Understanding Liver Cancer: Causes, Risk Factors, and Prevention Strategies

Liver cancer is a type of cancer that begins in the cells of the liver. The liver, located in the upper right portion of the abdomen, is a vital organ that performs numerous essential functions, such as detoxifying harmful substances in the body, producing bile to help digest fats, and storing glycogen for energy. There are several types of liver cancer, but the most common is hepatocellular carcinoma (HCC), which starts in the primary liver cells called hepatocytes. Other types include intrahepatic cholangiocarcinoma (bile duct cancer) and metastatic cancer deposits (that originate elsewhere and then spread to the liver).

What are the stages of liver cancer?

Liver cancer staging is a way of describing the extent of the cancer, including how large the tumour is and whether it has spread to other parts of the body, helping healthcare providers determine the best treatment options. The stages of liver cancer are typically categorised as follows:

Stage I

The cancer is confined to the liver and has not spread to nearby blood vessels, lymph nodes, or distant sites, generally originating from a single tumour (of any size).

Stage II

The cancer is still within the liver but has started to affect nearby blood vessels or multiple small tumours may be present (none larger than 5 cm).

Stage III

• Stage IIIA: Multiple tumours larger than 5 cm or a tumour that has invaded a major branch of large blood vessels (the portal or hepatic veins).
• Stage IIIB: Tumours that have invaded nearby organs (other than the gallbladder) or have perforated the visceral peritoneum.
• Stage IIIC: Tumours involving nearby lymph nodes but not distant organs.

Stage IV

• Stage IVA:The cancer has spread to nearby lymph nodes and may have spread to nearby organs but not to distant sites.
• Stage IVB: The cancer has spread to distant organs or tissues.

What causes liver cancer?

The main cause of Liver cancer is chronic liver damage, which can result from various causes and factors such as:

Chronic hepatitis infections

• Hepatitis B Virus (HBV): Chronic HBV infection is a leading cause of liver cancer worldwide. The virus can cause long-term liver inflammation, leading to cirrhosis and increasing the risk of cancer development.
• Hepatitis C Virus (HCV): Chronic HCV infection is another significant risk factor for liver cancer. Like HBV, it can lead to liver inflammation, cirrhosis, and ultimately, liver cancer.

Cirrhosis

• Alcohol consumption: Long-term heavy alcohol consumption can lead to liver cirrhosis, significantly increasing the risk of liver cancer.
• Non-Alcoholic Fatty Liver Disease (NAFLD) and Non-Alcoholic Steatohepatitis (NASH): These conditions, often associated with obesity, type 2 diabetes, and metabolic syndrome, can progress to cirrhosis and increase the risk of liver cancer.

Exposure to carcinogens

• Aflatoxins: These are toxic substances produced by moulds that can contaminate certain foods, particularly in warm, humid climates. Chronic exposure to aflatoxins, particularly in combination with viral hepatitis, significantly increases the risk of liver cancer.
• Chemical exposure: Exposure to certain chemicals and toxins in the environment or workplace can increase the risk of liver cancer.

Metabolic disorders

• Obesity and Type 2 diabetes: Both obesity and type 2 diabetes are associated with an increased risk of liver cancer, likely due to their association with NAFLD and NASH.

Genetic factors

• Hereditary conditions: Inherited genetic disorders such as hemochromatosis, Wilson's disease, and alpha-1 antitrypsin deficiency can increase the risk of liver cancer.

Other Risk Factors

• Smoking or tobacco use: Tobacco use, in all forms, is associated with an increased risk of liver cancer.
• Gender: Men are more likely to develop liver cancer than women, possibly due to higher rates of viral hepatitis and alcohol consumption.
• Age: Liver cancer incidence increases with age, with most cases diagnosed in people over 60.

What are the signs and symptoms of liver cancer?

The signs and symptoms of liver cancer can vary and may not appear until the disease is in its later stages. Here are the common signs and symptoms:

• Unintentional weight loss
• Loss of appetite
• Persistent pain in upper right abdomen
• Nausea and vomiting
• General weakness and fatigue
• Swelling in the abdomen
• Jaundice
• White, chalky stools
• Dark urine
• Itching
• Fever
• Enlarged liver or spleen

Note: The aforementioned symptoms can also be associated with various other conditions. It is, therefore, essential to seek medical evaluation for an accurate diagnosis if they occur.

How do Healthcare Providers Diagnose Liver Cancer?

Liver cancer is diagnosed by using a combination of methods. The diagnostic procedure typically starts with a thorough review of the patient’s medical history, followed by a physical examination, during which the doctor checks for any signs of liver cancer, such as an enlarged liver or spleen, jaundice, or ascites. After the initial assessment, the doctor may use a number of diagnostic tests and procedures, such as:

• Liver Function Tests: Liver Function tests assess the liver's ability to produce proteins, process nutrients, and clear waste products. Abnormal results can indicate liver damage, which may be due to cancer.
• Imaging Tests: Imaging techniques are crucial for detecting liver tumours and determining their size, location, and extent. Common imaging tests include:

○ Ultrasound: Often the first imaging test used to detect liver abnormalities.

○ Computed Tomography (CT) scan: Provides detailed cross-sectional images of the liver.

○ Magnetic Resonance Imaging (MRI): Offers detailed images using magnetic fields and can help in assessing blood flow and liver tissue characteristics.

○ Positron Emission Tomography (PET) scan: May be used to determine if the cancer has spread to other parts of the body.

• Blood tests: Blood tests can check liver function and look for specific markers that may indicate liver cancer, such as alpha-fetoprotein (AFP). Elevated AFP levels can be a sign of liver cancer, although they are not definitive.
• Genetic and molecular testing: In some cases, tests may be conducted to look for specific genetic mutations or molecular markers associated with liver cancer. This can help in tailoring targeted therapies.
• Endoscopy: Occasionally, an endoscopy may be used to visualise the liver and nearby organs directly, especially if there's suspicion of cancer spreading to the bile ducts or other structures.
• Biopsy: A liver biopsy involves removing a small sample of liver tissue for examination under a microscope. This is the definitive way to diagnose liver cancer. The biopsy can be performed using a needle (fine-needle aspiration or core biopsy), laparoscopy, or during surgery.

Combining these diagnostic methods allows healthcare providers to accurately diagnose liver cancer, assess its stage, and develop an appropriate treatment plan.

How do healthcare providers treat liver cancer?

Healthcare providers treat liver cancer using various methods, depending on the stage of cancer, the patient's overall health, and specific tumour characteristics. Treatment options include:

Localised treatments: Targeting the cancer cells directly, these treatment options include.

• Radiofrequency Ablation (RFA): is a targeted therapy that uses heat to destroy cancer cells.
• Microwave Ablation: again a targeted therapy that destroys tumours using microwaves.
• Cryoablation: Freezes and destroys cancer cells.
• Transarterial Chemoembolization (TACE): Delivers chemotherapy drugs directly to the tumour and also blocks blood supply to the tumour.
• Selective Internal Radiation Therapy (SIRT or TARE): Delivers radiation directly to the tumour via tiny radioactive beads (Y90) injected into the liver's blood vessels. 

Surgical treatment

Removes the part of the liver having the tumour. Sometimes [block]4[/block] may be needed and the remaining liver is not healthy enough to support bodily functions.

Systemic treatments

These treatments affect the entire body. Targeted therapy drugs focus on specific molecules involved in cancer growth, immunotherapy boosts the immune system to fight cancer, and chemotherapy uses drugs to kill or slow the growth of cancer cells.

Radiation therapy

High-energy rays are used to destroy cancer cells or shrink tumours. External beam radiation therapy focuses radiation from outside the body, while stereotactic body radiation therapy delivers high doses precisely to the tumour.

Supportive care

This focuses on managing symptoms and improving quality of life, including pain management, nutritional support, and psychosocial support for patients and families.

Treatment plans for liver cancer are individualised based on factors such as tumour size, location, stage, and the patient's overall health and preferences. A multidisciplinary team of specialists collaborates to determine the most appropriate approach for each patient.

Are there Ways to Prevent Liver Cancer?

Yes, there are several ways to help prevent liver cancer by addressing the risk factors associated with the disease. Here are some key preventive measures:

• Vaccination against Hepatitis B: Getting vaccinated against hepatitis B virus (HBV) can significantly reduce the risk of liver cancer, especially in areas where HBV is common.
• Screening and treatment for Hepatitis C: Regular screening for hepatitis C virus (HCV) and appropriate treatment if infected can prevent chronic liver disease and reduce the risk of liver cancer.
• Limit alcohol consumption: Limiting alcohol intake can prevent liver cirrhosis, which are major risk factors for liver cancer.
• Maintain a healthy weight: Obesity is linked to non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH), both of which can lead to liver cancer. Maintaining a healthy weight through diet and exercise can lower this risk.
• Maintain a healthy diet: Eating a balanced diet rich in fruits, vegetables, whole grains, and lean proteins can support liver health. Avoiding foods contaminated with aflatoxins, which can be found in improperly stored grains and nuts, is also important.
• Avoid smoking: Smoking is a risk factor for many types of cancer, including liver cancer. Quitting smoking can reduce your risk.
• Limit exposure to toxins: Reducing exposure to harmful chemicals, such as those found in certain industrial settings, can lower the risk of liver cancer.
• Regular medical check-ups: Regular check-ups with your healthcare provider can help monitor liver health, especially if you have risk factors like chronic liver disease or a family history of liver cancer.
• Manage underlying health conditions: Properly managing conditions like diabetes and high cholesterol can reduce the risk of developing liver disease and subsequently liver cancer.

By taking these preventive measures, individuals can significantly lower their risk of developing liver cancer.

Final words

Understanding liver cancer's risk factors, symptoms, stages, and treatment options is vital for early detection and effective management. If you or a loved one has been experiencing any of the symptoms of liver cancer or have concerns about liver health, it is important to consult a specialist as soon as possible. That’s when you can trust Max Hospitals to provide expert, compassionate, and comprehensive care. With a team of some of the best liver and cancer specialists in the country and advanced diagnostic and treatment technologies, we are ideally positioned to offer personalised treatment plans, ensuring the best possible outcomes. Consult a specialist at Max Hospitals and take control of your liver health.