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Liver Cancer


OVERVIEW OF Liver Cancer :

When abnormal proliferation of the cells occurs it might result in the Liver cancer.


STRUCTURE of Liver Cancer :

Structure of liver:

The liver is located in the upper right-hand portion of the abdominal cavity, below the diaphragm, and on top of the stomach, right kidney, and intestines.

Shaped like a cone, the liver is a dark reddish-brown organ that weighs about 3 pounds.

There are 2 distinct sources that supply blood to the liver, including the following:

  • Oxygenated blood flows in from the hepatic artery
  • Nutrient-rich blood flows in from the hepatic portal vein

The liver holds about one pint that is 13% of the body's blood supply at any given moment. The liver consists of 2 main lobes. Both are made up of 8 segments that consist of 1,000 lobules (small lobes). These lobules are connected to small ducts (tubes) that connect with larger ducts to form the common hepatic duct. The common hepatic duct transports the bile made by the liver cells to the gallbladder and duodenum (the first part of the small intestine) via the common bile duct.

 

The following are the types of the liver cancer. The cancer which starts at the liver is called as the primary cancer. The following are the types of the cancer:

 Hepatocellular carcinoma:

This is the most common form of liver cancer in the adult. It can have different growth patterns.

Benign tumours starts in the liver but it is not easily spread to the other organs in the body

A second types consists of multiple nudules that spreads throught the liver and it is seen throught the liver.

Intrahepatic cholangiocarcinoma:(bile duct cancer)

 About 20% of the cancers that starts in the liver are intrahepatic cholangiocarcinomas. The cancers start in the cells that line the small bile duct.

Angiosarcoma and hemangiosarcoma:

These cancer develops in the cells lining the blood vessels of the liver.people who have been exposed to vinyl chloride or to thorium chloride are more likely to develop the liver cancer. Some other factors include exposure to arsenic, radium or inherited conditions such as hereditary hemochromatosis.

Hepatoblastoma:

This is very raresat form of cancer that develops in children usually less than 4 years of age.

 

 

Secondary liver cancer/metastatic liver cancer:

Most of the time when the cancer is found in the liver it does not start there already it might have spread to the somewhereelse in the body such as the colon,stomach,breast,lung or pancreas. Because this cancer has spread from its original site it is called as the secondary liver cancer.

 

Benign liver tumour:

Benign tumours grows in size but they do not spread to the other organs. If they want to be treated they can be treated using surgical methods.

Hemangioma:

The most common cause of the benign tumour of the liver that occurs in the blood vessel.

Hepatic adenoma

Hepatic adenoma is a benign tumor that starts from hepatocytes (the main type of liver cell). Mostly no symptoms and do not need treatment. But some eventually cause symptoms, such as pain or a lump in the abdomen (stomach area) or blood loss. Because there is a risk that the tumor could rupture (leading to severe blood loss) and a small risk that it could eventually develop into liver cancer, most experts will usually advise surgery to remove the tumor if possible.

Using certain drugs may increase the risk of getting these tumors. Women have a higher chance of having one of these tumors if they take birth control pills, although this is rare. Men who use anabolic steroids may also develop these tumors. Adenomas may shrink when these drugs are stopped.

Focal nodular hyperplasia:

Focal nodular hyperplasia (FNH) is a tumor-like growth made up of several cell types (hepatocytes, bile duct cells, and connective tissue cells). Although FNH tumors are benign, they might cause symptoms. It can be hard to tell them apart from true liver cancers and doctors sometimes remove them when the diagnosis is unclear.

Both hepatic adenomas and FNH tumors are more common in women than in men.


EPIDEMIOLOGY :

It is more common among men when compared to women.


CAUSES :

Chronic alcohol consumption

Hepatitis B, C  and D

Cirrhosis

Obesity

Fatty liver disease

Gender(men are commonly more prone for liver cancer than others)

Ingestion of steroids

Type 2 diabetes

Alpha 1 antitrypsin deficiency

Wilson’s disease


PATHOPHYSIOLOGY :

There are many types of aetiological factors have been liked to the development of hepatocellular cellular carcinoma development, the vital factors, chronic alcohol consumption and aflatoxin B1 contaminated foods.

HBV infections leads to host viral interactions, sustained cycles of necrosis followed by inflammation and regeneration , viral and endoplasmic interactions resulting in oxidative stress formation and these integration causes the viral genome to interact with the host genome resulting in the development of the oncogenes.

Aflatoxin B1 induced hepatocarcinogenesis is mostly associated with the carcinogenic mutations.

Various genetic factors have been associated with the development of HCC includes inactivation of the tumour suppressor p53, mutation in the beta catenin,  overexpression of various ErbB receptor family members and overexpression of the Met receptor.

Telomere erosion, chromosome segregation defects and alterations in the DNA damage response pathways.

Gene-expression analyses of human HCCs have led to the successful molecular classification of HCCs on the basis of prognosis, aetiology and intrahepatic recurrence.

Many challenges and opportunities exist in this field, including the need for a more detailed and clinically grounded genomic characterization of human HCCs, deeper understanding of the mechanisms of genomic instability, host–viral interactions, microenvironmental processes (inflammation and cirrhosis), cell of origin in hepatocarcinogenesis and the identification of biomarkers to identify early stage disease as well as those at greatest risk of developing HCC.

 


COMMON CLINICAL SIGNS AND SYMPTOMS :

Loss of weight

Metabolic problems

Vomiting

Constipation

Diarrhoea

Night sweats

Loss of sleep


DIAGNOSTIC :

Blood test:

In blood test for liver the alpha fetoprotein levels may shoot up and this is considered as the tumour marker.

Angiogram:

 During this test, a dye is injected into an artery to show liver tissue and any tumors.

Laproscopy:

The doctor uses a thin tube with a light (laparoscope) to observe the liver and other organs inside the stomach area.

Biopsy:

 The removal of tissue for study under a microscope. It may be done using a laparoscope. A biopsy is the most reliable way to determine cancer.

CT scan: is shows the 3D images of the liver

MRI(magnetic resonance imaging):

It uses magnetic and radiofrequency waves to view the soft tissues. It alos used to reveal the metastasis of the cancer cells.

PET scan(positron emission tomography):

It also reveals the metastasis that the cancer cells has spread to the distant organ or not.

Stages in the liver:

Stage 0:

The cancer is not spread but has potential development of the cancer in the future which is termed as carcinoma insitu.

Stage I:

One tumor is found in the liver only.

Stage II:

One tumor is found, but it has spread to the blood vessels, OR more than one tumor is present, but they are all smaller than 3 cm.

Stage III:

In Stage III liver cancer, there is more than one tumor and one of them at least is larger than 5 cm, OR the cancer has moved beyond the liver to large blood vessels, another organ, or to the lymph nodes.

Stage IV:

The cancer has spread to other places in the body, such as the lungs or bones, as well as lymph nodes.


TREATMENT AND PROGNOSIS :

Surgery:

Surgical removal of liver:

The liver can be completely or partially it can be removed.

Liver transplantation:

The damaged liver can be replaced with healthy liver. And this treatment is effective in its early stages.

Localized treatments

Localized treatments for liver cancer are those that are administered directly to the cancer cells or the area surrounding the cancer cells. Localized treatment options for liver cancer include:

Radiofrequency ablation:

Using an computer aided device the physician passes the needle which emits the electric current in the tumour and causes the tumour to shrink or ablation.

Cryoablation:

A cryoprobe containing liquid nitrogen is placed onto the liver tumours and the it results in destruction of the tumour

Placing beads filles with radiation in the liver:

Tiny spheres that contains beads which emits the radiation is placed inside the liver and this results in destruction of the tissue.

           Other therapies:

  • Radiation therapy:
  • It uses powerful x rays or emission of protons to destroy the cells. The radiation therapy also aids  in shrinkage of the cells and also relief the symptoms caused by the cancer.

 

  • Immunotherapy
  • it is a drug treatment that uses your immune system to fight cancer. Your body's disease-fighting immune system may not attack your cancer because the cancer cells produce proteins that blind the immune system cells from recognizing the cancer cells. This immunotherapy boos those cells and helps the body to fight against it.
  • Targeted therapy:
  • This therapy involves targeting the specific organs. It involves the emission of rays.
  • Chemotherapy:
  • A chemotherapy is after the sugery or before the surgery to shrink the cancer cells. A chemotherapy is nothing but the delivery of drug intravenously
  • Palliative care:
  • Palliative care specialists work with you, your family and your other doctors to provide an extra layer of support that complements your ongoing care. 

 


PROGNOSIS :

The five year survival rate is 34%.


PREVENTION :

Avoid alcohol consumption

Avoid smoking

Have a halthy diet

Reduce the exposure to harmful chemiacal agents

Be physicaly active

Reduce the weight


Medicines used in the Treatment :

  • Gemcitabine (Gemzar)
  • Oxaliplatin (Eloxatin)
  • Cisplatin.
  • Doxorubicin (pegylated liposomal doxorubicin)
  • 5-fluorouracil (5-FU)
  • Capecitabine