What Is Liver Cancer? What Causes Liver Cancer?

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What Is Liver Cancer? What Causes Liver Cancer?

Article Date: 29 Nov 2009 - 4:00 PST

http://www.medicalnewstoday.com/articles/172408.php

Liver cancer begins in the cells of the liver. The liver is a football-sized

organ that sits in the upper right portion of the abdomen.

The liver carries out many vital functions, such as digesting proteins and fats,

removing toxins from the body, producing chemicals that stop blood clotting and

releasing bile in order to aid digestion. Liver cancer is a serious condition

because the disruption, or loss, of any of these functions can be fatal.

Primary liver cancer

Cancer that begins in the liver is known as primary liver cancer. The major

cause of primary liver cancer is hepatocellular carcinoma (HCC). This is cancer

that begins in the main liver cells. It is more common among men, and those over

the age of 60.

Another type of primary liver cancer is cholangiocarcinoma, which is also known

as cancer of the bile duct.

Secondary liver cancer

Most cases of liver cancer are known as secondary. It means that the cancer

started somewhere else in the body before spreading (metastasizing) to the

liver.

The best ways to prevent HCC are to drink alcohol in moderation and avoid

behavior that increases the chance of catching hepatitis C (such as injecting

drugs and having unprotected sex).

According to Medilexicon's medical dictionary:

Hepatocellular carcinoma is a " ..malignant tumor of the liver that

develops in the setting of chronic liver disease or cirrhosis. Hepatocellular

carcinoma is derived from hepatocytes that are transformed into adenocarcinoma.

Up to 60% of patients with HCC have elevated serum alpha fetoprotein levels.

Tumor has a poor long-term prognosis unless treated surgically by resection or

liver transplantation. Noninvasive imaging (e.g., MRI or CT scan) may

distinguish hepatomas from other benign tumors such as hemangiomas. "

What are the signs and symptoms of liver cancer?

A symptom is something the patient feels and reports, while a sign is something

other people, such as the doctor detect. For example, pain may be a symptom

while a rash may be a sign. Most people do not have signs and symptoms in the

early stages of primary liver cancer. When symptoms do appear, they may include:

* Abdominal swelling

* Enlarged liver

* Fatigue

* Tiredness

* General weakness

* Loss of appetite

* Nausea and vomiting

* Unintentional loss of weight

* Upper abdominal pain

* Yellow discoloration of the skin and the whites of the eyes (jaundice)

* Pain in the abdomen that may also extend to the right shoulder

What causes liver cancer?

DNA (deoxyribonucleic acid) is the genetic material that is found in all human

cells. DNA is a code which contains instructions for producing all the

characteristics of the body, such as sex, height, and eye and hair color. DNA is

inherited from the parents.

Cancer

Cancer occurs when the structure of the DNA is suddenly changed. This is known

as a genetic mutation. DNA also provides the cells with instructions about when

to grow, reproduce, and when to stop reproducing. The mutation in the DNA

changes these instructions, so that the cells carry on growing. The cells

continue to reproduce in an uncontrollable manner producing a lump of tissue

known as a tumor. There are two types of tumor:

benign - where the cancerous cells do not have the ability to spread

beyond the tumor

malignant - where the cells can spread beyond the tumor and affect other

parts of the body

The DNA in the cells can be changed by exposure to chemicals, or toxic

substances. A toxic substance that causes cancer is known as a carcinogen.

Hepatocellular carcinoma (HCC) and cirrhosis

It is still unclear what causes the cells in the liver to become cancerous. But

in some cases, the cause is known. For instance, chronic infection with certain

hepatitis viruses can cause liver cancer. However, cirrhosis (a serious

condition that destroys healthy tissue) is known to be a major risk factor.

In the past most cases of cirrhosis-associated HCC were due to alcohol abuse.

However, in recent years, the leading cause of HCC is cirrhosis caused by the

blood-borne viral infections, hepatitis B and hepatitis C.

A vaccination is available that can protect against hepatitis B, but there is no

vaccine for hepatitis C.

The number of cases of HCC has risen due to the associated rise of people

infected with hepatitis C.

Alcohol abuse: The liver removes toxins from the body, such as alcohol. However,

when drinking too much alcohol, the liver is unable to cope with the amount of

alcohol and becomes damaged.

Hepatitis B and Hepatitis C: They are both blood-born viral infections that can

gradually cause damage to the liver over many years. In some people, the

infections can be successfully treated but, in others, treatment is ineffective.

Autoimmune hepatitis: It is a rare inherited condition where the immune system

attacks the cells of the liver as if they were a 'foreign' infection. What

triggers this attack is unknown. Most cases of autoimmune hepatitis can be

treated using medicines, known as immunosuppressant. They stop the immune system

from functioning.

Haemochromatosis: It is another rare genetic condition where the body absorbs an

excess amount of iron from food, leading to a build-up of iron in the body. The

excess levels of iron have a toxic effect on the liver and cause cirrhosis.

Non cirrhosis-related HCC

Fibrolamellar carcinoma: It is a rare variation of HCC. It normally appears in

people who are between 20 to 40 years of age, and who have no associated history

of cirrhosis. As fibrolamellar carcinoma does not damage the whole of the liver,

the outlook for those with the condition is much better than for those with HCC.

However, the cancerous part of the liver will need to be removed. The liver

should be able to function normally after the procedure.

What are the risk factors of liver cancer?

A risk factor is something which increases the likelihood of developing a

condition or disease. For example, obesity significantly raises the risk of

developing diabetes type 2. Therefore, obesity is a risk factor for diabetes

type 2. Factors that increase the risk of primary liver cancer include:

* Age. In North America, Europe and Australia, liver cancer most commonly

affects older adults. In developing countries of Asia and Africa, liver cancer

diagnosis tends to occur at a younger age ( between 20 and 50).

* Certain inherited liver diseases. Liver diseases that can increase the

risk of liver cancer include hemochromatosis, autoimmune hepatitis and 's

disease.

* Chronic infection with HBV or HCV. Chronic infection with hepatitis B

virus (HBV) or hepatitis C virus (HCV) increases the risk of liver cancer.

* Cirrhosis. This progressive and irreversible condition causes scar tissue

to form in the liver and increases the chances of developing liver cancer.

* Diabetes. People with this blood sugar disorder have a greater risk of

liver cancer.

* Excessive alcohol consumption. Consuming more than a moderate amount of

alcohol can lead to irreversible liver damage and increase the risk of liver

cancer.

* Exposure to aflatoxins. Consuming foods contaminated with fungi that

produce aflatoxins greatly increases the risk of liver cancer. Crops such as

corn and peanuts can become contaminated with aflatoxins.

* Nonalcoholic fatty liver disease. An accumulation of fat in the liver

increases the risk of liver cancer.

* Obesity. Having an unhealthy body mass index increases the risk of liver

cancer.

* Sex. Men are more likely to develop liver cancer than are women.

How is liver cancer diagnosed?

Screening for hepatocellular carcinoma (HCC)

Some people are recommended to have regular screening for the condition.

Screening typically involves an ultrasound exam or blood tests once or twice

each year. This is because the earlier the cancer is diagnosed, the greater the

chances of curing it.

Screening is recommended for people who..:

* ..have cirrhosis due to hepatitis B, or hepatitis C

* ..have alcohol-related cirrhosis, and have now stopped drinking

* ..have cirrhosis as a result of haemochromatosis

Testing for HCC

Several tests can be used to detect the presence of HCC. These include:

* Blood tests which can detect a protein, known as alpha fetoprotein (afp),

which is often produced by tumors. Liver function abnormalities can be revealed.

* An MRI (magnetic resonance imaging) scan, which uses a strong magnetic

field and radio waves to build up a picture of the inside of the body.

* A CT (computer topography) scan, which uses a series of X-ray images to

create a more detailed image of the inside of the body.

* Removing a sample of liver tissue for testing. During a liver biopsy, a

sample of tissue is removed from the liver and examined under a microscope. A

thin needle is inserted through the skin and into the liver to obtain a tissue

sample. Liver biopsy carries a risk of bleeding, bruising and infection.

Determining the extent of the liver cancer

Once cancer is diagnosed, the doctor will work to determine the extent of the

liver cancer. Staging tests help determine the size and location of cancer and

whether it has spread. Imaging tests used to stage liver cancer include CT, MRI,

chest X-ray and bone scan.

The stages of liver cancer are:

* Stage I. At this stage, liver cancer is a single tumor confined to the

liver that has not grown to invade any blood vessels.

* Stage II. Liver cancer at this stage can be a single tumor that has grown

to invade nearby blood vessels. There can be multiple small tumors in the liver.

* Stage III. This stage may indicate that the cancer is composed of several

larger tumors. Or cancer may be one large tumor that has grown to invade the

liver's main veins or to invade nearby structures, such as the gallbladder.

* Stage IV. At this stage, liver cancer has spread beyond the liver to other

areas of the body.

What is the treatment for liver cancer?

Treatments for primary liver cancer depend on the stage of the disease as well

as age, overall health and personal preferences of the patient.

The goal of any treatment is to eliminate the cancer completely. When that is

not possible, the focus may be on preventing the tumor from growing or

spreading. In some cases only comfort care is appropriate. In this situation,

the goal of treatment is not to remove or slow the disease but to help relieve

symptoms, making the patient as comfortable as possible. HCC can usually only be

cured during the early stages of the condition, when there is a small number of

tumors, which are not larger than 5 cm (2 inches) in diameter, and the damage to

the liver is minimal. However, a range of treatment options can help to extend

life for many years and relieve symptoms of pain.

Liver cancer treatment options may include:

* Surgery to remove a portion of the liver. Partial hepatectomy can be

recommended to remove the liver cancer and a small portion of healthy tissue

that surrounds it if the tumor is small and the liver function is good. As the

liver has the ability to regenerate itself, it may be possible to remove some of

the liver without seriously affecting the patient´s health.

* Liver transplant surgery. During liver transplant surgery, the diseased

liver is removed and replaced with a healthy liver from a donor. Liver

transplant surgery may be an option for people with early-stage liver cancer who

also have cirrhosis. The donated liver is usually taken from someone who has

recently died, although in some cases, a small part of the liver can be taken

from a living relative. After the transplant, a medicine known as an

immunosuppressant will be given. Immunosuppressants help decrease the risk that

the immune system will treat the new liver as a foreign object and try to attack

it. If this happens, the body is known to 'reject' the liver.

* Freezing cancer cells. Cryoablation uses extreme cold to destroy cancer

cells. During the procedure, an instrument (cryoprobe) containing liquid

nitrogen is placed directly onto liver tumors. Ultrasound images are used to

guide the cryoprobe and monitor the freezing of the cells. Cryoablation can be

the only liver cancer treatment or it can be used along with surgery,

chemotherapy or other standard treatments.

* Heating cancer cells. This procedure is called radiofrequency ablation.

Electric current is used to heat and destroy cancer cells. Using an ultrasound

or CT scan as a guide, the surgeon inserts several thin needles into small

incisions in the abdomen. When the needles reach the tumor, they are heated with

an electric current, destroying the cancer cells.

* Injecting alcohol into the tumor. During alcohol injection, pure alcohol

is injected directly into tumors, either through the skin or during an

operation. Alcohol dries out the cells of the tumor and eventually the cells

die.

* Injecting chemotherapy drugs into the liver. Chemoembolization is a type

of chemotherapy treatment that supplies strong anti-cancer drugs directly to the

liver. During the procedure, the hepatic artery, which is the artery from which

liver cancers derive their blood supply, is blocked and chemotherapy drugs are

injected between the blockage and the liver. The benefit of this approach is

that some of the side effects associated with other forms of chemotherapy, such

as hair loss, are minimized. However, vomiting, nausea and abdominal pain may be

experienced after receiving the injections.

* Radiation therapy. This treatment uses high-powered energy beams to

destroy cancer cells and shrink tumors. During radiation therapy treatment, the

patient lies on a table and a machine directs the energy beams at a precise

point on the body. Radiation side effects may include fatigue, nausea and

vomiting.

* Targeted drug therapy. Sorafenib (Nexavar) is a targeted drug designed to

interfere with a tumor's ability to generate new blood vessels. Sorafenib has

been shown to slow or stop advanced liver cancer from progressing for a few

months longer than with no treatment. More studies are needed to understand how

this and other targeted therapies may be used to control advanced liver cancer.

* Pain relievers.There are many different medicines (analgesics) that can be

used to relieve pain. The analgesics used will depend on the severity of the

symptoms. In the case of mild pain, acetaminophen (paracetamol) can be used. If

symptoms are more severe symptoms, an opiate-based analgesic, such as codeine,

or morphine, may be required. Constipation is a common side effect of these

types of analgesic. A laxative may also be given.

* Clinical trials. As the current methods of curing liver cancer are

limited, some people may wish to take part in a clinical trial. Clinical trials

are studies that use new and experimental techniques to see how well they work

in treating, or curing, cancer. However, there is no guarantee that the

technique being studied in the clinical trial will be effective. The healthcare

professionals responsible for treatment and care will be able to inform of any

available clinical trials in the area, as well as explaining the risks and

benefits involved.

What are the complications of liver cancer?

Being diagnosed with cancer can be very distressing, particularly if it is

incurable. Many people who are diagnosed with cancer experience the classic

stages of the grieving process. These are outlined below.

* Denial - Initial disbelieve of the diagnosis.

* Anger - Resentment of friends, family, or medical staff.

* Bargaining - Sometimes, people with terminal conditions will try to

'bargain' with their doctors, asking for any sort of treatment that can prolong

their life.

* Depression - Loss all interest in life and feeling that situation is

hopeless.

* Acceptance - In time, most people will eventually accept the diagnosis.

After a cancer diagnosis, talking to a counselor or psychiatrist may help combat

feelings of depression and anxiety. Anti-depressants, or medicines that help

reduce feelings of anxiety, may also help support the patient. Although there

are no easy answers for people dealing with liver cancer, some of the following

suggestions may be of help:

* Learning about liver cancer. Asking about liver cancer, including the

stages of cancer, treatment options and prognosis. Seeking for trusted sources

of information to learn more about liver cancer and treatment options. One good

source of information is the National Cancer Institute.

* Keeping friends and family close. Keeping close relationships strong will

help. Friends and family can provide the practical support needed. And they can

serve as emotional support.

* Finding someone to talk with. Finding a good listener who is willing to

listen about hopes and fears. This may be a friend or family member. The concern

and understanding of a counselor, medical social worker, clergy member or cancer

support group also may be helpful.

* Make plans for the unknown. Having a life-threatening illness, such as

cancer, requires preparing for the possibility of dying. For some people, having

a strong faith or a sense of something greater than themselves makes it easier

to come to terms with a life-threatening illness.

Alternative medicine

Alternative treatments may help control pain in people with advanced liver

cancer. Doctors will work to control pain with treatments and medications. But

sometimes pain may persist. Alternative treatments that may help cope with pain,

such as:

* Acupressure

* Acupuncture

* Deep breathing

* Listening to music (music therapy)

* Massage

How can liver cancer be prevented?

Alcohol: Cirrhosis of the liver is the leading risk factor for hepatocellular

carcinoma (HCC). Therefore, limiting the amount of alcohol can help prevent

damage to the liver, and lower the risk of HCC. The recommended daily amount of

alcohol consumption is 3 to 4 units for men, and 2 to 3 units for women. A unit

of alcohol is equal to about half a pint of normal strength lager, a small glass

of wine, or a pub measure (25ml) or spirits.

Hepatitis B: When at risk of being infected with the hepatitis B virus,

vaccination against hepatitis B vaccine is recommended. Protection lasts years

and may even be lifelong. The vaccine can be given to almost anyone, including

infants, older adults and those with compromised immune systems. People at risk

include:

* People who inject drugs, and share needles and other equipment,

* People who have frequent unprotected sex,

* People who have an occupation which brings them in close contact with

blood products, such as nurses, doctors, dentists, prison wardens, and medical

laboratory staff, and

* People who frequently travel to parts of the world where hepatitis b is

common, such as north america, south-east asia, and the eastern mediterranean.

Hepatitis C: There is currently no vaccine for hepatitis C, and no guaranteed

way to protect oneself against infection. However, the risks can be reduced by:

* Knowing the health status of any sexual partner. Do not engage in

unprotected sex unless you are absolutely certain partner is not infected with

HBV, HCV or any other sexually transmitted disease.

* Not using IV drugs, but if you do, use a clean needle. The best way to

protect yourself from HCV is not to inject drugs. But if that is not an option,

make sure any needle you use is sterile, and do not share it. Contaminated drug

paraphernalia is a common cause of hepatitis C infection.

* Seeking safe, clean shops when getting a piercing or tattoo. Needles that

may not be properly sterilized can spread the hepatitis C virus. Before getting

a piercing or tattoo, check out the shops in your area and ask staff about their

safety practices. If employees at a shop refuse to answer your questions or do

not take questions seriously, take that as a sign that the facility is not right

for you.

Written by Brunner (B.A.)

Some info on alternative medicine research for liver cancer:

http://www.healthyhepper.com/livercancerEFH.htm

http://www.healthyhepper.com/livercancerCIE.htm