Liver Cancer: Hepatocellular Carcinoma

What is hepatocellular carcinoma?

Liver is an organ present in the upper right abdomen of the body, above the stomach and beneath the diaphragm. Hepatocellular carcinoma or HCC is the cancer of the liver cells (hepatocytes). It is the most common type of primary liver cancer.

It is important to note that not all cancers in the liver are termed as liver cancer. Cancers that originate in other parts of the body (like breast or colon) and spread to the liver are called metastatic cancers. For a cancer to be termed as hepatocellular cancer, it must originate in the hepatocytes themselves.

What are the causes of the disorder?

The exact cause of liver cancer is not known.

However, certain risk factors make some people prone to developing hepatocellular carcinoma. These are:

1. Cirrhosis (Scarring of the liver tissue)
2. Chronic hepatitis B or C infection
3. Diabetes
4. Inherited liver diseases (Wilson's disease, hemochromatosis)
5. Non-alcoholic fatty liver disease
6. Excessive alcohol consumption
7. Obesity

What one needs to know about symptoms or signs?

The early stages of hepatocellular carcinoma may not exhibit any symptoms.

The symptoms that develop as the disease progresses include:

1. Loss of appetite
2. Weight loss for no apparent reason
3. Nausea and vomiting
4. Upper abdominal pain and tenderness
5. Jaundice (yellow skin and white of eyes)
6. White, chalk-like stools

Which specialist should be consulted in case of signs and symptoms?

A general practitioner must be consulted upon experiencing any of the signs and symptoms. If the doctor suspects liver cancer, s/he will refer the concerned person to a hepatologist (doctor specializing in liver diseases) or an oncologist (doctor specializing in treating cancer).

What are the screening tests and investigations done to confirm or rule out the disorder?

Diagnosis of liver cancer involves the following tests and procedures:

1. Blood tests - Blood tests that check liver function can detect any abnormalities in the organ.
2. Imaging tests - The doctor may recommend imaging tests like computerized tomography (CT scan), magnetic resonance imaging (MRI) and ultrasound to generate images of the liver's condition.
3. Biopsy - A thin needle is inserted in the skin and into the liver to obtain a tissue sample that is studied in the laboratory.

What treatment modalities are available for management of the disorder?

The doctor may recommend the following treatment options to treat a patient's liver cancer depending upon the latter's cancer spread and overall heath:

1. Radiation therapy- Radiation therapy involves directing high-energy beams to destroy liver tumour. Sterotactic radiosurgery is a specialised radiation treatment that focuses beams at a single point in the liver. There are many liver cancer clinical trials going on that increase the hope of an effective and efficient treatment.
2. Surgery (Hepatectomy) - The doctor may follow a partial hepatectomy in patients whose tumour is relatively small and overall liver function is good. A portion of the liver containing the tumour is removed along with a small healthy tissue from the surrounding area.
3. Liver transplant - Transplanting the diseased liver with a healthy liver from a donor can treat early stage or slow-growing liver cancer.
4. Chemotherapy - Anti-cancer drugs can be directly injected into the liver. Known as chemoemobilisation, this treatment involves injecting drugs into the hepatic artery that supplies blood to the liver, and then blocking it to cut off blood supply to cancerous cells.
5. Clinical trials- Clinical trials are the studies of new procedures or treatments. Your doctor may discuss this with you as another treatment option. Patients can volunteer to participate clinical trial after a discussion with their doctor and if they meet study criteria. New liver cancer clinical trials give patients more potential treatment options

What are the known complications in management of the disorder?

Patients may experience the following complications:

1. Gastrointestinal bleeding
2. Spread of the cancer to other body parts (metastasis)
3. Liver failure

How can the disorder be prevented from happening or recurring?

Healthy lifestyle choices and vaccinations for protection against liver infection can prevent the advent of liver cancer:

1. Preventing viral hepatitis by ensuring hepatitis B vaccination
2. Limiting alcohol intake
3. Periodic screening for persons suffering from chronic hepatitis or cirrhosis