Liver Cancer

Liver cancer, also known as hepatocellular carcinoma, is a malignant tumour of the liver tissue that can lead to long-term loss of liver function and damage to the surrounding tissue. More often than liver cancer itself, cancer in the liver develops through metastases (offshoots) from distant localisations.
The survival prognosis for liver cancer is usually poor because it is often detected late, at an advanced stage.

What is liver cancer?

The malignant disease liver cancer is also known as liver carcinoma or hepatocellular carcinoma. It is a malignant cancer of the liver and develops increasingly at an older age. Moreover, men are affected by liver cancer about three times more often than women.

As the largest solid organ in the body, the liver performs hundreds of vital functions, such as maintaining healthy blood sugar level and regulating blood clotting. Most importantly, the liver filters all of the blood in the body, breaks down poisonous substances (such as medication, alcohol and drugs) and removes all these toxins from the body’s blood supply. However, since our environment is becoming increasingly toxic, the liver is exposed to higher levels of poisons which it is unable to detoxify. This might explain why in Switzerland and in Europe, the number of new cases of liver cancer is steadily increasing.

Types of liver cancer

The types of liver cancer include hepatocellular carcinoma, intrahepatic cholangiocarcinoma and Klatskin tumour.

HCC - Hepatocellular carcinoma

The more common variant of liver carcinoma is hepatocellular carcinoma. It originates from the liver cells and therefore has a direct impact on the vital function of the liver. As a rule, hepatocellular carcinoma develops in a liver that has already been weakened or damaged by a previous disease.

Intrahepatic cholangiocarcinoma

Cholangiocarcinoma, also known as cholangiocellular carcinoma or bile duct cancer, describes a new formation in the area of the bile ducts in the liver. As a result, bile builds up in the gallbladder. The gallbladder cannot empty and swells. This can lead to digestive problems, deficiency symptoms and liver damage.

Klatskin tumour

Similar to intrahepatic cholangiocarcinoma, the Klatskin tumour also develops from the bile duct epithelium. However, the affected bile ducts are located outside the liver, in the area of the right and left large hepatic ducts. As a result, the bile accumulates in the liver. This also leads to digestive problems, deficiency symptoms and liver damage. Consequently, at an advanced stage, the Klatskin tumour can grow into the liver and metastasise to nearby lymph nodes.

Causes of liver cancer

The most common causes of liver cancer are liver cirrhosis, infections with the hepatitis virus, obesity with the development of a fatty liver and high alcohol consumption. However, genetic factors also appear to be a cause of liver cancer.
Smoking, an unhealthy diet and a poor functioning, diseased intestine also play a role in the development of liver cancer. Intestinal dysbiosis (due to for example bad microorganisms) and a leaky gut can ensure that the liver is permanently burdened with an increased amount of toxins.

If these risk factors are present or if you have any doubts, it is worth consulting an experienced, integrative doctor.

Symptoms of liver cancer

As with many cancers, there are few or very unspecific symptoms in the early stages. For example, weight loss, nausea, pressure pain in the right upper abdomen or loss of appetite may occur.
In advanced stages, liver cirrhosis or ascites, which is an accumulation of water in the abdomen, may also occur.

Symptoms in the early stages

Symptoms in the early stages are usually non-specific and are difficult to diagnose as liver cancer. Early symptoms can include unintentional weight loss, nausea and vomiting, loss of appetite and tenderness in the right upper abdomen. Those affected can also complain of weakness, rapid fatigue and night sweats. Moreover, reduced liver function can also cause the skin to turn yellowish in colour and appear as jaundice (icterus).

If these symptoms occur, a medical examination should be carried out by a specialised doctor to rule out liver cancer or other diseases.

Symptoms in the final stage

Symptoms of end-stage liver cancer are cirrhosis of the liver and water in the abdomen, this latter is also known as ascites. In this case, water collects in the abdominal cavity and blocks important vessels and drains. If left untreated, it can lead to serious complications.

Moreover, the formation of yellow skin and pain in the upper abdomen become more severe. Finally, liver cancer can metastasise and affect other organs such as lymph nodes, lungs or bones.

Liver metastases

If a cancer metastasises, different organs can be affected by the metastases. If the metastasis reaches the liver, it is referred to as a liver metastasis. Because the liver is a very centralised and connected organ in the body, many types of cancer can spread to the liver. Most liver metastases start as colorectal cancer, because the blood supply from the intestines is directly connected to the liver through a large blood vessel called the portal vein. Although less frequent, other types of cancers, such as breast cancer, lung cancer, esophageal cancer, stomach cancer, skin cancer (melanoma), neuroendocrine, kidney cancer and pancreatic cancer, can also form metastases in the liver.

Liver metastases show similar symptoms to liver cancer and are also usually only diagnosed when the cancer is at an advanced stage. Compared to liver cancer, liver metastases occur more frequently.

Diagnostics for liver cancer

Various approaches have proven effective for a full diagnosis of suspected liver cancer. In addition to a detailed clinical examination, laboratory tests and imaging procedures are also useful.

Blood values - tumour markers

In liver cancer, some functional parameters of the liver may change, which can be detected in a blood test. For example, liver enzymes, liver waste products and coagulation factors can be tested in the laboratory as the concentration of these may be abnormally altered in liver cancer.

Moreover, various tumour markers also provide valuable indications of liver cancer and should be individually integrated into the diagnosis.

However, it is important to note that although blood values can provide initial indications, imaging and possibly biopsies are also necessary for a definitive diagnosis.

Ultrasound

Ultrasound is a rapid imaging technique that can provide initial indications of possible changes in the liver parenchyma. MRI, CT and a biopsy can then provide more precise information about the nature of the changes.

Ultrasound is also ideal for monitoring the progression of cancer, as it provides real-time imaging and provides a clear picture of soft tissues that do not show up well on x-ray images. Moreover, ultrasound is extremely safe and does not use any harmful substances such as chemicals or radiation. Thus, ultrasound imaging can be performed without exposing the patient to any form of radiation.

MRI and CT

MRI and CT are imaging procedures that can confirm a suspicion and provide an indication for a liver biopsy. MRIs (Magnetic Resonance Imaging) use radio waves and can provide more detailed and clearer pictures of the structure and condition of your soft tissues, nerves, and blood vessels. On the other hand, CT (Computed Tomography) scans use X-rays to provide pictures of harder tissues, organs, and skeletal structure. It can help diagnose and reveal bone fractures as well as stages of cancer.

Both procedures provide detailed images and enable experienced radiologists to recognise even the smallest neoplasms. Nevertheless, if an MRI is available, it should be preferred to a CT in order to avoid unnecessary radiation exposure. In advanced stages, however, a CT scan can be helpful to recognise possible bone metastases in detail.

Biopsy

A biopsy can be a final diagnostic step to confirm the suspicion of liver cancer. To take a biopsy, a fine needle is usually inserted through the abdominal wall using ultrasound guidance in order to remove liver tissue, which is then analysed under a microscope.

However, as the blood test (tumour markers) and imaging are usually sufficient to confirm a carcinoma, a biopsy is not necessary in most cases.

Treatment of liver cancer

There are different approaches to treat liver cancer. Classic and complementary medical treatment options can be combined or used separately, depending on the individual situation.

Surgery

Not all patients with liver cancer are candidates for surgery. The decision to operate depends on various factors, including the stage of the disease, the size, location and extent of the tumour, the patient’s general state of health and other individual factors.

If surgery is indicated, either a partial resection can be performed or the liver can be completely removed and replaced with a transplant. In both cases, it is a very complex operation that is accompanied by a long regeneration phase.

It is therefore always necessary to clarify on an individual basis whether an operation is desirable and sensible.

Radiotherapy

The aim of radiotherapy is to trigger mutations in the affected cancer cells and thus provoke their death.

However, radiotherapy is a rarely used treatment method for liver cancer, as the liver parenchyma is very sensitive to mutations and the side effects are therefore severe.

In some cases, it is possible to apply highly locally concentrated radiation in order to the spare surrounding tissue and kill the cancer.

Hyperthermia

Hyperthermia is a treatment method in which the cancer cells are exposed to high temperatures for a short period of time, causing them to die. Both whole-body hyperthermia and localised hyperthermia can be used successfully for liver cancer.

Possible side effects include nausea, slight signs of burning and fatigue. However, these are all only temporary, making hyperthermia a very tolerable treatment.

Evidence based tools to improve efficiency of currently administered oncotherapies for tumors of the hepatopancreatobiliary system

Status of hyperthermia in the treatment of advanced liver cancer

Hydralazine augmented ultrasound hyperthermia for the treatment of hepatocellular carcinoma

Hyperthermia enhances 17-DMAG efficacy in hepatocellular carcinoma cells with aggravated DNA damage and impaired G2/M transition

The effects of hyperthermia on human hepatocellular carcinoma stem and mature cancer cells

Mistletoe therapy

Mistletoe therapy is a complementary medical cancer treatment in which mistletoe extracts are administered by injection to improve the effect of cancer therapy.

Studies show an immunostimulant activity as well as an antitumor effect, which leads to patients experiencing fewer side effects from other therapies and also promotes the effectiveness of cancer therapy.

Mistletoe Extract Viscum Fraxini-2 for Treatment of Advanced Hepatocellular Carcinoma: A Case Series

Phase II study of viscum fraxini-2 in patients with advanced hepatocellular carcinoma

Age distribution in liver cancer

The age distribution of liver cancer can vary depending on region, population group, gender and risk factors. In general, liver cancer occurs more frequently at an older age.

Most initial diagnoses of liver cancer are made between the ages of 65 and 80, with men being affected slightly more frequently than women.

Chance of cure and life expectancy for liver cancer?

Life expectancy in liver cancer depends on gender and general health, as well as the stage of the tumour.

In stage 1, the five-year survival rate is around 58%.

In stage 2, the five-year survival rate is around 33%.

In stage 3, the five-year survival rate is around 15%.

In stage 4, the five-year survival rate is around 2%.

Thus, early detection is the most important means of successful treatment, as liver cancer is considered very aggressive and offers poor survival rates.

Med. pract. Dana Hreus M.A.

If there are any signs of liver problems, it is advisable to seek medical help immediately. Early diagnosis and treatment can help to achieve the best possible results.

Med. pract. Dana Hreus M.A.

Frequently asked questions and answers about liver cancer

The topic of liver cancer can give rise to many questions from those affected. Below we answer frequently asked questions about liver cancer.

Yes, elevated liver values can be observed in liver cancer, although this is not always the case. Liver enzymes and proteins that are produced by the liver and may indicate liver damage are commonly tested for in liver cancer. These include albumin, coagulation factors and liver enzymes such as ALT and AST.

The likelihood of survival depends largely on the stage of the disease, the patient’s general state of health and the type of treatment.

Overall, liver cancer is considered a very aggressive cancer that is difficult to treat. An integrative approach with proven effective methods can optimise the likelihood of survival.

As the liver is one of the most vital organs of metabolism, the prognosis for liver cancer is very poor. In addition, liver cancer is usually detected late and may therefore have already spread or caused too much damage for the liver to recover.

Liver cancer in people under the age of 30 is rather rare, but it can occur. In most cases, liver cancer occurs in older adults, especially in people over the age of 60.

The chances of curing liver cancer depend on a number of factors, including the stage of the disease at the time of diagnosis, the treatments selected and the patient’s general health.

The course of the disease can be roughly divided into four phases of varying duration.

Firstly, there is the early phase, which can be completely asymptomatic.

During the progression to the advanced phase, non-specific symptoms such as digestive problems, nausea, weight loss, abdominal pain and general fatigue can occur and become worse.

When a person has entered an advanced stage which cannot be cured, this is called the palliative phase. In this phase, the aim is to maintain quality of life for as long as possible, alleviate pain and prepare and mentally support the patient for the final stage of life.

The final phase is the dying phase. The aim here is to make death calm and pleasant for the patient and not to leave them alone with their fears and wishes.

This is due to the dysfunction of the liver in liver cancer. This is a health condition in which less bilirubin is broken down by the liver and therefore the bilirubin enters the blood in high concentrations. It is then deposited in the tissue, in this case the white eye tissue. Yellow eyes and a yellow face colour are the result and are known as jaundice.

The symptoms are very similar in men and women. However, women may also experience problems with the regularity of their menstrual cycle and swelling of the breasts.

Further information

The information listed contains relevant topics and serves to improve understanding.