Liver Cancer: Causes, Symptoms, Stage, Treatment & Survival Rate

Liver cancer is a condition in which the liver cells start to grow rapidly and in an uncontrolled manner. The liver is a large vital organ situated in the upper right corner of the stomach and under the diaphragm. It helps in removing toxins and also helps in digesting foods. Several types of cancer can be formed in the liver. The most common type of cancer found in the liver is hepatocellular carcinoma (cancer that starts in hepatocytes). Hepatocytes are the cells of the liver. Some other types of liver cancer that can be found in the liver are hepatoblastoma and intrahepatic cholangiocarcinoma. It is difficult to diagnose liver cancer in its initial stage because there are no symptoms shown to the person in the initial days of the liver cancer. The seriousness of liver cancer depends upon the location and size of the tumour and the health of the patient. 

Most people do not experience any symptoms or signs in the early stages of liver cancer. But, when symptoms appear, they may be among these:-

1. Loss of appetite
2. Loss of weight
3. Yellowing of skin and whites of eyes. (jaundice)
4. Weakness and fatigue
5. White, chalky-coloured stool
6. Nausea and vomiting
7. Pain in the upper abdominal part
8. Presence of a lump below the rib cage
9. Pain and swelling on the right side of the abdominal region
10. Pain near the right shoulder
11. Swelling in legs
12. In the advanced stage, the metastatic stage, the symptoms may include a decrease in sex drive, fatigue and pain in the abdomen. This pain is due to enlargement of the spleen. 

Liver cancer occurs in liver cells. Cancer is a state in which the cells of the body start to grow uncontrollably. Cancer that occurs in the liver is called primary liver cancer, and it is of 5 types. 

1. Hepatocellular carcinoma
2. Fibrolamellar carcinoma
3. Cholangiocarcinoma
4. Angiosarcoma
5. Hepatoblastoma

Secondary liver cancer is when cancer has not started in the liver but has spread to the liver from other body parts such as the pancreas, lung, stomach etc. In European countries and the United States, metastatic cancer is a more common type of cancer than primary. 

In some cases, the cause of liver cancer can be determined, such as chronic hepatitis infection is the cause of liver cancer. However, in other cases, the cause of liver cancer remains unknown. However, certain factors increase the risk of liver cancer. These are:

1. Hepatocellular carcinoma occurs due to damage to the liver at the time of birth, excessive alcohol intake, and chronic infections caused by diseases like hepatitis B. 
2. Cirrhosis, a condition caused due to alcohol abuse.
3. Obesity and fatty liver disease 
4. Having a family history of primary liver cancer
5. Men are more likely to be affected by Liver cancer
6. Having certain medical conditions like hepatitis B, Diabetes, and gallstone

A risk factor of any medical condition does not mean that they will develop that condition. These factors increase the risk of developing a particular condition. The risk factors for liver cancer are:-

1. Diabetes
2. Obesity
3. Wilson disease
4. Overconsumption of alcohol for a long time
5. Being a man. Chances of liver cancer in men are more than in women
6. Exposure to the poison of mouldy crops
7. Liver disease
8. High cholesterol
9. Tyrosinemia. (a genetic disorder in which tyrosine (the amino acid that helps in the formation of protein) is broken.

The presence of liver cancer is detected by the presence of lumps in the liver. It can be diagnosed by performing some tests:-

1. Blood test: Serum marker test and Liver enzyme tests are the tests that can be performed for diagnosing liver cancer. In the "serum marker test," the level of AFP (alpha-fetoprotein) is detected. An increased level of AFP indicated the presence of a tumour in the liver. In a liver enzyme test, if the liver enzyme level is increased, it indicates the presence of liver disease.
2. Ultrasound (sonography): it is used to get an image of the tissues of the liver. 
3. Angiogram: In this test, the dye is injected into the blood vessels, which helps get an image of the liver and tumours.
4. Laparoscopy: In this method, a thin tube is used to get an image of the liver. Any tumours, if present, are visible through this laparoscope (a thin tube having a camera and light at its tip).
5. CT Scan: A special X-ray is used to get a clear image of the liver. It helps in detecting the tumours in the liver.
6. Endoscopic Retrograde Cholangiopancreatography: The doctor performs this procedure to determine the presence of cancer in the liver, bile ducts, and pancreas. The procedure involves the use of an endoscope and x-rays.
7. Percutaneous Transhepatic Cholangiography: This test involves the use of x-rays for examining the bile ducts. The patients undergo this procedure when ERCP is contraindicated or was not useful in detecting abnormality.

There are several risks associated due to delay in liver cancer treatment. The disease may progress further resulting in more severe symptoms. Further, the disease may also move to the next stage. There are the following stages of liver cancer:

Stage I: This stage is characterised by a single tumour that has not grown into blood vessels and not spread to surrounding lymph nodes or to distant sites.

Stage II: In this stage, there is either a single tumour which is larger than 2 cm and has grown to nearby blood vessels or multiple tumours with none of them greater than 5 cm but not spread to surrounding lymph nodes or to distant sites.

Stage III: The patients at this stage have at least one tumour (of any size) which has spread to the major branch of the portal or hepatic vein and has not spread to surrounding lymph nodes or to distant sites.

Stage IV: This stage is characterised by one or more tumours of any size that may or may not spread to nearby lymph nodes but has spread to distant organs, such as lungs or bones.

What are the treatments available for liver cancer?

Several factors affect the choice of treatment for liver cancer. These include the stage of cancer, age of the patient, type of liver cancer, personal preferences and overall health.

1. Surgery: Generally, two types of surgeries are used to cure liver cancer. They are:-
   1. Surgery to remove tumours: In this surgery, the tumours are removed using a small incision. The tumours are removed, and a few healthy tissues are also removed to avoid cancer spreading.
   2. Liver transplant: The surgeon replaces the recipient's diseased liver with a healthy donor liver. 
2. Radiation therapy: During radiation therapy, an X-ray beam is focused on the tumours for destroying the cancerous cells.
3. Targeted therapy: This treatment focuses on the specific abnormality of the tumour. A combination of the drug is given to the patient to stop the growth of the tumour.
4. Immunotherapy: This treatment aims in boosting the immune system of the person by using different medicines.
5. Chemotherapy: A drug or a combination of the drug is given to the patient to kill or delay the growth of the tumour cells in the liver.