Risk Factors
The following factors increase the risk of liver cancer:
- Chronic infection with hepatitis B and C viruses
- Alcohol abuse leading to scar tissue formation in the liver
- Aflatoxin, which is a poisonous substance produced in a fungus that affects peanuts
- Inherited disorders that cause damage to the liver
- Certain chemicals like vinyl chloride, hydrocarbons, solvents, nitrites
- Long-term use of anabolic steroids
- Drinking water contaminated with arsenic
Most liver cancers can be prevented by public health measures that reduce exposure to known risk factors. For example, the most significant risk factor for liver cancer worldwide is chronic infection with the hepatitis B and C viruses. Family members of patients with hepatitis B are advised to check their hepatitis B status and seek immunisation if they are not infected. Children are advised to be immunised at birth for hepatitis B as part of the national immunisation programme. There is currently no immunisation method for hepatitis C.
Screening
When liver cancer is detected early, it is small, localised, and easier to remove surgically. Survival rates are also better when liver cancer is detected early. Screening is advised for high risk groups with liver cirrhosis and chronic hepatitis B infection. Regular screening may involve blood tests for alpha-fetoprotein (AFP) and liver function assessments every 3 months, as well as ultrasound scans of the liver every 6 months.
Signs & Symptoms
Signs and symptoms of liver cancer do not usually appear until later stages of the disease. It is very often detected by chance as a result of an ultrasound test or CT scan for other unrelated problems. Some of the most common symptoms of liver cancer are:
- Loss of appetite or weight, fatigue, or general weakness
- Feeling very full after a small meal
- Persistent pain in the abdomen or near the right shoulder blade
- Swelling or fluid build-up in the abdomen
- Jaundice
- Itching
- Nausea and vomiting
Diagnosis
To confirm a diagnosis, a series of follow-up investigations may include:
- Analysing one's medical history and undergoing a physical exam
- Blood Test for alpha-fetoprotein (AFP), a tumour marker that is often raised in people with liver cancer
- Ultrasound, CT, and MRI scans to confirm the presence and extent of liver cancer
- Invasive tests such as angiogram to study the operability of the cancer
- Biopsies of the suspected cancer is obtained for microscopic analysis
- Bone scans to check for the spreading of cancer to the bones
Treatment
Treatment options depend on many factors such as age, general health, personal preference, social circumstances, location, and extent of the tumour. Generally, surgery, chemotherapy, and radiation therapy are the 3 main methods of cancer treatment.
- Surgery involves removal of all cancer visible to the surgeon at the time of the operation. Complete removal may not be possible if the cancer is large or if several small cancers are present in different parts of the liver. People with cirrhosis are considered eligible for surgery only if their cancers are very small.
- In chemotherapy, anti-cancer drugs are injected into the bloodstream and reaches all parts of the body. This makes this treatment potentially useful for cancers that have spread to other organs. Chemotherapy, however, also damages some normal cells.
- Radiation therapy uses high-energy rays to kill cancer cells. Liver tumors can be treated with radiation by injecting small radioactive beads into the hepatic artery.
Other treatment methods include the use of cryosurgery, ethanol injection, and high energy waves to destroy liver cancer. For example, cryosurgery destroys liver tumours by freezing them. This method has shown promise in delaying its progress. For more advanced liver cancers, targeted therapy could be used to prolong patients’ survival. In selected cases, a liver transplant is a definitive treatment for liver cancer.
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