Liver cancer

Liver cancer

Liver cancer is a malignant neoplasm that develops in the liver. The disease is more common in men than women, but in Russia it is quite rare. Treatment of liver cancer is hampered by the late treatment of patients for help. Aggravating circumstances of treatment and survival is cirrhosis of the liver, which significantly worsens the prognosis and limits the choice of treatments for liver cancer.

In medicine, there are two types of liver cancer:

  • Primary liver cancer - in this case, the tumor develops directly in the liver, from the cells of this organ. There are two types of these tumors:
    • hepatocellular carcinoma is a tumor of the liver that occurs in hepatocytes - the main cells of the organ;
    • cholangiocarcinoma, or cancer of the intrahepatic and extrahepatic bile ducts, is a tumor of the epithelial cells of the hepatic ducts.
  • Secondary liver cancer, or metastatic liver cancer, is cancer metastasis from another organ that has entered the liver through the blood and lymph due to the progression of the primary cancer.

All these types of liver cancer are different types of tumors, but they are united by localization. Hepatocellular carcinoma of the liver is much more common than cholangiocarcinoma. And metastatic liver cancer occurs almost 30 times more often than primary. The reason for this is the good blood supply to the liver. Because of this, almost a third of malignant neoplasms of other organs can metastasize to this organ.

In some cases, liver cancer is diagnosed as a collection of cancer cells in the form of small nodules, but sometimes - as one large liver tumor that can progress rapidly.

There are other types of liver cancer: sarcoma, angiosarcoma, undifferentiated sarcoma, lymphoma, cystadenocarcinoma, fibrolamellar carcinoma, melanoma, hepatoblastoma.

If you suspect the presence of malignant neoplasms, for diagnosis and treatment of liver cancer, seek medical help at our clinic "K+31".

The main symptoms of liver cancer

It can be very difficult to identify the disease at an early stage and start its treatment on time. Liver cancer is often asymptomatic and is detected in patients during a routine examination or during examination for reasons of other diseases or pathologies. Obvious discomfort in liver cancer or other painful sensations and signs is not observed either at the beginning of the onset of the malignant process of this important organ, or at later stages. Even in advanced liver cancer, when treatment no longer has such an optimistic prognosis, the signs are often quite vague. You should be concerned if there is:

  • significant weight loss for no apparent reason;
  • periodic occurrence of nausea and even vomiting;
  • loss of appetite or its decrease, refusal of favorite foods;
  • the presence of symptoms of bloating and pain of varying strength and frequency in the right hypochondrium;
  • growing pains in the upper abdomen (they can radiate to the back and often get worse at night);
  • showing symptoms similar to those of diabetes;
  • A haunting feeling of constant fatigue even without physical exertion.

A serious, most common harbinger of a formidable disease of the bile ducts and liver is obstructive jaundice, in which not only the sclera of the eyes and skin, but also the mucous membrane acquire a dark yellow color. Against this background, blood clotting is disturbed, there is a feeling of constant uncontrolled itching of the skin, feces become light, and the color of urine, on the contrary, darkens. The body as a whole undergoes serious painful changes - it is gradually poisoned by the products of bile formation in the liver, which destroy this organ.

Many of the symptoms described above, such as pain in the right side, nausea, fatigue, bloating, yellowing, are often observed already in the later stages of liver cancer. Therefore, having noticed at least one of them, you need to urgently consult a doctor in order to start treatment for liver cancer as soon as possible.

The clinical picture of the disease is characterized by the fact that the size of the organ increases, the level of bilirubin rises (this may be a sign of liver cirrhosis), the spleen enlarges, fever appears, which is not brought down by antibiotics and anti-inflammatory drugs, internal bleeding from the veins of the esophagus is observed.

Some patients with liver cancer experience signs of hypoglycemia, osteoporosis, and the function of the thyroid and / or parathyroid glands may be impaired. Sometimes there are symptoms from other organs into which metastases of liver cancer have penetrated, for example, from the lungs, bones, brain.

Liver cancer

Causes of liver cancer

In most cases, liver cancer develops due to metastases of a tumor in another organ. Risk factors for this disease also include:

  • chronic liver diseases such as cirrhosis and hepatitis C and B;
  • alcohol abuse;
  • overweight and malnutrition;
  • hemochromatosis (excessive accumulation of iron);
  • heart failure;
  • diabetes mellitus;
  • cholelithiasis;
  • syphilis;
  • parasites and oncogenic viruses;
  • endocrine system disorders;
  • disorders of the circulatory and lymphatic systems;
  • biliary tract disorders;
  • drugs that are toxic to the liver;
  • genetic predisposition.

But the most important risk factor for developing liver cancer is cirrhosis. Cirrhosis is often the result of long-term chronic liver disease. It can develop for the following reasons:

  • hepatitis B and C, autoimmune hepatitis;
  • alcohol abuse;
  • insulin resistant diabetes mellitus;
  • poisoning with certain toxins (aflotoxin, vinyl chloride, other substances);
  • hemochromatosis.

In 90% of cases, liver cancer occurs against the background of various pathologies of the tissues of this organ. In healthy liver tissue, a tumor forms very rarely.

Liver cancer

Diagnosis of liver cancer

During diagnosis, in order to select the most appropriate treatment regimen for liver cancer, it is important to determine the size of the tumor and its location, the stage of development of the disease, its prevalence and liver reserves.

Proper and timely diagnosis is essential for the effective treatment of liver cancer. The first and easiest step is laboratory blood and urine tests. More complex, but accessible in "K+31", methods of hardware diagnostics include:

  • Ultrasound of the abdominal cavity (liver, spleen, pancreas, gallbladder). It is a simple and safe method for diagnosing liver cancer with good sensitivity. It allows you to determine the presence of a malignant neoplasm in the liver, the degree of its invasion into the surrounding tissues, the degree of cancer of the hilum of the liver, the presence of metastases of a malignant tumor and fluid in the abdominal cavity, the degree of fibrosis of the liver tissues.
  • Magnetic resonance imaging (MRI). This method of diagnosing liver cancer is more sensitive and can detect small malignant tumors (less than 1 cm in diameter) even in the presence of cirrhosis of the liver.
  • A clear picture of the state of the internal organs (both the liver and those where liver cancer metastases could penetrate) is also given by radiography of the chest cavity and computed tomography (CT), examination of the esophagus, duodenum and stomach, endoscopy, gastroscopy . Angiography is used to diagnose the pathology of blood vessels in liver cancer. Less commonly used is PET-CT, but it is more commonly used in cases of secondary liver cancer. In some situations, laparoscopy is performed.

Modern equipment, diagnostics carried out with its help and the results obtained allow us to determine the extent of liver cancer, including:

  • identify a neoplasm, its localization, accurately determine the size of a malignant liver tumor, the rate of its increase;
  • get information about the presence of liver cancer metastases;
  • get information about which organs metastases have spread to.

Research helps the doctor decide on the most appropriate methods of treating liver cancer, on the possibility of effective tumor resectability, that is, radical surgery.

But a biopsy is always prescribed to determine the malignancy or benignity of the tumor, as well as other characteristics of the neoplasm. It is carried out under the control of abdominal ultrasound.

To find metastases of liver cancer, the same ultrasound, X-ray, CT scan of the chest, MRI, etc. are used. To assess the functional reserve of the liver, if the patient is diagnosed with cirrhosis, special tests are done that can be used to assess the levels of albumin and bilirubin in the blood , prothrombin index and other indicators.

What are the treatments for liver cancer?

In order to select the appropriate treatment for liver cancer, the prevalence of the malignant tumor and the functional reserve of the organ must be taken into account at the time of diagnosis. Surgical removal (resection) of the affected area, X-ray endovascular or ablative methods, drug or radiation therapy for liver cancer can be used.

Three main treatments are used to stop the spread of type 1 or type 2 liver cancer:

  • Surgical. This method of treating liver cancer is indicated for small tumors of a clear shape, without metastases to other organs and blood vessels. Liver cells are well regenerated, which allows the body to recover on its own to the volume that it had before the operation. A contraindication to this method is cirrhosis of the liver and other serious diseases.
  • Minimally invasive radiofrequency thermal ablation. Based on the ability to destroy cancer cells using radio frequency radiation.
  • Chemotherapy for liver cancer, in which chemotherapy drugs are administered systemically or directly into the artery of the liver. Refers to complementary treatments for liver cancer.

Sometimes, to achieve a positive result, you have to combine two or even more treatments.

Surgical intervention (operation)

If a portion of the liver can be removed (the liver is resectable), this is the preferred treatment for liver cancer. With the preservation of the functions of the organ sufficient for the life of the patient, up to 80% of the liver tissues can be removed. However, this is not possible or possibly limited due to fibrotic tissue changes if the patient has cirrhosis.

If a patient with cirrhosis has one liver cancer less than 5 cm, or 2-3 tumors less than 3 cm, and the cancer has not invaded the blood vessels, a liver transplant is an option.

Liver cancer ablation

This procedure for the treatment of liver cancer is to damage the malignant tumor and its cells using chemical agents or physical means. It is used when there are single tumor nodes. To damage the neoplasm, a laser, photodynamic, ultrasonic, radio frequency or microwave exposure, low temperatures, ethanol are used.

X-ray endovascular surgery for liver cancer

This method of treating liver cancer is used when the malignant tumor is inoperable, and there are no distant metastases, the cancer has not grown into the main vessels of the organ, and there is no thrombosis in them. The method is possible due to the double blood supply to the liver. The hepatic artery supplies blood to the liver to supply the organ, and the portal vein supplies blood that the liver filters. If arterial blood is blocked in the tumor node, the supply of the malignant liver tumor will stop, which will lead to its reduction. To this effect is added the effect of a chemotherapy drug that is injected into the tumor. But first, in order to find out the blood supply pattern of a malignant neoplasm, a radiopaque drug is injected into it.

X-ray endovascular methods are combined with other methods of antitumor therapy. But they are contraindicated in the presence of decompensated cirrhosis, tumor foci outside the liver, coagulopathy with bleeding, or intractable ascites.

Radiation therapy for liver cancer

If it is not possible to perform surgical removal of liver cancer, ablation or apply methods of X-ray endovascular surgery in the patient's case, then radiation therapy is prescribed. But it is used as a palliative treatment for liver cancer. If the patient has solitary tumors, radiation therapy can be directed directly at them with minimal damage to adjacent healthy tissues.

Drug therapy for liver cancer

Some patients are treated with chemotherapy. But in most cases of liver cancer, it is ineffective and cannot replace surgery. Therefore, targeted therapy or immunotherapy is used, which shows better results. Sometimes these methods are combined. Drugs that are used to treat liver cancer: sorafenib, bevacizumab, atezolizumab, regorafenib.

Liver cancer prevention

Prevention of liver cancer is easier than cure. Even if there are no symptoms indicating problems in the body, it is necessary to treat your health carefully and respectfully. Good preventive measures are:

  • periodic check-ups with a therapist, which are worth visiting at least once a year;
  • if necessary, based on test results, CT or MRI;
  • in the direction of a doctor - testing for tumor markers CEA, SA-19.9, AFP.

Avoiding a serious disease or detecting it at the earliest stages will allow screening, which will help in the prevention of pathology or the search for it at the asymptomatic stage of liver cancer. Oncological checkup at K+31.

Compulsory regular examinations are indicated for patients with cirrhosis of the liver and other pathologies or chronic diseases of this organ. If you do not belong to the risk group, then to prevent liver cancer, you should give up alcohol, eat right, control your weight and diabetes, get vaccinated against hepatitis B, treat all liver problems in a timely manner. Chronic liver diseases are especially dangerous (they can lead to cirrhosis), and you need to direct your efforts to eliminate them in order to prevent the occurrence of liver cancer.

The presence of cirrhosis is not only the main cause of liver cancer, but also strongly influences the choice of treatment. In addition, the effects of cirrhosis on the body can be more dangerous than liver cancer itself. Therefore, preventing the development of this disease is the main preventive measure in the fight against liver cancer.

Our doctors at K+31 clinics in Moscow treat a variety of oncological diseases, including colon cancer, breast cancer, stomach cancer, cancer of the uterus, gallbladder, intestines, etc. We have the most modern equipment and highly qualified specialists, as well as a comfortable hospital. You can learn more about our services by phone. You can make an appointment with a doctor on the website.



Specialists

All specialists
Merkulov
Igor Alexandrovich

Deputy chief physician for oncology, oncologist

Doctor of Sciences, PhD

Lyadov
Konstantin Viktorovich

Academician, professor, Doctor of Sciences, PhD

Petrov
Dmitry Yurevich

Deputy chief physician for oncology, surgeon

PhD, Docent

Ershova
Ksenia Igorevna

Head of department, oncologist

PhD

Abashin
Sergey Yuryevich

Head of oncology projects, oncologist

Doctor of Sciences, PhD, professor

Rasner
Pavel Ilyich

Consultant in urology, urologist

Doctor of Sciences, PhD, professor

Malygin
Sergey Evgenyevich

Oncologist-mammologist, surgeon

Pshikhachev
Ahmed Mukhamedovich

Urologist, Oncologist

Doctor of Sciences, PhD

Shevchuk
Alexei Sergeyevich

Oncogynecology consultant, obstetrician-gynecologist

PhD

Chichkanova
Tatyana Vladimirovna

Oncologist-mammologist, radiologist

Katz
Ksenia Vladimirovna

Dermatovenerologist, oncologist

Udin
Oleg Ivanovich

Deputy chief physician for surgery, surgeon

PhD

Kogonia
Lali Mikhailovna

Chemotherapist

Doctor of Sciences, PhD

Ushenina
Maria Valerievna

Oncologist-chemotherapist

PhD

Volkova
Daria Mikhailovna

Head of the radiation therapy department

Gomov
Mikhail Alexandrovich

Consultant in oncogynecology, obstetrician-gynecologist

Grishin
Igor Igorevich

Obstetrician-gynecologist

Doctor of Sciences, PhD, professor

Achba
Maya Otarovna

Radiologist, ultrasound diagnostician, oncologist-mammologist

Dubinina
Yulia Nikolaevna

Head of the oncology department of antitumor drug therapy, oncologist, hematologist