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Liver Cance - Primary


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The organs and tissues of the body are made up of tiny building blocks called cells. Cancer is a disease of these cells. Rather than dividing in a normal and controlled manner, cancer cells are abnormal cells which carry on dividing and develop into a tumour which can be benign or malignant.

Approximately 3,100 people in the UK are diagnosed with primary liver cancer each year. You may hear a lot about liver cancer in the UK but most cases are cancer that has spread into the liver (secondary liver cancer) and not primary liver cancer.

Hepatocellular cancer (HCC) develops from main liver cells called hepatocytes and is the most common type of primary liver cancer (accounts for 85% of primary liver cancer diagnosed). HCC usually occurs in people that have a damaged liver from cirrhosis (but only three or four people out of hundred with cirrhosis will go on to develop HCC). It is more likely to develop in men than women and also becomes more common with increasing age.

The other types of primary liver cancers are: cholangiocarcinoma (a cancer that starts in the cells that line the bile ducts), angiosarcoma (a cancer that begins in blood vessels of the liver) and hepatoblastoma (a very rare cancer that affects young children).
Doctors and scientists do not know exactly what causes liver cancer but some things do increase the risk.

Liver cirrhosis (scarring due to previous damage caused by viral infections such as Hepatitis B or C, alcohol and some inherited diseases) can increase the risk of getting liver cancer.

Anabolic steroids (a hormone used by some body builders to increase muscle bulk), arsenic (a poison present in drinking water in some developing countries) and aflatoxin (a substance found in mouldy peanuts, wheat and soyabean) if taken over long term may increase the risk of getting liver cancer.

Smoking- People who are infected with hepatitis B or C have a higher risk of liver cancer if they smoke.

Other factors like diabetes, obesity, family history of liver cancer and having low immunity (e.g. due to HIV/AIDS) may increase the risk of liver cancer.
In the early stages of primary liver cancer there are often no symptoms. Jaundice, swollen abdomen and weight loss are the common symptoms which may occur as liver cancer develops.

Jaundice If the liver cancer spreads to the bile duct, it can hamper the drainage of bile away from the liver and lead to build up of bile in the bloodstream, causing jaundice. This can make the skin and whites of the eyes yellow, skin very itchy, urine dark-coloured and stools pale.

Swollen tummy This can happen in liver cancer for two reasons: either the liver can get bigger from the growing cancer or there can be generalised swelling of the abdomen caused by a build up of fluid (ascites).

Weight loss Significant weight loss is usually defined as loss of more than 10% the body weight i.e. a stone for every 10 stone the patient weighs. There can be many different reasons for weight loss (including dieting) but any unexplained weight loss should be further evaluated.

Many of these symptoms are vague but if you have any of these symptoms you should see your doctor.

Other symptoms of primary liver cancer may include loss of appetite, being sick, feeling full or bloated even after a small meal, pain or discomfort in the tummy, a sudden worsening of health in somebody with known cirrhosis, a high temperature and sweating.
How it is diagnosed
Usually, your GP will examine you and arrange for any tests or x-rays that may be necessary. These tests will be carried out at a hospital, where you can receive expert advice and treatment. Tests may include blood tests [liver function tests (LFTs) and alpha-fetoprotein (a chemical, levels of which can be higher than normal in patients with HCC)], a liver ultrasound scan, a CT scan, an MRI scan and possibly a liver biopsy.
The treatment for primary liver cancer depends on the type of cancer, stage of the cancer and the patient’s general health. In most hospitals, a team of specialists- the multidisciplinary team (MDT) will meet to discuss and agree on the plan of treatment they feel is best suited to a patient’s situation.

Surgery for primary liver cancer is one of the treatment options if the cancer hasn’t spread. There are two main types: liver transplant and surgery to remove the cancer from the affected part of the liver. These are both potentially curative treatments but, unfortunately, only a small number of patients have cancer diagnosed early enough to benefit from surgery. Also surgery is a major operation with some serious risks.

Non-surgical treatments like ethanol injection (injecting alcohol through the skin, directly into the cancer, and killing the cancer cells by dehydration), radiofrequency ablation (using radio waves to destroy cancer cells), cryotherapy (destroying cancer cells by freezing them with liquid nitrogen),
chemoembolisation (introducing chemotherapy directly into the cancer) and radiotherapy (not very useful for primary liver cancer as normal liver cells are badly affected by radiation) may be used in appropriate patients where surgical therapy is not possible.

Systemic therapies like doxorubicin (a chemotherapy agent) and sorafenib (a biological agent which acts by blocking a group of chemical messengers that play a part in growth of cancer cells) can sometimes be used to treat appropriately selected patients with primary liver cancer in whom the cancer cannot be removed by surgery or treated with non-surgical approaches.

Palliative treatment is done by specialists and the purpose is to relieve cancer-related symptoms. There are several new treatments which are being tested for liver cancer. Your doctor or specialist nurse can give you further information about new treatments.

Prevention Research is ongoing to look at ways to prevent liver cancer developing and main areas of interest include: genetics of liver cancer, risk factors like hepatitis B & C, alcohol and also controlling hepatitis to try to control liver cancer.
When to see your doctor
If you have any symptoms that could be caused by liver cancer it is important to have them checked by your GP, but remember they are common to many other conditions and most people with these symptoms won't have cancer.
Useful Tips
NB. Many of the facts mentioned in this article have been taken from Cancer research UK website Accessed Jul 2009

Further information on liver cancer may be obtained from:

Cancer Research UK - Phone 02071216699

British Liver trust - Phone 08006527330

Macmillan Cancer Support - Phone 02078407840

This article was prepared by Bayer Schering Pharma as a service to medicine. July 2009 9NEXA71