Today’s urban lifestyle and choices are the prime reasons behind the surging number of ailments. Millions of people adopting unhealthy habits encounter illness, disability and death. One of such ailments is liver cancer.

Liver or hepatic cancer is one of the fastest spreading ailments in India. Every year around 50,000 Indians is diagnosed with this disease. 

Keep reading to learn about the types, stages, symptoms, causes, treatment, and risk factors contributing to this cancer.

When the cells in the liver grow at an abnormal speed leaving less space for new cells to develop, it results in the liver or hepatic cancer.

Below is a list of reasons responsible for liver cancer.

• Gender
• Race or ethnicity
• Heavy alcohol consumption
• Excessive consumption of tobacco via cigarettes, gutkha etc.
• Chronic viral hepatitis A and B
• Inherited metabolic disease
• Obesity
• Type 2 diabetes etc.

The symptoms of hepatic cancer become primarily prominent in the later stages, including-

Early Liver Cancer Symptoms

• Unexplained weight loss
• Vomiting
• Nausea
• Anorexia (loss of appetite)
• Fatigue
• Swelling in the abdomen (ascites)

However, these symptoms are generic and can indicate other forms of cancer and chronic diseases as well.

Stage 4 Liver Cancer Symptoms

• Jaundice (yellowish discolouration of skin and sclera or the white part of the eye)
• Abdominal pain
• Pain near the right shoulder blade
• Fluid build-up in the abdomen
• Enlargement of liver or spleen or both
• Back Pain
• Itching
• Fever
• White-coloured stool

Hepatic cancer may lead to swollen veins visible under our abdominal skin, bruising and bleeding. 

In some cases, hepatic cancer initiates hormone production that affects other body organs and systems, including-

• Gynaecomastia

It is one of the liver cancer symptoms in males, causing breast enlargement or shrinkage of testicles.

• Erythrocytosis 

This increases the red blood cells level in the body.

• High Cholesterol

This is one of the primary risk factors for heart diseases.

• Hypercalcemia

When the calcium level increases, one may feel weak, nauseous, confused. This may also lead to constipation and muscle issues.

• Hypoglycaemia

Under this condition, an individual may feel fatigued as the blood sugar level deteriorates.

However, there are no distinctive liver cancer symptoms in females.

Numerous risk factors make human bodies susceptible to developing liver cancer cells. Very Well Health published an article that states 40% of liver cancer is correlated with Hepatitis B and C, 11% with alcohol consumption, and 10% due to other problems. 

What are those? Let us find out.

• Cirrhosis
• Non-Alcoholic Fatty Liver Diseases (NAFLD) 
• Aflatoxins
• Anabolic Steroid-Induced Liver Injury
• Wilson Disease
• Alpha-1 Antitrypsin Deficiency
• Hemochromatosis
• Glycogen Storage Disease
• Primary Biliary Cholangitis
• Porphyria Cutanea Tarda
• Tyrosinemia

For treatment purposes, oncologists have classified liver cancer into 4 categories -

1. Transplantable Cancer

This type includes Stage I and some Stage II cancers in the TNM system among patients without a history of cirrhosis or other ailments. If the patient’s body sustains surgery, this form of cancer can be removed entirely. Alternatively, doctors opt for liver transplants in such cases.

2. Unresectable Cancer

Though not spread to the lymph nodes or distant organs, this cancer variant develops at the junction of the liver and the major arteries, veins and bile ducts. Thus it cannot be removed safely through an operation.

3. Inoperable Cancer With lOnly Local Disease

Though this type is small and can be removed by surgery, the patient must be healthy enough to sustain surgery. Especially it is unsafe for patients with cirrhosis and other serious ailments.

4. Advanced Cancer

This variant includes Stage IVA and IVB in the TNM system. When the tumour spreads to lymph nodes or other organs, it is referred to as advanced or metastatic cancer.

Doctors conduct the following tests to diagnose liver cancer and its severity.

• Blood tests
• CT and MRI scan
• Ultrasound
• Biopsy

Depending on the liver cancer stages, patients may consult different cancer specialists. The list includes-

• Surgical oncologist (conduct surgeries)
• Radiation oncologist (conducts radiation therapy)
• Medical oncologist (treats cancers with medicines and suggest chemotherapy and immunotherapy, based on the condition)
• Gastroenterologist (specialised in treating digestive system diseases)
• Interventional radiologist (conducts ablations and embolisations)

However, individuals suffering from stage 4 liver cancer may require additional assistance, including nurse practitioners, nurses, social workers, nutritionists, rehabilitation specialists, and other health professionals.

Below is the list of the most-practised liver cancer treatments across the world.

1. Surgery

Two effective ways to cure liver cancer are surgical resection (removal of the tumour) and liver transplant. In this respect, the patients have to be healthy to survive the extensive surgery. 

• Fragmentary Hepatectomy

This process involves partial removal of the affected part. Surgeons recommend this treatment to patients with only 1 tumour that has not spread into blood vessels. 

The process involves CT, or MRI scans with angiography to determine whether it is possible to remove the affected area. However, during surgeries, if the doctor finds that the tumour is too large to be removed, they do not conduct surgical resection.

Risks and Side Effects

Liver resection is a critical operation and thus conducted only by experts. If operated by an inexperienced oncologist, patients may suffer the following side effects-

• Bleeding
• Infection
• Complications due to anaesthesia
• Blood coagulation
• Pneumonia and more

If the affected area is not eradicated, it may lead to new carcinogenic cell development in the liver.

• Liver Transplantation

When the tumours are more in number and more prominent in size, oncologists opt for transplantation. 

Note: Doctors recommend liver transplantation if the tumour is smaller than 5 cm or there are 2 or 3 tumours of less than 3 cm in size and not grown into the blood vessels. 

Liver transplantation is an expensive surgery but assures no new cancer develops further.

Risks and Side Effects

Patients who need liver transplantation have to wait until finding a suitable donor. They have to undergo other treatments like embolisation and ablation to stop the spread further. Also, doctors suggest a surgical resection to control the spread and then transplant the liver when available.

Similar to partial hepatectomy, liver transplantation involves several risks. Therefore, it should be treated by reliable surgeons only. Elsewise, one may suffer-

• Bleeding
• Infection
• Blood coagulation and more

However, before transplantation, several checks like blood tests, biopsies etc., are conducted to avoid rejection of the new liver.

2. Chemotherapy

Also known as chemo, this treatment destroys cancer cells with the use of drugs. Doctors recommend this therapy if a patient cannot survive surgery and does not respond to other therapies like ablation or embolisation.

There are 3 types of chemotherapies widely practised by oncologists-

• Systematic
• Regional
• Hepatic Artery

Risks and Side Effects

Some of the common side effects of chemotherapy include-

• Hair loss
• Mouth sores
• Anorexia (loss of appetite)
• Nausea
• Diarrhoea
• White and red blood cell count deterioration etc.

These side effects last till the treatment. Individuals can seek assistance from experts to reduce them.

3. Additional Liver Cancer Treatments

Experts have come up with several forms of treatments for unresectable tumours. It includes-

• Clinical trials of the latest targeted therapies 
• Immunotherapy
• Other forms of chemotherapies
• Radiation therapy and more

4. Stage 4 Liver Cancer Treatment

If the tumour spreads to lymph nodes or other body organs, experts recommend the following treatments-

• Medications
• Clinical trials
• External Beam Radiation Therapy (EBRT)
• Stereotactic Body Radiation Therapy (SBRT)

According to Cancer.Net, the 5-year liver cancer survival rate depends on a patient’s health condition and the stage of the ailment. For instance, 44% of patients diagnosed with hepatic cancer at the early stage has 34% 5-year survival rate. If cancer spread to surrounding parts or tissues or lymph nodes, the rate is 12%. And patients suffering from last stage liver cancer have a 5-year survival rate of 3% only.

However, in 2020, about 4.7%, that is, 9,05,677 new liver cancer cases, were reported worldwide, and the death rate was 8.3%. So, if you come across any of the mentioned liver cancer symptoms, opt for a thorough check-up to get it diagnosed at the early stage to reduce the spread rate.