Contributors:Jung Hee Lee, MScBMC, Tina Collins, Rachel Yancey, Antonella Melani, MD, Ahmed A. Abu Ajeene, Mary Roberts MSN, RN
Liver cancer is a malignant tumor that can originate in the liver or, more frequently, spread to the liver from another organ.
Now, let’s go over some anatomy and physiology, The liver is a large, solid organ located in the right upper quadrant of the abdomen, which has several functions, including the production of bile, cholesterol, and certain blood proteins like albumin and clotting factors, as well as helping with glucose and fat metabolism, drug metabolism, and detoxification to eliminate harmful substances like alcohol.
To be able to carry out these functions, the liver needs to have a rich blood supply, and there are two main sources. One source is the hepatic portal vein, which carries deoxygenated venous blood from the intestines and spleen into the liver to be filtered and detoxified before entering the systemic venous system. On the other hand, the hepatic artery supplies the liver with oxygenated arterial blood from the systemic arterial system.
So, liver cancer can arise due to chronic tissue damage from a variety of factors. Modifiable risk factors include prolonged exposure to harmful substances like alcohol, high fat or carbohydrate diet, as well as obesity and smoking.
On the other hand, non-modifiable risk factors include having a chronic liver disease, such as cirrhosis or chronic hepatitis B or C infection; genetic disorders like hemochromatosis or alpha-1 antitrypsin deficiency; as well as family history, older age, and being assigned male at birth.
Now, liver cancer can be either primary or secondary. Primary liver cancer occurs when the malignant tumor originates in the liver, the most common type being hepatocellular carcinoma. On the other hand, secondary liver cancer occurs when a malignant tumor originates in another organ, and then manages to metastasize or spread through blood and ultimately settle in the liver. And because of the liver’s rich blood supply, the majority of liver cancer cases are actually secondary, most often coming from primary colorectal, breast, or lung cancers.
Okay, so the clinical manifestations of liver cancer may vary based on the size and location of the tumor. Initially, clients are typically asymptomatic. As the disease progresses over time, clients may develop hepatomegaly, and can experience symptoms like weight loss, fatigue, early satiety, abdominal pain, nausea, and vomiting.
If the tumor obstructs the outflow of bile from the liver, clients may also develop obstructive jaundice. If the hepatic portal vein is blocked, pressure builds in the portal system, leading to portal hypertension; this can result in splenomegaly, or spleen enlargement, as well as ascites, or abdominal swelling as fluid is pushed into the peritoneal cavity. In addition, the cancer may impair the liver’s ability to produce clotting factors, resulting in coagulopathy or impaired coagulation, so clients can present with easy bruising or bleeding.
The diagnosis of liver cancer starts with the client’s history and physical assessment, followed by additional diagnostic tests. Laboratory test results are generally non-specific, and may show elevated blood levels of amylase and lipase, as well as tumor markers like alpha-fetoprotein or AFP for short, as well as carbohydrate antigen or CA 19-9, and carcinoembryonic antigen or CEA. Imaging tests like abdominal ultrasound, CT scan, and MRI can be used to stage the tumor by defining the location, and look for lymph node involvement or metastasis. Once a suspicious lesion is found on imaging, a biopsy is performed to confirm the diagnosis.
Treatment for liver cancer depends on its aggressiveness and extension. Unfortunately, most clients with liver cancer have a poor prognosis, since it’s often pretty advanced at the time of diagnosis.
For small, localized tumors, the treatment of choice is surgical resection with partial hepatectomy, where the affected part of the liver is removed. On the other hand, larger but still localized tumors can be treated with liver transplantation.
There are nonsurgical treatment options for clients with localized tumors who can’t undergo surgery. These include tumor thermal ablation, such as radiofrequency ablation, microwave ablation, or cryoablation; as well as transarterial chemoembolization or radioembolization; percutaneous injection therapy; or external beam radiation therapy. These clients can also be treated with chemotherapy, or with targeted therapies like sorafenib.