Liver Cancer: A Comprehensive Overview & Treatment Options
The liver is a crucial organ in the human body that has multiple roles. Although it is considered to be part of the digestive system, it has other important functions as well. This includes but is not limited to: “detoxification of metabolites, protein synthesis, and production of digestive biochemicals such as bile.” As a result of the liver's multitasking functions, when it becomes cancerous, it can interfere with many processes in the body. According to Alzahrani et al., “liver cancer is the fifth most common cancer in the world, and the third most common cause of death.” According to the National Cancer Institute, there is only a 17.2% chance of survival five years after its onset. The medical specialty of the liver, gallbladder, biliary tree, and pancreas is known as hepatology.
The liver's digestive function involves the production of bile, a substance responsible for emulsifying fats. Once bile is produced, it is stored in the gallbladder. When an individual consumes food, the gallbladder contracts and releases the necessary amount of bile into the duodenum (the first part of the small intestine) to aid in the digestive process. As a result of this function, sometimes cancer may not necessarily be found in the liver itself, but in the bile duct and/or gallbladder. These are all classified under the hepatobiliary system and are dealt with accordingly.
The most common type of primary liver cancer (cancer that stems from the liver) is known as hepatocellular carcinoma (HCC). It is also known as malignant hepatoma. The main cause of HCC is dependent on the geographical location. In countries where hepatitis is prevalent, HCC is secondary to a hepatitis infection (Hep B and/or Hep C). In countries like the United States, where hepatitis vaccinations are common, it is most likely to be caused by cirrhosis. Cirrhosis is most commonly caused by excessive alcohol consumption (alcoholism). Szabo et. al discusses in more detail the correlation between very heavy alcohol consumption and liver cancer. For quantitative purposes, according to the GBD 2013 study, with regards to liver cancer:
- 300,000 deaths were caused by Hepatitis B
- 343,000 deaths were caused by Hepatitis C
- 92,000 deaths were alcohol related
In countries where the hepatitis immunization vaccines are commonplace, it is important to consider that liver cancer can be metastatic. In fact, secondary liver cancer is quite common. This is due to many factors and includes but is not limited to the size of the liver (one of the largest organs in the body), its multiple functions in the body, and its proximity to other organ systems in the peritoneum. In fact, the most common causes of secondary liver cancer are GI related cancers (e.g. colorectal cancer). According to Memorial Sloan Kettering, between 60 and 70% of GI cancers will spread to the liver. They state that is because of the direct blood supply between the intestines and the liver. Some of the less common roots of secondary liver cancer include the breast, prostate, pancreas, lungs, and esophagus.
Some of the most common diagnostic procedures to diagnose liver cancer are ultrasound and CT scan. If the physician finds abnormalities, then they may order a liver biopsy, which is one of the most accurate methods to determine the type of cancer since it involves extracting an actual liver sample. Treatment options vary depending on the stage and type of liver cancer. If the cancer is non-cirrhotic in nature, then surgery is the most common method of treatment. If cirrhosis is present, then a liver transplant may be considered. Surgical resection for a non-cirrhotic liver has shown great promise, which is partially related to the liver's natural regenerative properties.
There is a newer form of treatment that can be used for certain cases of liver cancer. It is known as percutaneous tumor ablation. According to the American Cancer Society, it “destroys liver tumors without removing them.” This is common for patients who have a few small tumors, and who are not good candidates for surgery. The pro of this method is it is a more minimal approach, and thus some of the complications that may arise via surgery aren't present. The con of this method is that there isn't full closure like there is with surgery, and if the tumor is located in a vital area (like near major blood vessels or diaphragm), then this method is not the best approach. An oncologist and/or interventional radiologist would be the best resources to see if you are eligible and what type of ablation would be best.
Finally, based on the premise of liver cancer, there are two main preventative measures that can be implemented from a young age. First and foremost, given the statistics, it is paramount that children are administered a Hepatitis B vaccination for immunity. According to Arzumanyan et al., Rosen et al., and the National Cancer Institute, primary liver cancer caused as a result of the hepatitis viral infection accounts for 80% of HCCs. In addition, to prevent the cirrhosis aspect of the liver, moderate alcohol consumption is advised. Cirrhosis happens over a long period of time, so it is important that both younger and older people do not consume alcohol excessively in a short period of time. Rahib et al. conducted a study where they used statistical data to predict the future trend of hepatology cancers. They estimate that by 2030, pancreatic and liver cancers are projected to surpass breast, prostate, and colorectal cancers globally. Despite this alarming prediction, preventative measures can alter this course and should be implemented. As always, please consult your regular physician before making any changes to your lifestyle.
About SC Ali
S.C. Ali is an author/editor. He has a degree in Chemistry, and is interested in the study and practice of medicine. His blog can be found here: http://thebronzelifestyle.com/