Let's talk about liver cancer. What you need to know!

It's normal to feel a little scared when you hear about liver cancer. But it's important to have a proper understanding of this. The liver is not only the largest organ in our body, but it also performs a very important function that is essential for survival. So, when cancer develops in such an important organ, it can be life-threatening.

What is Liver Cancer? Let's understand it simply!

Simply put, liver cancer is a malignant tumor that develops in the liver. There are two main types of this. 1. Primary Liver Cancer: In this case, the cancer starts in the liver. We will mainly talk about this type in this article. 2. Secondary Liver Cancer: In this case, a cancer that develops elsewhere in the body (for example, the lungs, colon) later spreads to the liver.

What are the types of primary liver cancer?

There are also three main types of primary liver cancer. Let's take a look at what they are:

• Hepatocellular carcinoma (HCC): This is the most common type of liver cancer . Most of the time, when we talk about liver cancer, we are talking about this `(HCC)`.
• Intrahepatic cholangiocarcinoma (IHC) : This is a little different. This cancer (also called `Cholangiocarcinoma`) develops in the bile ducts of our liver. It accounts for between 10% and 20% of all liver cancers .
• Hepatic angiosarcoma: This is a very rare type. It accounts for about 1% of all liver cancers. This cancer starts in the walls of the blood vessels in the liver. This type of cancer, called ``Angiosarcoma``, can sometimes develop in other organs.

What are the symptoms of liver cancer? How do we recognize it?

The symptoms of all three types of liver cancer are very similar. However, sometimes there may be no symptoms at all in the early stages. That is what is a little scary. But let's be aware of these symptoms:

• Dark urine or gray/pale stools: You should be concerned if your urine suddenly changes color to dark brown, or if your stools are gray or clay-colored instead of their usual color.
• Bruising for no reason: If you suddenly develop blue spots or bruises on your body, that is also a symptom.
• Fatigue : Feeling tired and lifeless, no matter how much sleep you get.
• Fever: A persistent, unexplained fever.
• A lump or tightness that feels like a lump under the rib cage, on the right side: If you feel a lump in the upper right part of your abdomen, just below where your ribs end, don't ignore it.
• Itchy skin: Especially if you scratch your whole body for no reason.
• Anorexia or just weight loss: Not feeling like eating, and losing weight without even trying.
• Nausea and vomiting: If you experience frequent nausea and vomiting.
• Pain or bloating in the upper right abdomen: If you have pain in the upper right abdomen, or if your stomach just feels bloated.
• Jaundice: This is a symptom that many people are familiar with. It is a yellowing of the skin and whites of the eyes . Imagine that a friend of yours, let's say Nimal, suddenly notices that his eyes are turning yellow and his urine is turning dark. He may think, 'Oh, this must be jaundice.' But not all yellowing is simple jaundice, it can sometimes be a sign of a more serious condition like this.

What are the early warning signs of liver cancer?

Here's the problem. Most of the time, liver cancer doesn't show any symptoms in its early stages. So if you think you're at risk (we'll talk about that later), the best thing to do is see a doctor and have your liver checked. They'll then order the necessary tests (like `Liver function tests`).

What are the causes of liver cancer?

Liver cancer occurs when the `DNA` of healthy liver cells is affected. Did you know, `DNA` is the genetic information that tells our cells how to work? We all have genes in our bodies that tell our cells to grow, divide, and die at the right time. For example, genes called `(Oncogenes)` help cells grow and divide. Genes called `(Tumor suppressor genes)` stop cells from dividing uncontrollably and also cause cells to die at the right time. However, when our `DNA` changes (`mutates`), the cells get new, incorrect instructions. These incorrect instructions cause the cells to become cancer cells and start growing uncontrollably. Some diseases and other conditions can damage the `DNA` of the liver, increasing the risk of cancer.

Risk Factors for Liver Cancer

The main risk factor for liver cancer is long-term infection with hepatitis B (HBV) or hepatitis C (HCV). These infections can damage the liver and cause cirrhosis.Cirrhosis is a condition in which the liver becomes hardened and shrunken. This condition can later lead to liver cancer.

Important: Hepatitis B and C are diseases that are transmitted through blood and body fluids, so it is very important to take steps to protect yourself from them.

There are several other risk factors:

• Excessive alcohol consumption: We all know that drinking too much alcohol is not good. It can damage the liver, lead to cirrhosis, and even cancer.
• Metabolic dysfunction-associated steatotic liver disease (MASLD): This is a condition that is seen in many people these days. Simply put, it is the accumulation of fat in the liver. This too, if it persists for a long time, increases the risk of cancer.
• Obesity: Excessive weight gain can lead to fat deposits in the liver and other health problems, which can increase the risk of cancer.
• Type 2 diabetes: People with diabetes also have a slightly higher risk of developing liver cancer.
• Tobacco use: Like cigarette smoking, tobacco use is a cause of many types of cancer, including liver cancer.

How do doctors diagnose liver cancer?

If you have symptoms of liver cancer, or if you have risk factors, when you see a doctor, he or she will first do a physical examination . He or she will ask you about your symptoms. Then, you may be referred for tests such as:

• Angiogram: This can be used to examine the blood vessels in the liver.
• Blood tests: There are special blood tests (such as `tumor markers`) to check for cancer. Liver function tests are also done.
• CT scan: This can take detailed pictures of the liver. This can help determine the size and location of the tumor.
• ERCP test: This test can be done if there is a suspicion of bile duct cancer (`Cholangiocarcinoma`).
• Liver ultrasound: This also takes pictures of the inside of the liver.
• MRI: This uses a large magnet, radio waves, and a computer to take very clear pictures of the liver.

If these blood tests and scans reveal liver cancer, your doctor will often order a liver biopsy , which is the most reliable way to confirm cancer.

What are the stages of liver cancer?

Staging is a way for doctors to determine how far the cancer has spread and plan treatment accordingly. The most common staging system for liver cancer is the Barcelona Clinic Liver Cancer system (BCLC) . It takes into account factors such as symptoms, liver function, and the size of the tumor. Your doctor may use different names when describing these stages to you. For example, Stage I to Stage V, Stage O to C, or "early stage cancer" / "advanced stage cancer." Let's take a simple look:

• Stage I / Stage O / Very early stage: There is only a single tumor in the liver. It is less than 2 centimeters (about 4/5 inches). Blood tests show normal levels of `(Bilirubin)`.
• Stage II / Stage A / Early stage: There is a single tumor, which may be 5 centimeters (about 2 inches) in size. Or, there may be several tumors smaller than 3 centimeters (about 1 1/4 inches). This also includes cases where the cancer has spread to the blood vessels.
• Stage III / Stage B / Intermediate stage: There is more than one tumor, and/or one tumor is 5 centimeters or larger. The cancer may have spread to lymph nodes, large blood vessels, or other organs.
• Stage IV / Stage C / Advanced stage: The cancer has spread to other parts of the body (such as the lungs, bones).

How is liver cancer treated?

There are several ways to treat liver cancer. Some are medical treatments, some are surgical. Medical treatments may include:

• Chemotherapy: Giving drugs to kill cancer cells.
• Chemoembolization: Administering chemotherapy directly through the blood vessel that supplies the tumor with blood and blocking that vessel.
• Immunotherapy: Stimulating the body's own immune system to fight cancer cells.
• Radiation therapy: Destroying cancer cells using high-energy rays.
• Radioembolization: Insertion of small radioactive seeds into the tumor.
• Targeted therapy: Giving drugs that target specific molecules that help cancer cells grow and spread.

Surgical treatments can include:

• Ablation: The destruction of cancer cells using heat, extreme cold, or chemicals.
• Hepatectomy (liver resection): Surgical removal of part of the liver along with the cancerous tumor.
• Liver transplantation: The complete removal of the diseased liver and transplantation of a healthy liver.

Can liver cancer be cured?

A successful liver transplant can cure liver cancer. However, not everyone who needs a liver transplant can get one. For example, their health may be too poor to tolerate a transplant. Also, it may be difficult to find a suitable donor liver. Other treatments can help control the cancer, slow its spread, and prolong the patient's life.

What is the life expectancy of someone with liver cancer?

Although this is something that many people want to know, it is difficult to say exactly how long you can live. This is because it depends on many factors, such as the stage of the cancer, the response to treatment, and the patient's overall health. Researchers are constantly improving liver cancer treatments to help people live a little longer. However, liver cancer is still a life-threatening disease. According to statistics (these are American data, the situation in Sri Lanka may be different), about 21% of people with `(HCC)` or `(IHC)` are alive five years after diagnosis. For early-stage (stage I or II) cancer, the five-year survival rate is about 37%. However, it drops to 13% for stage III and 3% for stage IV.

Remember, these statistics are just a general estimate. Your situation may be much different. It is best to talk to your oncologist about this and find out what is relevant to you.

What can we do to prevent liver cancer?

We may not be able to completely prevent liver cancer, but there are some things we can do to reduce our risk:

• Get the hepatitis B shot: This is very important. The government now provides this vaccine. If you haven't received it, ask a doctor about it.
• Protect yourself from Hepatitis C: There is no vaccine for Hepatitis C yet. So avoid contact with infected blood. Do not use needles or syringes that have been used by others.
• If you smoke, try to stop: If you need help, ask your medical team about smoking cessation programs.
• Reduce or stop drinking alcohol: Excessive alcohol consumption can cause cirrhosis and increase the risk of liver cancer.
• Maintain a healthy weight that suits you: Obesity is a risk factor.
• Ask your doctor about screening for liver cancer: If you have liver disease, diabetes, or obesity, or if you drink alcohol excessively, it's wise to get regular blood tests and liver ultrasounds.

Primary liver cancer is a serious disease. It may be at an advanced stage by the time you are diagnosed with liver cancer. Treatment options are limited. Your medical team will use treatments to stop the cancer from growing. They will also help you manage your symptoms and maintain your quality of life. Talk to your doctor about the treatment options for advanced cancer. He or she will tell you about the benefits and side effects of each option. This will help you feel confident about making decisions.

The most important things you need to remember (Take-Home Message)

It's normal to feel scared when talking about liver cancer, but awareness is the greatest strength.

• The liver is an essential organ in our body. It is our responsibility to protect it.
• The main causes of liver cancer are hepatitis B and C infections and cirrhosis. Excessive alcohol consumption, obesity, and diabetes are also risk factors.
• Symptoms may not appear in the early stages, so it is important for people with risk factors to have regular medical checkups.
• There are now various treatments for liver cancer. The best treatment is chosen based on the stage of the disease and the patient's condition.
• Prevention is best. Get the hepatitis B vaccine and follow a healthy lifestyle.

If you have any further questions or concerns about this, be sure to talk to a doctor. They will help you. Never suffer alone, ask for help. Liver Cancer, მიდების მიდები, Hepatocellular carcinoma, HCC, Cirrhosis, Hepatitis B, Hepatitis C, მიდები