Bile duct (liver) cancer, otherwise known as hepatic cancer, affects the liver. Liver cancers are malignant tumours that grow on the surface of or inside the liver. The liver, located below the right lung and under the ribcage, is one of the largest organs of the human body. It is divided into the right and left lobes. Nutrient-rich blood is carried by the portal vein, from the intestines to the liver, while oxygen-rich blood reaches the liver from the hepatic artery. The liver has a range of functions, including detoxification (getting rid of toxins), synthesising proteins, breaking down of fats and producing biochemical components that are essential for digestion. Liver cancer consists of malignant hepatic tumours (growths) in or on the liver. The most common type of liver cancer is hepatocellular carcinoma (or hepatoma or HCC). Liver cancers affect males more than females.
According to medical experts, common causes of liver cancer are regular, high alcohol consumption, having unprotected sex and injecting drugs with shared needles.
The following are the symptoms that manifest when a person suffers from liver cancer:
A swollen abdomen: Swelling of the abdomen can show in liver cancer for two reasons. The liver itself can get bigger from the growing cancer. This can cause swelling over the right side of the abdomen. There could also be generalised swelling of the abdomen, caused by a buildup of fluid. This is called ascites. The fluid builds up because the liver is congested. This squeezes the blood vessels inside the liver and the blood that normally flows through it gets backed up into the veins. The pressure in these veins increases and forces fluid to leak from the veins, into the abdomen. The veins may grow in size, so much that they can be seen underneath the surface of the skin. If the liver is not able to make blood proteins as it should, fluid also tends to leak out of the veins, into the abdominal cavity.
Yellowish skin, dark coloured urine and pale coloured stools: Primary liver cancer develops from the cells that constitute the liver. Liver cancer can grow and spread outside the liver. It may grow into the bile duct. If this happens, bile cannot be drained out of the liver, causing the bile’s yellow pigment to be excreted through the kidneys. This makes the urine dark and the faeces pale. The build-up of bile in the bloodstream causes jaundice. Jaundice is a yellowing of the skin and whites of the eyes. It may make the skin itch.
Weight loss: Unexplained weight loss is another classic symptom of liver cancer. Therefore, if there is no obvious reason for one’s weight loss, it should not be ignored.
Other symptoms associated with liver cancer may include:
Although the exact cause of liver cancer is unknown, it has been linked to damage and scarring of the liver. Below are some of the risk factors that result in the occurrence of liver cancer among individual:
Anabolic steroids: These are the steroids which are used by athletes and weightlifters. These male hormones, if used regularly and for long enough can raise the risk of developing liver cancer, as well as some other cancers.
Aflatoxins: This is a substance that is made by a fungus and may be found in mouldy wheat, groundnuts, corn, nuts, soybeans and peanuts. For liver cancer risk to increase there needs to be long-term exposure. This is more of a problem in some poor countries than in industrialised nations.
Liver disease and inherited liver disease: People with cirrhosis and hepatitis B or C have a significantly higher risk of developing liver cancer, as compared to other healthy individuals.
Diabetes: Patients with diabetes, especially if they also have hepatitis or regularly consume a lot of alcohol, are more likely to develop liver cancer.
Family History: People whose mother, father, brother or sister suffers from liver cancer, have a higher risk of developing it themselves, as compared to others.
Low Immunity: People with weakened immune systems, such as those with HIV/AIDS, have a risk of liver cancer that is five times greater than other healthy individuals.
Obesity: Obesity raises the risk of developing many cancers, including liver cancer.
Gender: A higher percentage of males get liver cancer, as compared to females. Some experts believe this is not due to gender, but due to lifestyle problems – on an average, males tend to smoke and consume alcohol more than females.
Smoking: Individuals with Hepatitis B or C have a higher risk of liver cancer if they smoke. Water wells with arsenic: People who rely on water wells that have arsenic may have a significantly high risk of developing several conditions or diseases, including liver cancer.
High-risk individuals for HCC (hepatocellular carcinoma) should have regular screenings for liver cancer. Liver cancer, if not diagnosed early, is much more difficult to get rid of.
The only way to know whether a patient has liver cancer, early on, is through screening because one will present no symptoms. High-risk people include those with hepatitis C and B, patients with alcohol-related cirrhosis, other alcohol abusers, and those that have cirrhosis as a result of Hemochromatosis.
Diagnostic tests may include:
Blood test: Liver cancers secrete a substance, called Alpha-Fetoprotein (AFP) that is normally present in foetuses but goes away at birth. An elevated AFP in adults may indicate liver cancer as it is produced in 70% of all liver cancers. Elevated levels of iron may also indicate the presence of a tumour.
Imaging scans: Imaging with ultrasound is the initial diagnostic test as it can detect tumours as small as one centimetre. High-resolution CT scans and contrast MRI scans are used to diagnose and stage these tumours.
Biopsy: A small sample of tumour tissue is removed and analysed. The analysis can reveal whether the tumour is cancerous (malignant) or non-cancerous (benign).
Laparoscopy: This is useful in detecting small tumours, determining the extent of cirrhosis, or obtaining a biopsy, and confirms previous tests, among other things.
The treatment for primary liver cancer patients depends on the stage of the disease as well as the person’s age, overall health and personal preferences. Liver cancer treatment options may include:
Surgery to remove a portion of the liver: In certain situations, the doctor may recommend partial hepatectomy to remove the cancer and a small portion of healthy tissue that surrounds it, if the tumour is small and liver function is good. Liver transplant surgery is a procedure where the diseased liver is removed and replaced with a healthy liver from a donor. Liver transplant surgery is only an option for a small percentage of people with early-stage liver cancer.
Freezing cancer cells: Cryoablation or freezing uses extreme cold to destroy cancer cells. During the procedure, the doctor places an instrument (cryoprobe) containing liquid nitrogen directly onto liver tumours. Ultrasound images are used to guide the cryoprobe and monitor the freezing of the cells.
Heating cancer cells: It is also called radiofrequency ablation and uses electric current to heat and destroy cancer cells. Using ultrasound or CT scan as a guide, a surgeon inserts one or more thin needles into small incisions in the abdomen. When the needles reach the tumour, they’re heated using electric current and destroying the cancer cells.
Alcohol injections: The injection of pure alcohol directly into tumours, either through the skin or during an operation is also a form of treatment. Alcohol causes tumour cells to die.
Injecting chemotherapy drugs into the liver or Chemoembolisation: It is a type of chemotherapy treatment that supplies strong anti-cancer drugs directly to the liver. During the procedure, chemotherapy drugs are injected into the hepatic artery — the artery from which liver cancers derive their blood supply — and then the artery is blocked. This procedure cuts blood flow to the cancer cells and delivers chemotherapy drugs to the cancer cells.
Radiation therapy: Radiation therapy uses high-powered energy beams to destroy cancer cells and shrink tumours. During radiation therapy, the patient lies down on a table and a machine directs the high-energy radiation beams precisely towards the liver tumour. Radiation therapy for liver cancer may involve a technique called stereotactic radiosurgery that simultaneously focuses many beams of radiation towards one point in the body.
Targeted therapy: Targeted drug therapy works by interfering with a tumour’s ability to generate new blood vessels. They have been shown to slow or stop advanced hepatocellular carcinoma from progressing for a few months longer than with no treatment.