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Liver Cancer: Causes, Symptoms & Treatment

Liver cancer is a malignant disease of the liver. It most often develops in people with liver cirrhosis or chronic hepatitis and is one of the most common cancers worldwide.

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Things worth knowing about "Liver cancer"

Liver cancer is a malignant disease of the liver. It most often develops in people with liver cirrhosis or chronic hepatitis and is one of the most common cancers worldwide.

What Is Liver Cancer?

Liver cancer (medically known as hepatocellular carcinoma, or HCC) is a malignant tumor arising from liver cells (hepatocytes). It is one of the most common cancers globally and a leading cause of cancer-related death. In addition to HCC, other forms include intrahepatic cholangiocarcinoma, which originates in the bile ducts within the liver, and secondary liver tumors (liver metastases), which have spread from other organs.

Causes and Risk Factors

Liver cancer most commonly develops against the background of pre-existing liver disease. The main risk factors include:

Liver cirrhosis: Scar tissue formed after long-term liver damage significantly increases cancer risk.
Chronic hepatitis B and C: Viral liver inflammation is the most common cause of liver cancer worldwide.
Alcohol misuse: Long-term alcohol consumption damages the liver and promotes the development of cirrhosis.
Non-alcoholic fatty liver disease (NAFLD): Increasingly recognized as a risk factor, especially in connection with obesity and type 2 diabetes.
Aflatoxins: Toxins produced by the mold Aspergillus flavus, which can contaminate certain foods.
Hemochromatosis: A hereditary condition causing iron overload in the body.

Symptoms

In the early stages, liver cancer often causes no or only nonspecific symptoms. As the tumor grows, the following symptoms may appear:

Pain or pressure in the upper right abdomen
Unexplained weight loss and loss of appetite
Jaundice: Yellowing of the skin and eyes due to bile buildup
Abdominal swelling caused by fluid accumulation (ascites)
General fatigue and weakness
Nausea and vomiting

Diagnosis

The diagnosis of liver cancer involves a combination of different examinations:

Ultrasound: Recommended as a screening tool every 6 months for high-risk groups.
CT scan and MRI: Imaging methods used to accurately assess tumor size and extent.
AFP blood test: The tumor marker alpha-fetoprotein (AFP) may be elevated in liver cancer.
Liver biopsy: Tissue sampling for microscopic examination and confirmed diagnosis.
Liver function tests: Blood tests to assess overall liver health.

Treatment

Treatment depends on the stage, tumor size, liver function, and the general health of the patient:

Surgical Options

Liver resection: Surgical removal of the affected liver tissue in cases of localized tumors.
Liver transplantation: A potentially curative option for eligible patients that also addresses the underlying liver disease.

Local Ablation Techniques

Radiofrequency ablation (RFA): Destruction of tumor tissue using heat generated by high-frequency electrical current.
Microwave ablation: Similar to RFA and suitable for larger tumors.
Transarterial chemoembolization (TACE): Combines local delivery of chemotherapy drugs with blockage of the tumor blood supply.

Systemic Therapies

Targeted therapy: Drugs such as sorafenib or lenvatinib block tumor growth at the molecular level.
Immunotherapy: Checkpoint inhibitors such as atezolizumab combined with bevacizumab are used in advanced HCC.
Chemotherapy: Plays a limited role in primary liver cancer, as the liver is often already compromised.

Radiation Therapy

Stereotactic body radiation therapy (SBRT) can be used in inoperable tumors to slow tumor growth.

Prevention and Early Detection

Many cases of liver cancer are potentially preventable. Key prevention measures include:

Vaccination against hepatitis B
Treatment of chronic hepatitis B and C infections
Reducing alcohol consumption
Maintaining a healthy body weight and a balanced diet
Regular screening for high-risk patients (e.g., ultrasound every 6 months)

References

World Health Organization (WHO): Cancer Fact Sheets - Liver Cancer. https://www.who.int/news-room/fact-sheets/detail/cancer (2024)
European Association for the Study of the Liver (EASL): EASL Clinical Practice Guidelines: Management of hepatocellular carcinoma. Journal of Hepatology, 69(1), 182-236 (2018).
Llovet JM et al.: Hepatocellular carcinoma. Nature Reviews Disease Primers, 2, 16018 (2016).

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