What is liver cancer? Expert explains causes, symptoms and how to treat it
Experts predict that the share of liver cancer cases linked to obesity will grow from 5 per cent to 11 per cent, urging stronger efforts to prevent avoidable cases.
New projections from a Lancet Commission on Liver Cancer report estimate that global liver cancer cases will increase from 0.87 million in 2022 to 1.52 million by 2050.
Many adults remain unaware of the risk factors for liver cancer, so we spoke to a medical adviser at the British Liver Trust, Anya Adair, who is also a consultant transplant and hepatobiliary surgeon at Edinburgh Royal Infirmary. She shared some key insights into the main causes, symptoms and treatments of this serious disease.
What is liver cancer and what causes it?
'Cancer that develops within the liver is primary liver cancer, but when cancers arise from somewhere else in the body and then spread to the liver, that is secondary cancer,' explains Adair.
How serious liver cancer is depends on the patient's general health, where the cancer is in the liver, how big it is, if it has spread and if it's primary or secondary cancer. according to the NHS website.
'Liver cancer can develop within the liver tissue, which is called primary hepatocellular carcinoma (HCC),' explains Adair. HCC occurs when cells called hepatocytes start to multiply and grow more than they should, according to the Liver Cancer Trust, part of the British Liver Trust.
'However, cancer can also develop within the bile duct systems in the liver, which is called cholangiocarcinoma,' adds Adair.
Around three out of four cancers that start in the liver are HCC, according to the Liver Cancer Trust, which typically develops in livers that are already scarred and damaged, a condition known as cirrhosis.
'You could have a scarred cirrhotic liver due to alcohol consumption, but it can also be because of MASLD (Metabolic Dysfunction-Associated Steatotic Liver Disease), previous known as Nonalcoholic Fatty Liver Disease,' highlights Adair.
Both autoimmune hepatitis and primary biliary cholangitis (both of which are autoimmune liver diseases) can also lead to a scarred cirrhotic liver if left untreated, she adds.
What are some common symptoms?
'The problem with HCC is that it often doesn't present with any symptoms at all,' says Adair. 'So, it is usually found incidentally on a scan that has been done for something else if the person didn't know that they had a scarred liver.'
HCC is also sometimes flagged up during a routine ultrasound that people who know they have a cirrhotic liver tend to have.
'Sometimes people with a cirrhotic liver are in surveillance and have ultrasounds every six months because the risk is higher, and during the scan a new swelling or shadow in the liver is picked up,' notes Adair.
Although liver cancer is often silent in the beginning stages, Adair highlights that once it becomes more advanced, patients may start to develop symptoms such as jaundice, unexplained weight loss, tiredness and/or nausea.
'Anyone who develops jaundice should seek urgent medical attention, and unexplained weight loss in particular is also an alarm bell,' says Adair.
How is it diagnosed?
'Liver cancer is usually spotted on an ultrasound initially, which is then followed by CT and MRI scans,' says Adair. 'So, it's usually a radiological diagnosis, and in some situations you need a biopsy for confirmation.'
What are the treatment options?
'There are a lot of treatment options depending on how bad your liver disease is, how many cancers in the liver you have, how big they are and what your general fitness is,' explains Adair.
There are several curative options, including surgery.
'If the cancer is picked up relatively early, and you are within transplant criteria, then a liver transplant is a curative option,' says Adair. 'If the liver is working well and there is only one area of cancer, then patients could think about having a liver resection, where you take part of the liver away.
'In addition, patients who have a single lesion that is below three centimetres can opt for ablation.' This minimally invasive procedure uses heat or extreme cold to destroy the targeted tissue, according Liver Cancer UK.
There are also other treatment options that help hold the liver cancer tumour at bay or are a bridge to further treatment, such as chemoembolisation (combining chemotherapy with a method to block blood flow to the tumour) or local radiation.
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