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Liver Cancer: Causes, Diagnosis and Treatment

What is liver cancer?

The liver cancer occurs when abnormal cells form uncontrollably in its tissues. Primary cancer (also called hepatocarcinoma ) is a cancer that starts in liver cells (called hepatocytes). Secondary or metastatic cancer comes from cancer that first formed in the body before spreading through the bloodstream.

The growth of abnormal cells can cause the formation of a benign or malignant tumor . A benign tumor does not threaten to spread to the rest of the body and can be removed without risk of complications. On the other hand, a malignant tumor must be treated because it can spread and pose a threat to survival.

Located on the right side of the abdomen, under the diaphragm and to the right of the stomach, the  liver  is one of the largest organs. Its functions are multiple and important:

  • It filters the  toxins  absorbed by the body.
  • It stores and transforms the  nutrients  absorbed by the intestines.
  • It makes  proteins  that help to coagulate blood.
  • It produces  bile  that allows the body to absorb fat and cholesterol.
  • It helps to regulate  glucose  (glucose) and some  hormones .

Symptoms of liver cancer

At the onset of the disease,  liver cancer  very rarely triggers specific and obvious symptoms. It is therefore difficult to diagnose the disease at an early stage. This cancer is more often detected when it reaches an advanced stage. At this point, it can manifest itself by the  following symptoms  :

  • unexplained weight loss
  • loss of appetite
  • pains in the abdomen;
  • nausea and vomiting
  • general fatigue
  • the appearance of a mass in the region of the liver;
  • jaundice (complexion and yellow eyes, pale stools and dark urine).

Be careful, these  symptoms  do not necessarily indicate the presence of a cancerous tumor. They may be signs of other more common health problems. If such symptoms occur, it is important to  consult a doctor  to ensure proper examinations and the cause, especially for those at risk.

People at risk liver cancer

  • People with chronic hepatitis B or C
  • Patients with cirrhosis of the liver from any source;
  • Those who consume alcohol in excess.
  • People with diabetes.
  • People suffering from obesity.
  • People suffering from iron overload (hemochromatosis, genetic disease common in Brittany because of a mutation of a gene transmitted by Celtic ancestors);
  • People suffering from overload of fats in the liver, such as:
    • People with diabetes.
    • People suffering from obesity

Types OF liver cancer

The most common form of primary liver cancer is hepatocellular carcinoma that is formed from liver cells (hepatocytes).

There are other, less common forms of liver cancer, such as the cholangiocarcinoma that affects the duct that leads the bile produced by the liver to the gall bladder; or angiosarcoma, very rare, from the lining of the blood vessels of the liver.

This card only deals with hepatocellular carcinoma.

Prevalence

It is the 5th most common cancer in the world. In Canada, liver cancer is relatively rare and accounts for less than 1% of all cancer deaths and deaths.

The regions with the highest incidence of liver cancer are the areas where hepatitis C virus infection is important, such as in Asia, Africa, Central and Eastern Europe. . Hepatitis B virus infection is thought to be involved in 50 to 80% of hepatocellular carcinomas.

Risk factors 

  • The viruses that cause hepatitis B and C (HBV and HCV), are the cause of most hepatocellular carcinomas, because they cause a “chronic” disease of the liver. The attacked cell regenerates, or heals, but in an abnormal form (fibrosis) and makes the bed of cancer. However, 10 to 30% of Hepatitis B-induced hepatocellular carcinomas develop in the absence of fibrosis or cirrhosis. Hepatitis A, on the other hand, is not a risk factor because it is an “acute” disease.
  • The liver cirrhosis is the other major cause of liver cancer. It is most often due to excessive consumption of alcohol, but can also occur as a result of chronic liver disease (chronic viral hepatitis, autoimmune disease, iron overload …).
  • The aflatoxin , a toxin produced by a type of mold that forms on improperly stored agricultural products is a carcinogen that can contribute to the development of a liver tumor.
  • The vinyl chloride used in the manufacture of some plastics, is recognized as a carcinogen that can cause a hepatoma.
  • The arsenic used to treat wood, as a pesticide or certain metal alloys, is a poison that can trigger the formation of a liver tumor.

 

Prevention OF liver cancer

Basic preventive measures
It is impossible to prevent liver cancer for sure, but it is possible to reduce the risk of developing it by protecting yourself against the hepatitis B and C viruses. To find out the various ways to prevent these infections, consult our website. Hepatitis record. For example, it is possible to receive a vaccine against the hepatitis B virus. The vaccine has reduced the frequency of Hepatitis B (HBV), and also the incidence of Cellular Hepatitis Carcinoma (HCC). in heavily affected areas. In Europe, in Italy, the number of HBV and CHC infections has been significantly reduced by vaccination.

There is no vaccine against Hepatitis C, so we insist on hygiene measures and the protection of sex (condoms). This is a transmission through the blood.

Avoid excessive alcohol consumption. Liver cirrhosis, chronic over-alcoholism is an important risk factor for hepatocellular carcinoma. Regular monitoring of anyone with excessive consumption is essential.

Medical treatments of liver cancer

“Curative” treatments are:
– Surgery, with the removal of the tumor or in some cases, liver transplantation and liver resection,
– Methods of destruction of the tumor by the dermal route (avoiding opening of the tumor). abdomen as it passes through the skin), initially with chemicals (pure alcohol or acetic acid ), these methods have been supplanted by methods of destruction of the tumor by more effective physical means  :

– Thermal methods to destroy the tumor  :

– cryotherapy (cold)

– radiofrequency (hot thermal diffusion),

– microwave (very high temperature at 100 °)

– Non-thermal methods to destroy the tumor:

              – Electroporation, a very recent technique whose studies are still in progress.

– Selective arterial chemoembolization that has supplanted the use of radioactive beads.

The choice between surgery and percutaneous ablation, the most common curative treatments depend on several criteria (underlying liver condition, number and size of lesions) and are discussed in multidisciplinary meetings, which bring together at least 3 specialties different (surgeon, oncologist, gastroenterologist) in reference centers.

Surgery

When possible, the surgery is the 1st  choice traitementet is a ”  partial hepatectomy  ” that is to say removal of part of the liver. Various conditions must be met: the tumor must be small (<3cm) and unique. It must be easy to access and care must be taken to ensure that the remaining healthy liver volume is sufficient to ensure normal liver function.

Liver tissues have the ability to regenerate , at least partially. Thus, in the weeks following the partial hepatectomy, the volume of the liver will increase. However, the liver will never regain its original size.

The surgical treatment may consist of a “total hepatectomy” followed by a transplant , ideal treatment if it is possible. The diseased liver is completely removed, and replaced by an entire liver, or liver lobe, of a compatible donor. Patients are selected in expert centers. Note that it is rare that it is possible to perform a liver transplant to treat a primary liver cancer. The wait is indeed very long, (6 months minimum), and the conditions required for the feasibility of the transplant are often exceeded: very sick underlying liver (advanced cirrhosis), tumor greater than 3 cm, more than 3 lesions .

Radiofrequency ablation (ARF)

When removal of the tumor by surgery is not possible, or the waiting time for a transplant too long, its radiofrequency ablation is the local therapeutic approaches 1 st intention. This technique involves inserting small electrodes into the liver to induce a high frequency wave discharge that induces ionicmovements , resulting in a thermal phenomenon, necrosis by coagulation of abnormal cells (cell death). Depending on the case, it is practiced in local or general anesthesia.

Targeted therapy

Increasingly, therapies are being used to combat factors that contribute to tumor growth. For example, antiangiogenic agents block the formation of new blood vessels (angiogenesis) that allow the tumor to grow. This type of therapy is very promising. It creates a lot of interest and hope in the medical community.

Other methods

Thermal method:

cryosurgery

Cryosurgery is no longer used today, because of the appearance of the techniques of destruction of liver tumors by heat (radiofrequency mainly). This technique consisted in inserting into the liver a probe containing liquid nitrogen at -200 C in order to burn the cancerous cells by cold .

Microwave

This technique causes movements of water molecules in the cells, making it possible to reach a very high temperature, 100, in a few seconds. It is still little used, and being evaluated against radio frequency.

Chemical method: percutaneous injection

This other approach is possible, but is less and less used. It involves destroying one or more small tumors by injecting ethanol or acetic acid . This has the effect of dehydrating them and causing their necrosis (cell death). This procedure can be performed under local anesthesia and can be repeated if the tumor does not completely disappear.

New Technique: irreversible electroporation:

In the course of evaluation, this technique plays on the permeability of the cell, and could be indicated in the contraindications of the radio frequency.

Chemotherapy

Chemotherapy is a solution when surgery or techniques of local destruction of the tumor are not possible, or in case of recurrence.

In the case where the primary cancer of the liver is extended (measuring more than 3 cm, with several lesions, but on the same side of the liver (we have a right liver and a left liver), it is sometimes possible to inject into the artery that vascularizes the tumor, beads containing chemotherapy directly into the tumor, which helps to mitigate the side effects.

Radiotherapy

Radiation therapy is very rarely used to treat primary liver cancer. This type of cancer is not very sensitive to radiotherapy. One time, tried the injection of radioactive beads by selective injection into the tumor by arterial route.

 Complementary approaches

Notice . Check out our Cancer fact sheet for all of the complementary approaches that have been studied in people with cancer, such as acupuncture, visualization, massage therapy and yoga. These approaches may be appropriate when used in  addition  to, but not substituting for, medical treatments.

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