Dr Nirasha Chiranjan gives us a rundown on cancer of the liver.
Liver cancer is a leading cause of cancer death in both men and women. Globally, the most common type of primary liver cancer is hepatocellular carcinoma (HCC). In many cases, it arises from underlying liver disease due to viral hepatitis or non-viral chronic liver disease.
The viral causes are hepatitis B and hepatitis C. The most common non-viral causes are alcohol and non-alcoholic fatty liver disease. The incidence of liver cancers is expected to rise in the future due to poor lifestyle and diet.1,2
What is the liver?
It is a large organ that is situated in the right upper quadrant of the abdomen. It’s an important organ and is vital for detoxification of chemicals and metabolism of drugs. The liver aids in food digestion and storage. It also makes important proteins for blood clotting.
What are the signs of liver cancer?
- Jaundice (yellow discoloration of skin and the whites of eyes)
- Weight loss
- Pale stools (white, chalky stools)
- Dark urine
- Swelling of the abdomen and feet
- Abdominal pain
- Easy bruising of the skin
- Enlarging mass in the abdomen
- Early fullness when eating
- Lack of appetite
- Skin changes and rashes7
What are the risk factors?
- Chronic infection with hepatitis B or hepatitis C.
- Cirrhosis, this irreversible condition causes scar tissue in the liver.
- Inherited liver diseases, like Wilson’s disease (excess copper build-up in the body) and hemochromatosis (iron overload).
- Non-alcoholic fatty liver disease. This is when too much fat is stored in the liver cells replacing normal liver cells.
- Exposure to aflatoxins (found in grains and nuts).
- Excessive alcohol consumption2-4
How is cancer of the liver diagnosed?
There are various tests, such as blood tests, specifically liver function tests and tumour marker tests. Abdominal sonar, CT scan or MRI can be used. Then lastly a liver biopsy.9-10
What are other cancers found in the liver?
There are many different types of cancers that can develop in the liver.
As mentioned before, the most common is HCC which originates from the liver cells, called hepatocytes.
Other primary liver cancers are hepatoblastoma which tends to occur in children and intrahepatic cholangiocarcinoma (cancer that develops in the cells within the bile ducts; both inside and outside the liver).
Cancer spreading to the liver from other sites, like the colon or breast, is more common than cancers developing primarily from the liver. These cancers are called liver metastases.
- Lifestyle change: maintain your ideal body mass index and limit alcohol consumption.
- Get vaccinated against hepatitis B.
- Prevent hepatitis C by screening yourself and your sexual partners. Don’t use intravenous drugs or share needles.
- Do screening with your doctor if you have risk factors.5-6
MEET THE EXPERT – Dr Nirasha Chiranjan
Dr Nirasha Chiranjan is a radiation oncologist. Her special interests are the breast, gynaecological, head and neck, and central nervous system areas. She is based at the Life Flora Hospital, Sandton Oncology (Morningside) and Ahmed Kathrada Cancer Institute.email@example.com
- Annual Report to the Nation on the Status of Cancer, 1975-2014, Featuring Survival.AU Jemal A, Ward EM, Johnson CJ, Cronin KA, Ma J, Ryerson B, Mariotto A, Lake AJ, Wilson R, Sherman RL, Anderson RN, Henley SJ, Kohler BA, Penberthy L, Feuer EJ, Weir HK SO J Natl Cancer Inst. 2017;109(9)
- The natural history of compensated cirrhosis due to hepatitis C virus: A 17-year cohort study of 214 patients.AU Sangiovanni A, Prati GM, Fasani P, Ronchi G, Romeo R, Manini M, Del Ninno E, Morabito A, Colombo M SO Hepatology. 2006;43(6):1303.
- Incidence and predictors of hepatocellular carcinoma in patients with cirrhosis.AU Ioannou GN, Splan MF, Weiss NS, McDonald GB, Beretta L, Lee SP SO Clin Gastroenterol Hepatol. 2007;5(8):938. Epub 2007 May 16
- Risk factors for hepatocellular carcinoma among patients with chronic liver disease.AU Tsukuma H, Hiyama T, Tanaka S, Nakao M, Yabuuchi T, Kitamura T, Nakanishi K, Fujimoto I, Inoue A, Yamazaki H SO N Engl J Med. 1993;328(25):1797
- Association between physical activity and risk of hepatobiliary cancers: A multinational cohort study.AUBaumeister SE, Schlesinger S, Aleksandrova K, Jochem C, Jenab M, Gunter MJ, Overvad K, Tjønneland A, Boutron-Ruault MC, Carbonnel F, Fournier A, Kühn T, Kaaks R, Pischon T, Boeing H, Trichopoulou A, Bamia C, La Vecchia C, Masala G, Panico S, Fasanelli F, Tumino R, Grioni S, Bueno de Mesquita B, Vermeulen R, May AM, Borch KB, Oyeyemi SO, Ardanaz E, Rodríguez-Barranco M, Dolores Chirlaque López M, Felez-Nobrega M, Sonestedt E, Ohlsson B, Hemmingsson O, Werner M, Perez-Cornago A, Ferrari P, Stepien M, Freisling H, Tsilidis KK, Ward H, Riboli E, Weiderpass E, Leitzmann MF SOJ Hepatol. 2019;70(5):885. Epub 2018 Dec 22.
- Meta-analysis: Treatment of hepatitis B infection reduces risk of hepatocellular carcinoma.AU Sung JJ, Tsoi KK, Wong VW, Li KC, Chan HL SOAliment Pharmacol Ther. 2008;28(9):1067
- Diagnosis of primary cancer of the liver.AUKew MC, Dos Santos HA, Sherlock SO Br Med J. 1971;4(5784):408.
- Cutaneous manifestations of gastrointestinal disorders. Part II.AU Gregory B, Ho VC SO J Am Acad Dermatol. 1992;26(3 Pt 2):371
- AASLD guidelines for the treatment of hepatocellular carcinoma.AU Heimbach J, Kulik LM, Finn R, Sirlin CB, Abecassis M, Roberts LR, Zhu A, Murad MH, Marrero J SO Hepatology. 2017
- Diagnosis, Staging, and Management of Hepatocellular Carcinoma: 2018 Practice Guidance by the American Association for the Study of Liver Diseases.AU Marrero JA, Kulik LM, Sirlin CB, Zhu AX, Finn RS, Abecassis MM, Roberts LR, Heimbach JK SO Hepatology. 2018;68(2):723.
- http://optn.transplant.hrsa.gov/policiesAndBylaws/policies.asp (Accessed on June 14, 2018).
- de . Jong MC, : Rates and patterns of recurrence following curative intent surgery for colorectal liver metastasis: An international multi-institutional analysis of 1669 patients. Ann Surg 250: 440-448, 2009
- Cheng AL, Kang YK, Chen Z, Tsao CJ, Qin S, Kim JS, et al. Efficacy and safety of sorafenib in patients in the Asia-Pacific region with advanced hepatocellular carcinoma: a phase III randomised, double-blind, placebo-controlled trial. Lancet Oncol. 2009;10:25–34.
- . Llovet JM, Ricci S, Mazzaferro V, Hilgard P, Gane E, Blanc JF, et al. Sorafenib in advanced hepatocellular carcinoma. N Engl J Med. 2008;359:378–390.
- Kudo M. Systemic therapy for hepatocellular carcinoma: Latest advances. Cancers (Basel) 2018
- Shimohigashi Y, Toya R, Saito T, Ikeda O, Maruyama M, Yonemura K, et al. Tumor motion changes in stereotactic body radiotherapy for liver tumors: an evaluation based on four-dimensional cone-beam computed tomography and fiducial markers. Radiat Oncol. 2017;12:61. doi: 10.1186/s13014-017-0799-7.
- Qi WX, Fu S, Zhang Q, Guo XM. Charged particle therapy versus photon therapy for patients with hepatocellular carcinoma: a systematic review and meta-analysis. Radiother Oncol. 2015;114:289–295. doi: 10.1016/j.radonc.2014.11.033.
- . Moore A, Cohen-Naftaly M, Tobar A, Kundel Y, Benjaminov O, Braun M, et al. Stereotactic body radiation therapy (SBRT) for definitive treatment and as a bridge to liver transplantation in early stage inoperable hepatocellular carcinoma. Radiat Oncol. 2017;12:163.