- What is the liver?
- Which diseases are treated by liver cancer specialists?
- Which diagnostic techniques do liver cancer specialists use?
- What treatment techniques are included in the range of services performed by liver cancer specialists?
- What are the special features of liver cancer specialists?
Liver cancer - Further information
What is the liver?
The liver is a relatively large organ located directly below the diaphragm, mainly in the right upper abdomen. In its immediate vicinity are the gall bladder, the spleen, the pancreas and the stomach. The liver, which is composed of a larger right-side hepatic lobe and a smaller left-side hepatic lobe, is insensitive to pain and is surrounded by the liver capsule. The strong flow of blood through the liver gives an indication of its essential functions - it cleans the blood of impurities, breaks down old red blood corpuscles (thereby generating bilirubin), alcohol and residues of medication, acts as a temporary store for certain nutrients, forms vital substances (including substances needed for blood coagulation and albumin and hormones) and produces bile, which plays an important role in the digestion of fats.
Important laboratory findings (liver function readings) which may indicate liver damage are aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma-glutamyltransferase (Gamma-GT) and alkaline phosphatase (AP). But other blood readings such as albumin or bilirubin levels can also indicate possible liver damage.
A variety of diseases can occur in the liver which could lead to liver cancer. These include cirrhosis of the liver (generally the consequence of alcohol abuse or viral hepatitis and in less frequent cases can be triggered by certain diseases, toxins or medication), fatty liver(which can be caused by alcohol, severe overweight or diabetes mellitus), fatty liver inflammation as the consequence of fatty liver and inflammation of the liver (hepatitis) after a hepatic viral infection.
Which diseases are treated by liver cancer specialists?
Patients with these diseases have an increased risk of developing liver cancer. Liver cancer, known by specialists as hepatocellular carcinoma, develops as a result of changes in the genome, generally from liver cells already damaged previously. Cholangiocarcinoma is a type of liver cancer which develops from cells located in the bile ducts. And finally, cancer cells from a tumor in another organ can be deposited in the liver, leading to liver metastasis. This is frequently the case with bowel cancer, pancreatic cancer, stomach cancer or esophageal cancer.
As well as these malignant tumorous diseases of the liver, liver specialists also treat benign liver tumors, i.e. swellings which generally do not spread (metastasize) into other organs These include the following benign liver tumors:
- liver hemangiomas (also known as cavernous hemangiomas) are the commonest liver tumors. Presumably, these are deformed vessels or dispersed embryonic tissue (hamartomas).
- Focal-nodular hyperplasias are individual nodes which occur relatively frequently and do not go on to develop into liver cancer.
- Hepatocellular adenomas (liver adenomas) are very rare and may go on to develop into liver cancer.
- Liver cysts are fluid-filled cavities in the liver.
The symptoms accompanying liver cancer which are treated by liver cancer specialists include:
- exhaustion and persistent fatigue
- intensive itching (pruritus)
- fluid accumulation in the abdominal cavity (ascites)
Which diagnostic techniques do liver cancer specialists use?
The first step in liver cancer diagnostics is to question the patient (anamnesis) for details of previous illnesses, lifestyle habits and disorders and of the medication currently being taken. The physical examination includes palpation of the abdomen. Laboratory tests give indications of possible liver damage.
If these investigations and tests indicate the possibility of a liver tumor, the next step is imaging techniques. Amongst the recommended techniques is a three-phase contrast-enhanced sectional imaging technique, in which the patient is given a contrast medium at particular time intervals followed by contrast medium enrichment in the liver and liver tumor. Finally, the contrast medium is flushed out and the whole process is assessed. This investigation can be carried out by ultrasound examination (sonography), computed tomography (CT) or magnetic resonance tomography (MRT).
If the results are unclear or in order to confirm diagnosis of smaller tumors a tissue sample can be taken (liver biopsy). If the condition has reached an advanced stage or if a follow-up review is needed during treatment, determination of the tumor marker alpha-fetoprotein (AFP) may be a practical next step.
If the suspected liver cancer is confirmed, liver cancer experts will conduct a procedure known as proliferation diagnostics, which clarifies the extent to which the liver tumor has already passed beyond the liver capsule and spread to adjacent organs and whether it has already led to metastatic tumors. At this point, contrast-enhanced magnetic resonance tomography (MRT) is used and, if spread of the tumor to the breast and abdominal cavity is suspected, also computed tomography.
The following are also important for treatment planning:
- tumor staging on the basis of the proliferation diagnostics
- assessment of the progress of the disease using the 'Barcelona Clinic Liver Cancer' classification (BCLC Classification)
- determination of the patient's physical condition using a special evaluation scheme known as the ECOG Performance Status (ECOG = Eastern Cooperative Oncology Group)
What treatment techniques are included in the range of services performed by liver cancer specialists?
Among the services performed by liver cancer specialists are the following treatment techniques:
- surgical removal of the liver cancer (tumor resection) if the individual tumors are clearly separate from each other
- tumor destruction through heat treatment (thermoablation) by means of radio frequency ablation (RFA); examples of other techniques are high-frequency ultrasound (HIFUS) and microwave ablation (MWA)
- liver transplantation
- cutting off the blood supply to the tumor and administration of medication directly into the bloodstream (known as transarterial chemo-embolization or TACE)
- selective intra-arterial radiotherapy (SIRT) in which radioactive particles are brought close to the tumor through the blood vessel
- systemic chemotherapy, i.e. chemotherapy applied to the whole body, especially with sorafenib
- palliative measures to alleviate the discomfort, pain treatment
- treatment of side-effects
- radiation to treat metastases in the bones or other organs
- percutaneous ethanol injection whereby ethanol is injected directly into the tumor
- treatment with new medication or techniques used in the course of clinical studies
- aftercare treatment
- psycho-oncological support
What are the special features of liver cancer specialists?
In a tumor conference, experts of all kinds of specialist fields work together to develop the most suitable treatment for patients. All hospitals specializing in the treatment of liver cancer hold tumor conferences attended by experts in the fields of internal medicine, gastroenterology and hepatology, nuclear medicine, radiology. surgery and pathology. The special features of liver cancer specialists are that they have a wealth of experience in the recommended diagnostic and therapeutic techniques. Oncological centers are generally certified by the German Cancer Association, which guarantees high-quality care of patients with liver cancer.
- Leitlinienprogramm Onkologie (Deutsche Krebsgesellschaft, Deutsche Krebshilfe, AWMF) (2013) Diagnostik und Therapie des hepatozellulären Karzinoms, Langversion 1.0, AWMF Registrierungsnummer: 032-053OL
- Leitlinienprogramm Onkologie (Deutsche Krebsgesellschaft, Deutsche Krebshilfe, AWMF) (2014) Leberkrebs. Ein Ratgeber für Patientinnen und Patienten. Patientenleitlinie
- Schünke M et al. (2018) Prometheus. Innere Organe: LernAtlas der Anatomie. Thieme, Stuttgart