The largest gland in the body, the liver plays an essential role to keep us alive. Among its many functions include storing vitamins and nutrients, the synthesis of proteins essential for blood clotting and the secretion of bile for digestion. It also contributes to the decomposition of various substances and filters out toxins in the blood.
The causes of liver cancer are not completely understood, but some risk factors have been identified, including:
* Hepatitis B or C infection
* Cirrhosis of the liver
* Exposure to toxins, namely certain types of fungi (aflatoxin), vinyl chloride, anabolic steroids and arsenic
* Diabetes mellitus
Symptoms and Complications
Liver cancer can go undetected for some time before any signs of abnormalities occur. Most symptoms, as are a result of damage to the liver:
* Ascites - fluid accumulation in the liver and intestines
* Jaundice - yellowing of the skin and whites of eyes
* Fatigue and weakness
* Abdominal pain
* Loss of appetite
* Weight loss
* Back pain in the abdomen or around the right scapula
* Presence of a hard mass in the chest
* Dark urine
* Stool gray
* Internal bleeding
Firstly, the doctor will inquire in detail about the family history of the patient before a physical examination. It may then recommend some of the following:
* Blood tests to check liver enzymes
* Abdominal ultrasound to check liver size and look for tumors or abnormalities
* Magnetic Resonance Imaging (MRI) scans of the abdomen
* CT scan of the abdomen
* Laparoscopy - where the doctor makes an incision and introduces a small tube called a laparoscope, which allows to visualize the liver and surrounding organs
* Biopsy - where one takes, using a laparoscope, a small piece of liver tissue for examination under a microscope
* Angiography - where we inject a contrast material into a vein in order to follow its progression in the liver and examine the vascular network
* Chest X-ray - to see if the cancer has spread
Once the cancer has been diagnosed, physicians should determine the cancer stage or classify tumors in order to recommend appropriate treatment. To do this, they use the TNM classification system:
* T - describes the tumor size ranging from T1 to T4, where T1 is the smallest dimension. TX is a tumor that is not visible enough for classification.
N * - indicates if the cancer has spread to lymph nodes. N1 means that the tumor has spread and NX, we can evaluate the lymph node involvement.
* M - indicates whether the cancer has spread to other organs of the body. MO reveal the absence of metastasis, M1 means that there has been metastasis and MX, as metastases can be assessed.
Some doctors use a different classification system:
* Localized unresectable: the cancer is contained within a single household and, as it did not spread, we can extract the tumor (usually these are tumors T1-T2, N0, M0)
* Localized unresectable: the cancer is still confined to one part of the liver but can be removed by surgery
* Advanced: cancer has invaded the liver and may have spread to other parts of the body
* Recurrent: Cancer has returned some time after treatment
In some schools, using multiple other classifications to help establish overall prognosis and classification of liver cancer to help determine the ability of the person to undergo surgery.
Treatment and Prevention
To combat liver cancer, like most cancers, there are three forms of treatment: surgery, chemotherapy and radiotherapy. Treatments can be administered separately or in combination.
In the case of localized resectable cancer, the treatment of choice is surgery. This involves removing the tumor and possibly some surrounding tissue. The liver is an organ unique, which can regenerate its cells and continue to operate as before.
The ablations also fall into this category. These processes destroy cancer cells using cryosurgery or alcohol (ethanol ablation). In cryosurgery, the surgeon uses a metal probe (cryoprobe) to freeze the cancerous cells. It makes a small incision and the probe in the tip of the liquid nitrogen can freeze the target cells. In ethanol, the surgeon injects alcohol directly into the tumor, either through the skin or during an operation.
The complete resection of the liver is not due to his role. Formerly, one could consider a liver transplant in people suffering from liver cancer at present, however, surgeons discovered that some people whose cancer is in its infancy can receive a liver transplant. After a successful transplant and to appropriate medical care, the receiver can continue to live a normal life in good health.
In the case of a localized unresectable cancer, the location of the tumor does not allow for surgical resection. The tumor may be in a very sensitive area of the liver where it has invaded a large part of the body. The treatment options are chemotherapy, liver transplantation, radiotherapy, radiofrequency ablation or injection of alcohol directly into the tumor.
Chemotherapy is used in drugs to kill cancer cells. Drugs are usually administered into a vein, but some of them are now available in tablets to take by mouth. In chemotherapy for liver cancer, one encounters an obstacle that many medications are metabolized (broken down) in the liver so that the options are rather limited.
Because chemotherapy drugs circulate throughout the body, side effects are widespread, although temporary:
* Nausea and vomiting
* Hair loss
* Shortness of breath
* Mouth sores
The perfusion of the hepatic artery, another form of chemotherapy, to administer drugs directly to the liver. It installs under the skin so a small pump fitted with a catheter that delivers medication directly to the hepatic artery. Research has not proven that this treatment improves the outcome of the disease, but it seems to improve the quality of life of patients with liver cancer. This form of treatment reduces side effects of drugs.
Chemoembolization can be seen in the presence of a tumor unresectable. It injects chemotherapeutic substances in the blood vessels that feed tumors, to block them. Cancer cells die for lack of supply.
Radiation therapy is an outpatient treatment that involves directing x-rays directly into tumors to destroy cancer cells and reduce tumor volume. In some cases, radiotherapy is administered before surgery to reduce tumor volume and facilitate resection. Is not used very often radiotherapy in the treatment of liver cancer because the tumors tend not to respond and the liver itself is very sensitive to treatment effects.
In people that are treated with radiotherapy, there are several possible side effects, including:
* Redness and dryness of the skin at the radiation
* Nausea and vomiting
* Loss of appetite
It is more difficult to treat liver cancer reached an advanced stage, because of its spread to other parts of the body. Chemotherapy and radiotherapy may be options.
Treatment of recurrent liver cancer depends on what has been done previously and stage of cancer.
We can not prevent liver cancer, but thanks to a good understanding of risk factors, it would be easier to detect in its early stages. Those at high risk, such as those with hepatitis or cirrhosis should undergo periodic screening with ultrasound or blood tests. These show the level of liver enzymes that educate physicians on the liver function.
read also Liver