On liver cancer, your risks, and how to minimise it

MALAYSIA - The liver has the distinction of being the largest internal organ in the body. It performs several vital functions, like processing and storing many of the nutrients absorbed by the intestines, making some of the clotting elements in blood, and also producing bile that is secreted into the intestine to help with nutrient absorption.

Another vital function carried out by the liver is the removal of toxic wastes from the body.

It stands to reason that should anything untoward happen to your liver, it could have life-threatening consequences.

Your liver can be affected by cancer. Before delving further into the subject, it's important to know that liver cancer can be classified as primary cancer (the cancer originates in the liver itself), or secondary or metastatic cancer (the cancer has spread to the liver from a cancer in another part of the body). The contents of this article focus on primary liver cancer, or hepatocellular carcinoma (HCC).

Globally, HCC is the sixth most common cancer in the world. In Malaysia, it is the 10th most common cancer overall, and the fifth most common cancer amongst men.

Risk factors for liver cancer

Certain risk factors may indicate whether a person is more likely to develop liver cancer than another. Studies have found the following risk factors for liver cancer:

Gender: Men are twice as likely as women to get liver cancer.

Infection: The hepatitis B virus (HBV) or hepatitis C virus (HCV) can increase your chances of developing liver cancer. Globally, both HBV and HCV are the main causes of liver cancer. While cancer is not a transmissible disease, HBV and HCV infections are contagious.

Smoking and alcohol: Just taking more than two drinks a day over many years increases your risk of liver cancer. The risk increases with the amount of alcohol that a person drinks.

Cirrhosis: This is a serious condition where your liver cells are damaged and is replaced with scar tissue. The most common causes of cirrhosis are HBV or HCV infection and heavy alcohol use.

Aflatoxin: This toxic substance is produced by certain fungi that can be found in certain foods like peanuts, corn, and other nuts and grains. It is fairly common in parts of Asia and Africa.

Iron storage disease (haemochromatosis): This disease causes the body to store too much iron in the liver and other internal organs.

Obesity and diabetes: Studies have shown that the risk for developing liver cancer is higher for people with obesity and diabetes.

Family history: If any of your family members have liver cancer, then you may also be at risk of developing this disease.

Symptoms

In the early stages, liver cancer often does not cause symptoms. The onset of symptoms usually occurs once the cancer has grown larger, and these symptoms may include unexplained weight loss, lack of appetite, feeling full after a small meal, a lump or pain in the area where your liver is located, a swollen abdomen, persistent stomach pain that extends to your back and shoulders and yellowish hue to the skin or jaundiced eyes

The above symptoms could be caused by liver cancer, but they can also be caused by other cancers or conditions. If you have any of these symptoms, make it a point to see your doctor quickly.

Treatment options

So what are the treatment options available? There are several possibilities, such as surgery (including liver transplantation), ablation, embolisation, targeted therapy, radiation therapy, and chemotherapy.

At this point in time, liver cancer is curable in the early stages and only if the cancer patient is healthy enough to have surgery. If surgery is not a viable option (either due to age or health), then they may opt for other treatments to help improve their quality of life.

Treatment options include:

Surgery: This option is only viable during the early stages of liver cancer. The surgeon may remove the whole liver, or only the cancerous portion. If the whole liver is removed, it's replaced with healthy liver tissue from a donor. The procedure to remove part of the liver is called partial hepatectomy, and is dependent upon the results of lab tests that will show how well the liver functions, as well as evidence that the cancer has not spread to nearby lymph nodes or other parts of the body.

Up to 80 per cent of the liver may be removed, and the normal liver tissue that is left will grow new cells over the course of several weeks.

Liver transplant: This is a viable option while the tumours are still small, the cancer is confined to the liver, and suitable donated liver tissue (either from a life donor or a deceased person) is available. Prior to implanting the donated liver tissue, the surgeon will remove your entire liver (total hepatectomy).

Ablation: This technique destroys the cancerous cells in the liver, and is used to control liver cancer and extend life. It is used for patients awaiting liver transplant, or patients who are not fit enough for surgery or liver transplantation.

Embolisation: This involves the insertion of a tiny catheter into an artery in the patient's leg and into the hepatic artery of the liver. Tiny sponges or other particles are injected that block the flow of blood through the artery.

Depending on the material injected, the blockage may be temporary or permanent. The disruption of blood flow is intended to kill off the tumour while healthy liver tissues will still continue receiving blood from the hepatic portal vein.

Targeted therapy: There are also orally administered drugs available that slows the growth of tumours in the liver while also reducing their blood supply. However, these drugs have been known to induce side effects like nausea, vomiting, mouth sores, loss of appetite, chest pain, bleeding problems, blisters on the hands or feet, and even high blood pressure.

Chemotherapy: Depending upon the type of drugs administered, you may not even need to be hospitalised. However, you should be aware that common side effects include nausea and vomiting, loss of appetite, headache, fever and chills, and weakness. You may also find yourself more susceptible to infections, bruise or bleed easily, and feel weak and tired.

Is it preventable?

Primary liver cancer is largely preventable, and the measures that you can take to reduce your exposure to risk factors (hence minimising your risks) include:

Vaccinate yourself: All children and high-risk adults should be vaccinated against HBV.

Guard against HCV: Learn all you can about it, especially how it is spread (e.g. via blood transfusion, sharing of contaminated needles by drug users, or having unprotected sex).

Avoid drinking alcohol regularly: Liver cirrhosis can lead to liver cancer, hence it is best to limit your alcohol intake, or better yet, stop completely.

Quit smoking: Cigarette smoke contains thousands of toxins which are absorbed by your body, subsequently making its way to your liver.

Get enough physical activity or exercise: Sufficient physical activity or exercise helps improve your cardiovascular fitness, strength and flexibility, burns up excess calories to keep you in the best condition of health, and generally helps you feel and think better.

Remember, the key to having good health is a healthy lifestyle. There are no shortcuts or "magic" pills to take that will ensure good health.

References:

1. www.webmd.com/cancer/understanding-liver-cancer-basic-information

2. www.cancer.gov/cancertopics/wyntk/liver

3. www.wcrf.org/cancer_statistics/data_specific_cancers/liver_cancer

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