Types of cancer

Liver cancer

Liver cancer can develop in the organ itself or as a tumor metastasis in another region. Hereditary diseases in the organ, chronic infections such as those caused by hepatitis B and C, cirrhosis and diabetes can trigger the tumor.
4 min de leitura
por: Grupo Oncoclínicas
Liver cancer
Liver cancer can develop in the organ itself or as a metastasis in another region, motivated by hereditary diseases and chronic infections.

The liver is a football-sized organ located in the upper right part of the abdomen. There are two types of cancer that can affect it: one that starts in itself, called a primary tumor, and one that originates in another organ and, as it evolves, affects the liver, being called secondary or metastatic.

Liver cancer occurs when liver cells develop changes in their DNA. Cellular DNA is the material that provides instructions for every chemical process that takes place in our body. DNA mutations can cause these instructions to change. As a result, cells can start to grow disorderly and form a tumor, which is nothing more than a cluster of cancer cells.

The American Cancer Society estimates that in 2021 about 42,230 new cases (29,890 in men and 12,340 in women) of primary liver cancer and intrahepatic cholangiocarcinoma will be diagnosed in that country. INCA does not have these statistics for Brazil, but it is known that more than 800,000 people worldwide are diagnosed with this type of neoplasm annually. It also leads the number of cancer-related deaths, accounting for more than 700,000 deaths per year.

Risk factors for liver cancer are:

  • Chronic infection caused by hepatitis B or C viruses;
  • Cirrhosis (chronic inflammation of the liver);
  • Some inherited liver diseases, such as hemochromatosis and Wilson’s disease;
  • Diabetes;
  • Non-alcoholic fatty liver disease (NAFLD), which causes fat to accumulate in the liver;
  • Exposure to aflatoxins (poisons produced by fungi that grow on foods that are not stored properly and are exposed to moisture, such as some types of grains and nuts); and
  • Excessive consumption of alcoholic beverages.

Types of liver cancer

Hepatocellular carcinoma, which starts in hepatocytes (cells located in the liver), is the most common type of liver cancer. It occurs more frequently in individuals with chronic liver diseases, such as cirrhosis, which can be caused by infection resulting from hepatitis B or hepatitis C, steatohepatitis, alcoholism, among other factors.

Other variations may also occur:

  • Intrahepatic cholangiocarcinoma – born in the bile ducts of the liver;
  • Hepatoblastoma – rare neoplasm that affects newborns and children in the first years of life; and
  • Angiosarcoma – an equally rare cancer that originates in the blood vessels of the liver.

Symptoms and signs of liver cancer

Most people have no signs and symptoms in the early stages of primary liver cancer. When they are present, they can manifest in the following ways:

  • Weight loss with no identifiable cause;
  • Loss of appetite;
  • Pain in the upper part of the abdomen;
  • Nausea and vomiting;
  • Feeling of weakness and fatigue;
  • Abdominal swelling (ascites);
  • Presence of abdominal mass;
  • Appearance of jaundice, which is characterized by yellowing of the skin and inside the eyes; and
  • White, chalky stools.

Liver cancer diagnosis

It is often difficult to diagnose liver cancer early, as its signs and symptoms do not usually appear until it is already in an advanced stage of the disease.

Screening tests for liver cancer are not widely recommended for the general population. This means that you should not order tests (a process called screening) in people who do not have symptoms. But the tests may indeed be recommended for some individuals at higher risk, such as those with cirrhosis, hemochromatosis (iron accumulation in the body) or chronic hepatitis B infection.

Depending on symptoms and medical suspicion, tests usually include:

  • Laboratory tests, such as blood tests, that assess alpha-fetoprotein (AFP, a tumor marker);
  • Imaging tests, such as ultrasound, CT and MRI, to see if tumors exist, how large they are, and whether they have spread to other parts of the body.
  • Liver biopsy, in which a needle is placed inside the lesion to remove a piece for analysis under a microscope to determine whether it is malignant or benign;
  • Exploratory laparoscopic surgery, which allows direct visualization of the organ and biopsy.

Treatment

The most indicated approach when the tumor is restricted to only part of the liver (primary tumor) is its resection (surgical removal). However, some patients with cirrhosis cannot tolerate the removal of part of the liver and, in these cases, other types of treatment may be necessary (ablation, chemoembolization, radiotherapy, liver transplantation), depending on the size, number of lesions and other characteristics. 

Surgery can also be performed, depending on the case, in metastatic tumors (which are in the liver, but born in other organs) in which the primary lesion has been resected or is likely to be resected in a curative way.

Radiation therapy is used to kill cancer cells. However, it may not be a good alternative for some patients whose livers are damaged by pre-existing conditions such as hepatitis or cirrhosis. It will be up to the doctor to evaluate this possibility. Overall, radiation therapy can be helpful in:

  • Liver cancer that cannot be surgically eliminated;
  • Liver cancer that cannot be treated by ablation or embolization techniques or that has not responded to these treatments;
  • Cancer with brain or bone metastases; and
  • In the treatment of pain resulting from large tumors.

Other important treatment options include:

  • Chemotherapy – one or more specific drugs enter the bloodstream to kill cancer cells;
  • Targeted Therapies – Just like chemotherapy, these drugs enter the bloodstream and spread to almost every area of ​​the body, fighting cancer. They are often far more effective than chemotherapy for primary liver cancer; and
  • Immunotherapy – is the use of drugs that help the person’s immune system identify and destroy cancer cells.

Prevention

To prevent any type of cancer, it is important to avoid its risk factors. In the case of liver cancer, it is important to be vaccinated against hepatitis B, prevent hepatitis C (using condoms during sexual intercourse, not sharing sharp objects such as needles, being careful with hygiene and sterilization measures in manicures and tattoo artists) and avoid factors that can trigger cirrhosis, such as excessive alcohol consumption and excess weight.

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