Liver Cancer Symptoms, Diagnosis and Treatment

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Liver cancer is divided into two main groups as primary (cancers originating from the liver) and metastatic (tumors arising as a result of liver spread of a tumor in another organ).

Metastatic tumors of the liver are usually multiple and 80% are related to tumors originating from the digestive system. Primary liver tumors are usually hepatocellular carcinomas and cholangiocarcinoma, hepatoblastoma and angiosarcoma are the rarer types.

The success of treatment in primary liver cancer depends on early diagnosis, and the 5-year survival rate in patients who can be surgically resected is around 30%.

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Hepatocellular Carcinoma (HCC)

Hepatocellular carcinoma (HCC) is a type of cancer that is becoming increasingly common and is usually diagnosed at an advanced stage. It ranks 6th among all cancers and approximately 600,000 people die from this cancer every year in the world.

The annual number of new patients in Europe and the USA is 2-4/100.000. It is 2 times more common in men than women. Its incidence is increasing in Asia and South Africa and reaches 100/100000.

The distribution of Liver Cancer in the world is parallel to the epidemiology of Hepatitis B. While the disease is generally seen around the age of 50-60 in western countries, it occurs at younger ages (25-35) in Asia and Africa, where the disease is more common.

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What Causes HCC Formation?

The annual rate of HCC carcinoma development in patients with liver cirrhosis is around 5%, and 1/3 of these patients develop HCC. Therefore, patients infected with hepatitis B and hepatitis C virus and patients with chronic liver disease due to other causes should be followed up for HCC development with ultrasonographic examination and blood alphafetoprotein (AFP) measurement twice a year.

  • Hepatitis B Virus
  • Hepatitis C Virus
  • Alcoholic Cirrhosis
  • Hepatic Adenoma
  • Aflatoxins
  • Wilson’s Disease
  • Herbal alkaloids
  • Oral Contraceptives
  • Androgenic Steroids
  • Vinyl Chloride
  • Contrast Substances (Thorotrast)

What Are The Symptoms Of HCC?

Weight loss, weakness, loss of appetite, pain in the right upper quadrant of the abdomen and fever are the main findings of the disease. Abdominal fluid collection (ascites) and liver enlargement may occur.

Sudden weight loss and the appearance of jaundice, especially in a patient with liver cirrhosis, should suggest the development of HCC.

How İs Liver Cancer Diagnosed?

karaciğer kanseri belirtileri The majority of patients with liver cancer have elevated serum levels of alpha-fetoprotein (AFP), a tumor marker. If the level of AFP measured in the blood is above 10, the patient should be examined for HCC.

Liver function tests (Alkaline phosphatase, GGT, bilirubins, LDH) may increase at varying rates (See Liver function tests). Sudden elevations in LDH and alkaline phosphatase levels in a patient with chronic liver disease should suggest HCC and blood AFP level should be checked with liver imaging.

Display Methods

To view the lesion in the liver; Ultrasonography (US), Computed Tomography (CT) and Magnetic Resonance (MR) imaging methods are used. US is used as a screening test especially in high-risk groups.

With US, the tumor in the liver and its spread to the great vessels of the liver (vena porta and vena hepatica) can be shown. In addition, fine needle biopsy can be performed under US for diagnosis, but nowadays this method is used less and less due to the advanced imaging methods and the risk of transplanting into the biopsy path.

MRI is the best method to show the spread of the tumor to other structures in the liver. Hepatic Angiography is used in suspicious cases and to detect anatomical variations.

Staging in HCC

The following staging systems are used in the staging of HCC. Staging allows deciding on the choice of treatment to be applied to the patient.
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Liver Cancer Treatment

Surgical removal of the tumor (Liver Resection):
Surgical treatment (resection) is only possible in 10-20% of patients in HCC, since patients usually present at an advanced stage.

Although it is recommended that patients with a tumor diameter less than 5 cm be evaluated for surgical treatment, the generally accepted view is that the tumor diameter is 2 cm or less for resection.

For resection, the tumor must be limited to the liver, no distant metastases, no thrombosis in the portal or hepatic veins, and adequate liver capacity. Because of the risk of underlying cirrhosis and decompensation of the remaining liver after resection in most patients with HCC, careful evaluation is required for resection before surgery.

The minimal liver size that should remain after resection should be 25% of the liver in the presence of normal liver and 50% of the liver in cirrhotic liver. Unfortunately, the incidence of tumor recurrence (recurrence) after resection in patients with cirrhosis is around 50-70% within 5 years.

This is mostly due to the spread of the primary tumor in the liver (70-80%), and a small part to the newly formed tumors (de novo tumor) (30-40%). Only 30% of patients survive for 5 years after resection.

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