Liver Cancer

SYMPTOMS

Early stages of liver cancer do not have any symptoms. But, if cancer grows, the following symptoms can be seen:

• Discomfort in the right side of the upper abdomen
• Abdominal swelling
• A hard lump under the rib cage on the right side
• Pain in the back or at the right shoulder blade
• Jaundice 
• Easy bleeding or bruising
• Unusual fatigue
• Nausea or vomiting
• Loss of appetite
• Unexplained weight loss

DIAGNOSIS

When liver cancer is suspected, information regarding the symptoms, health, past illnesses and treatment will be collected. Followed by this, a physical examination will be performed to check for the presence of lumps or unusual signs of the disease. 

The following tests may be recommendedto help diagnose liver cancer:

• Blood test:  Complete blood count measures the count of different types of blood cells like red blood cells, white blood cells, and platelets. 
• Alpha-fetoprotein test. This test measures the levels of alpha-fetoprotein in the blood. A high level of this protein may be a positive sign of liver cancer.
• Ultrasound scan: It uses high-frequency sound waves to create images of the liver. It helps to detect abnormalities in the liver.

If any of the above tests suggest a chance for liver cancer, the following tests can help in the confirmation of cancer.

• Computerizedtomography (CT) scan: This test takes a series of X rays of the liver to provide a three-dimensional image of the liver. 
• Magnetic resonance imaging (MRI) scan: This scan makes use of a strong magnetic field and radio waves to give a clear picture of the liver.  
• Biopsy: This procedure involves the insertion of a needle into the abdomen to collect a small sample of the liver tissue. The collected sample is viewed under a microscope to check for abnormal or cancer cells. 
• Laparoscopy:In this procedure, a small incision is made in the abdomen after administering anesthesia. A thin tube that contains a light and camera isinserted through the incision, to examine the liver and its surrounding areas. 

Staging:

Staging helps to determine the extent of cancer spread. The stages of liver cancer are:

• Stage I: The tumour is confined to the liver.
• Stage II: The tumour has spread to the blood vessels or, there are multiple tumours less than 5 cm.
• Stage III: The tumour has spread to the blood vessels and the outer lining of the liver. The tumours are greater than 5 cm in size.
• Stage IV: Cancer has spread to the lymph nodes and blood vessels near the liver and distant organs such as lungs, bones or brain.

In the initial stages, liver cancer may not show any sign and symptoms. As the cancer advances, symptoms like weight loss, loss of appetite, nausea and vomiting, abdominal swelling, and weakness may be apparent. 

RISK FACTORS

The following are the risk factors for liver cancer:

• Aflatoxins: Aflatoxins are the toxins produced by fungi, which contaminate foods such as corn, wheat, soybeans, rice and nuts preserved in hot and humid areas. A high intake of aflatoxin-contaminated foods can damage the DNA of the liver cells and increases the risk of liver cancer.
• Hepatitis infection: Hepatitis virus infection (hepatitis B or hepatitis C) increase the risk of developing liver cancer.
• Cirrhosis:Individuals with cirrhosisare likely to develop liver cancer.
• Alcohol: Excessive consumption of alcohol is linked to liver cancer.
• Smoking: Individuals who smoke oftenare at a high risk of liver cancer.

 Additionally, there are some other risk factors which increase the risk of liver cancer. They are:

• Hereditary hemochromatosis (HH)
• Glycogen storage disease
• Alpha-1 antitrypsin (AAT) deficiency
• Wilson disease
• Porphyria cutanea tarda (PCT)
• Diabetes
• Obesity

POST-OPERATIVE CARE

The following tips can help recover after surgery:

• Practice gentle exercises, such as walking
• Go for frequent checkups
• Eat a healthy and protein-rich diet
• Consult a physician if you experience pain or other symptoms
• Avoid driving
• Do not drink alcohol

Post-surgical complications:

• Bleeding
• Infections
• Formation of blood clots
• Ascites 
• Kidney problems
• Leakage of bile
• Alteration in sleeping habits

TREATMENT

Liver cancer can be treated by surgery, radiation, or chemotherapy.

Surgery: Surgery is the best treatment option to cure liver cancer. The surgical options for liver cancer include:

• Partial hepatectomy: This surgery involves the removal of a part of the liver affected by cancer. People who are healthy enough for surgery and those with a single tumour that has not spread to the blood vessels can opt for this surgery.
• Total hepatectomy: This procedure involves the complete removal of the liver. 
• Liver transplantation: It is an option for those with tumours, which cannot be removed by surgery. It is generally used to treat the individuals with small tumours that have not spread to the nearby blood vessels. It is rarely used in patients with resectable cancers (tumours that can be deleted). Liver transplantation reduces the risk of spread of cancer. 

Radiotherapy: This therapy uses high-energy rays to destroy the cancer cells. It can be given either externally or internally. 

Chemotherapy: This therapy uses medications to kill cancer cells. The medicines can be given systemically (as tablets or injections that travel throughout the body) or regionally (as injections that are injected directly into a specific area). In liver cancer, regional therapy is mostly preferred.  

Chemoembolization: This is a type of chemotherapy in which the chemo-drugs block the blood supply to the tumour. This eventually starves the cancer cells from blood and kills them.  

Duration of the treatment

The duration of surgery depends on the surgical approach used. Radiation therapy is given in small doses for 5 days a week for several weeks. Chemotherapy treatment is given in cycles. Each cycle includes the treatment followed by recovery time. The cycles are usually 2- 3 weeks long. 

FACTORS AFFECTING COST

The cost of treatment for liver cancer depends upon:

• the condition of the patient 
• the type of treatment modality chosen
• the technology used
• other problems in the patient