The causes of liver cancer are largely known. In 80 to 90 percent of cases, pre-existing liver diseases that lead to liver cirrhosis are responsible for the malignant degeneration of the liver cells. In liver cirrhosis, the liver tissue becomes scarred and the liver cells can no longer perform their function of detoxifying the body.
Liver cirrhosis is caused by many years of excessive alcohol consumption or infections with hepatitis B or hepatitis C.
Other causes of primary liver carcinoma are
- Metabolic diseases such as iron storage disease(haemochromatosis),
- the toxin aflatoxin from the mold Aspergillus flavus and
- the development of a fatty liver due to high obesity
should be mentioned.
In recent years, the incidence of liver cancer due to fatty liver has risen sharply. This leads to the storage of fatty tissue in the liver, which in turn can lead to fatty liver inflammation with subsequent liver cirrhosis.
Schematic representation of liver cancer © blueringmedia | AdobeStock
Risk factors for liver cancer at a glance:
- Excessive alcohol consumption
- Severe obesity
- Fatty liver
- Liver cirrhosis
- Type 2 diabetes mellitus
- Chronic hepatitis B
- Consumption of food contaminated with Aspergillus flavus (cereals, nuts)
Patients with liver cirrhosis, patients with chronic hepatitis B infection and people with fatty liver hepatitis require early detection examinations. At best, the liver of these risk groups should be monitored every six months by ultrasound examination.
If liver cancer develops, it can be detected much earlier, which significantly increases the chances of recovery.
Liver cancer hardly causes any symptoms in the early stages of the disease, so that liver cancer is usually only discovered when the liver tumor has already reached a certain size. Then there is often
- a feeling of pressure in the right upper abdomen
- unwanted weight loss,
- yellowing of the sclera (the white part of the eye) and the skin and
- an increase in the abdominal circumference due to water retention (ascites).
As many of the symptoms are very unspecific and can also occur in other diseases of the liver or digestive tract, a doctor specializing in liver diseases(gastroenterologist, hepatologist, surgical or medical oncologist) must first carry out a detailed diagnosis to determine whether liver cancer is present and rule out all other possible diseases.
When diagnosing liver cancer, the first step is to ask the patient about theirmedical history, previous illnesses, lifestyle habits and symptoms, and what medication they are taking. The physical examination includes palpation of the abdomen. Laboratory tests provide indications of possible damage to the liver.
If there is a suspicion of a liver tumor after these examinations, imaging procedures will follow. A three-phase contrast-enhanced cross-sectional imaging procedure is recommended, in which the accumulation of the contrast medium in the liver and the liver tumor and then the flushing out of the contrast medium are assessed after the administration of a contrast medium at certain intervals. This examination can be carried out using ultrasound (sonography), computer tomography (CT) or magnetic resonance imaging (MRI).
If the results are unclear or to confirm the diagnosis in the case of smaller tumors, a tissue sample can be taken(liver biopsy). At the time of diagnosis, as part of the follow-up after tumor surgery or in advanced stages to monitor the course of treatment, it may be useful to determine the tumor marker alpha-fetoprotein (AFP) for HCC, CA 19-9 for CCC and CEA for liver metastases of colon cancer.
If the suspicion of liver cancer is confirmed, the liver cancer experts will carry out a so-called spread diagnosis, which clarifies the extent to which the liver tumor has already broken through the liver capsule and spread to neighboring organs and whether it has already formed metastases.
Contrast-enhanced magnetic resonance imaging (MRI) is used first and, if the tumor is suspected to have spread to the chest and abdomen, computer tomography is also used.
The following are also important for planning treatment
- Determination of the tumor stage (tumor staging) based on the spread diagnosis
- Assessment of treatment options and the resulting course of the disease using the "Barcelona Clinic Liver Cancer" classification (BCLC classification)
- Assessment of the physical condition using a special evaluation scheme, the so-called ECOG Performance Status (ECOG = Eastern Cooperative Oncology Group)
The most successful method of liver cancer treatment to date is liver cancer surgery. Depending on the size of the tumor, parts of the liver are removed (segment resection or hemihepatectomy). Liver transplantation may also be available as a treatment option if the tumor is of a defined size and the underlying cirrhosis is terminal. Unfortunately, this treatment option often fails due to the availability of suitable donor organs.
Alternative liver cancer treatments: Transarterial chemoembolization
In transarterial chemoembolization(TACE), the blood supply to the liver cancer tumours is mechanically sealed with gel foam or small metal coils after a chemotherapeutic agent is first applied.
Alternative liver cancer treatments
Tumor destruction using heat: radiofrequency ablation (RFA), microwave ablation (MWA)
These are minimally invasive interventional radiology procedures. Liver carcinomas up to a maximum size of 5 cm are destroyed locally using heat.
In so-called thermal ablation, a thin probe is placed through the skin directly in the center of the liver tumor under CT or ultrasound control. The patient is slightly anaesthetized but conscious. The liver cancer cells are then heated up to 125°C using electricity, causing them to die.
The success of the ablation is then monitored by CT scans. The procedure is very gentle on the patient and can also be used in cases of impaired liver function due to liver cirrhosis.
Stereotactic radiation
The tumors are killed from the outside by specially focused radiation.
Systemic immune/antibody therapy
The best therapy option currently available for treating the whole body is the combination of immunotherapy with an antibody. Alternatively, a range of mostly oral drugs (tablets to be swallowed) are available that effectively inhibit certain tumor growth factors.
The earlier liver cancer is diagnosed, the greater the chances of recovery. Unfortunately, in most cases liver tumors grow unnoticed at first. In 80% of cases, they can no longer be operated on at the time of diagnosis.
If the liver cancer has metastasized to other organs, life expectancy is limited. If the liver cancer can still be operated on, 50% of patients survive longer than 5 years.
In a tumor conference, experts from a wide range of disciplines work together to develop the most suitable treatment for the patient. All hospitals that specialize in the treatment of liver cancer hold tumour conferences attended by experts from the fields of internal medicine, gastroenterology and hepatology, nuclear medicine, radiology, surgery and pathology.
Specialists in liver cancer are characterized by their extensive experience in the recommended diagnostic and therapeutic procedures. Oncology centers are usually certified by the German Cancer Society, which guarantees a high quality of care for patients with liver cancer.
