomy
– where a lobe of the liver, or a smaller sub-unit of a lobe,
are removed. Once it’s done, the liver
can regenerate itself until it has reached its original
size again. But it’s not really
suitable for patients with cirrhosis whose livers are
already scarred.
- Radiofrequency ablation – a
technique where high energy radio waves are selectively fired
at
the liver. Surgeons insert a probe,
using ultrasound to guide them, and heat up the tissue to
the point where it can destroy the
cancer and surrounding tissue. The technique can be used
alone or in combination with
surgery.
- Chemoembolization – this is
a way of delivering cancer treatment directly to a tumour in
the
liver. Under X-ray guidance, a small
catheter is inserted into an artery in the groin. The
catheter’s tip is threaded into the
artery in the liver that supplies blood flow to the tumour.
Chemotherapy is injected through the
catheter into the tumour, mixed with particles that
embolize or block the flow of blood to
the diseased tissue. It delivers a very high
concentration of chemotherapy directly
into the tumour, without exposing the entire body to
the effects of those drugs, and cuts
off blood supply to the tumour, depriving it of oxygen
and nutrients.
- Portal vein embolization –
a similar procedure but one which targets the portal vein that
connects to the liver. The idea is to
block off blood flow to the affected part of the liver only,
allowing the non-cancerous part to
regenerate and grow bigger, so that the tumour can be
surgically removed.
- Transplantation – a
transplant is sometimes the best option, particularly in primary
liver
cancer – hepatocellular carcinoma - and
cirrhosis. Patients are normally considered candidates
if they have small tumours, not too
spread across the liver. For some cirrhosis patients, a
transplant can sometimes be a better
option than a resection, although it depends on the
severity of their condition. But
transplants are not an option when the cancer has spread
beyond the liver. This is because the
cancer would almost certainly come back.
The techniques described above can be used
sequentially or in combination. An expert team of liver
specialists, as at The London Clinic, can guide patients to the
optimal timing and choice of treatments to achieve best
results.
Liver cancer warning signs
- - Unexplained weight loss
- - Loss of appetite over several weeks
- - Being sick
- - Feeling bloated even after a small meal
- - Tummy pain or discomfort
- - Swollen abdomen
- - Dark urine and pale faeces
- - High temperature and sweating
Liver cancer stages
The stage of a cancer tells the doctor how far
it has grown. Stages are a way to classify tumours according to the
size and spread in the organs and across the body.
Expert radiologists help to grade the tumours
in degrees of severity. These classifications help doctors to
tailor the best treatments, guide them to assess the response to
treatments and to a give prognostic judgement of the disease.
General Disclaimer
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engaged in rendering medical advice or professional services. The
information provided through these pagess should not be used for
diagnosing or treating a health problem or a disease. It is not a
substitute for professional care. If you have or suspect you may
have a health problem, you should consult your health care
provider.