Liver cancer (Hepatic cancer) is a cancer that originates in the liver.The liver is the largest internal organ.It is located in the upper righ-hand portion of the abdominal cavity, beneath the diaphragm (a sheet of muscle of separating the chest and the abdomen), and on the top of the stomach, righ kidney, and intestines.Primary liver cancer is a cancer that starts in the liver.Secondary liver cancer is cancer that is not found in the liver and it does not start from there, but has spread (metastasized) from somewhere else, such as the pancreas, colon, stomach, breast, or lung.
The functions of liver
- Liver breaks down and stores many of the nutrients absorbed from the intestine that the body needs to function
- It secretes bile into the intestines to absorb nutrients, especially fats.
- Liver filters out and break down toxic wastes in the blood, which are then removed from the body.
- It makes most of the clotting factors that keep from bleeding too much.
The Types Of Primary Liver Cancer
- Hepatocellular Cancer (HCC/ Hepatocellular Carcinoma) can have different the patterns of growth, including some begin as a single tumor that grows larger.Only late in the disease does it spreads to other parts of the liver and a second type seems to start as many small cancer nodules throughout the liver, not just a single tumor.
- Intrahepatic Cholangiocarcinoma ( Bile duct cancer) starts in the cells that line the small bile ducts (tubes that carry bile to gallbladder) within the liver.
- Angiosarcoma and Hemangiosarcoma are rare cancers that begin in cells lining the blood vessels of the liver.
- Hepatoblastoma is a very rare kind of cancer that develops in children, usually in those younger than four years old.
The Symptoms of Liver Cancer
- Pain in the abdomen or near the righ shoulder blade.
- Swelling or fluid buil-up in the abdomen.
- Yellow skin and whites of the eyes (jaundice).
- Unexplained weight loss.
- Nausea or vimiting.
- Loss of appetite.
- Itching.
- Feeling of fullness.
- Enlarged liver, felt as a mass under the ribs on the right side.
- Enlarged spleen, felt as a mass under the ribs on the left side.
Causes of Liver Cancer
- Viral infection either hepatitis C virus or hepatitis B virus
- Virus-related cirrhosis
- Heavy Alcohol intake
- Aflatoxin exposure (Fungi Aspergillus flavus and Aspergillus parasiticus)
- Tobacco smoking
- High grade dysplastic nodules
- Obesity
- Diabetes
- Liver fluke infection
- Gender
- Race
- Inherited metabolic disease
- Vinyl chloride and thorium dioxide
- Anabolic steroids
- Arsenic
- Birth control pills
Diagnosis
There are some tests and procedures to diagnose the liver cancer, including imaging tests, lab tests and procedure.If patients have signs or symptoms of liver cancer, doctor will find it by doing procedures and tests as follow :
- Medical history and physical exam.
- Ultrasound is the first test to look at the liver.
- Computed Tomography scan (CT scan) is an x-ray test that produce detailed cross-sectional images of the body.It can provide precise information about the size, shape, and position of any tumors in the liver or elsewhere in the abdomen and nearby blood vessels.
- Magnetic Resonance Imaging (MRI) provides detailed images of soft tissues in the body.
- Angiography is an x-ray test that look at blood vessels.
- A Bone Scan helps in looking for cancer that has spread (metastasized) to bones.
- Laparoscopy is a procedure that inserts a thin, lighted tube with a small video camera on the end through a small incision (cut) in the front of the abdomen to look at the liver and other internal organs.
- Biopsy is the removal of a sample of tissue to see if it is cancer.
- Needle biopsy is a hollow needle that is placed through the skin in the abdomen and into the liver.A fine needle aspiration biopsy sucks tumor cells into a very thin needle with a syringe.A core needle biopsy uses a slightly larger needle to get a bigger sample.
- Laparoscopic biopsy is to see the surface of the liver and take sample of abnormal-appearing areas.
- Surgical biopsy is to remove tumor.An incisional biopsy is to remove a piece of the tumor.An excisional biopsy is to remove the entire tumor and some surrounding normal liver tissue during an operation.
- Magnetic Resonance Cholangiopancreatography (MRCP)
- Endoscopic Retrograde Cholangiopancreatography (ERCP)
Lab Tests
- Alpha-Fetoprotein Blood (AFP) test is a protein that is normally present at high levels in the blood of fetuses but goes down to low levels shortly after birth.
Blood Tests
- Liver Function Test is to know the condition of the liver before starting the treatment.
- Blood Clotting Test.The liver makes protein that help blood clot when bleeding.
- Complete Blood Count is to measure the levels of red blood cells (which carry oxygen throughout the body), white blood cells (which fight infections), and platelets (which help the blood clot).
- Blood Chemistry Test is to check the levels of a number of minerals and other substances in the blood, some of which might be affected by liver cancer.
The Stage of Liver Cancer
- The Stage I : There is a single tumor (any size) that has not grown into any blood vessels.The cancer has not spread to nearby lymph nodes or distant sites.
- The Stage II : Either there is a single tumor (any size) that has not grown into any blood vessels or there are several tumors, and all are 5 centimeters (2 inches) or less across.The cancer has not spread to nearby lymph nodes or distant sites.
- The Stage IIIA : There is more than one tumor and at least one is larger then 5 centimeters (2 inches) across.The cancer has not spread to nearby lymph nodes or distant sites.
- The Stage IIIB : At least one tumor is growing into a branch of a major vein of the liver (portal vein or hepatic vein).The cancer has not spread to nearby lymph nodes or distant sites.
- The Stage IIIC : A tumor is growing into a nearby organ (other than the gallbladder) or a tumor has grown into the outer covering of the liver.The cancer has not spread to nearby lymph nodes or distant sites.
- The Stage IVA : Tumors in the liver can be any size or number and they may have grown into blood vessels or nearby organs.The cancer has spread to nearby lymph nodes.The cancer has not spread to distant sites.
- The Stage IVB : The cancer has spread to other parts of the body (Tumors can be any size or number and nearby lymph nodes may or may not be involved).
The Treatment of Liver Cancer
I. The Treatments of Hepatocellular Cancer include
I. The Treatments of Hepatocellular Cancer include
- Surgical Resection
- Liver transplantation
- Precutaneous ablation is the only non-surgical treatment that can offer cure.The forms of precutaneous ablation consist of injecting chemicals into the liver (ethanol or acetic acid) and producing extreme of temperature using radio frequency ablation, microwaves, lasers or cryotherapy
- Local chemotherapy may be used in a procedure known as transarterial chemoembolization.This procedure, cytotoxic drugs, such as doxorubicin or cisplatin with lipiodol are administered and the arteries supplying the liver are blocked by gelatin sponge or other particles.
- Targeted therapy drug (sorafenib) prevents cell proliferation and blood cell growth.
- Radiotherapy.
II. The Treatments of Intrahepatic Cholangiocarcinoma include
- Surgical Resection
- Liver Transplantation
- Adjuvant Chemoradiation
- Photodynamic Therapy is a novel treatment that utilitizes light activated molecules to treat the tumor.It can be used to improve quality of life and survival time in these unresectable cases.
- Systemic Chemotheraphy, such as gemcitabine and cisplatin is used in inoperable cases of cholangiocarcinoma.
- Radio Frequency Ablation
- Transarterial Chemoembolization
- Internal Radiotherapy (Brachytherapy)
- Radiotherapy
III. The Treatments of Hepatoblastoma include
- Surgical Resection
- Liver Transplantation
- Chemotherapy, including cisplatin, vincristine, cyclophosphamide, and doxorubicin are used for the systemic treatment of hepatoblastoma.
Drugs for Liver Cancer
- Cisplatin
- Sorafenib
- Gemcitabine
- Vincristine
- Cyclophosphamide
- Doxorubicin
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