Liver cancer – symptoms, treatment and life expectancy

Liver cancer - symptoms, treatment and life expectancy

In liver cancer (liver cell cancer), malignant tumors develop from originally healthy liver cells. In most cases, the symptoms that indicate such a  cancer disease  only become noticeable at a late stage. The first signs can be  tirednessloss of appetite  and weight loss. Due to the unspecific symptoms, liver cancer is often diagnosed at a late stage, which significantly reduces the chances of recovery. However, with the right treatment, life expectancy can be extended for many affected people.

Liver cancer: what types are there?

In general, a distinction is made between primary and secondary liver cancer in the case of malignant liver tumors. Primary liver cancer  is when the cancer has developed from the liver cells themselves If, on the other hand, metastases form in the liver from tumors in other organs – so-called liver metastases – this is referred to as  secondary liver cancer  . Secondary liver cancer is significantly more common in Germany than primary liver cancer.

In primary liver cancer, a distinction must be made between  liver cell carcinoma,  also known as hepatocellular carcinoma (HCC), and  bile duct carcinoma  (intrahepatic cholangiocarcinoma). Cholangiocarcinoma is cancerous cells that form in the bile ducts inside the liver. Both carcinomas differ significantly in terms of their causes, symptoms and therapy. In comparison to hepatocellular carcinoma, bile duct carcinoma in the liver is much rarer. For this reason, this article relates exclusively to hepatocellular carcinoma.

There are also benign liver tumors, such as blood sponges ( hemangiomas ),  cysts , follicular nodular hyperplasia (FNH) or hepatocellular adenomas. The latter can degenerate, i.e. become malignant.

Causes of liver cancer: Liver cirrhosis as a trigger

Certain diseases increase the risk of developing liver cancer. Cirrhosis  of the liver is found to be the cause of liver carcinoma particularly frequently (in about 80 percent of cases)  . Liver cirrhosis, in which the liver is irreversibly damaged, develops in the end stages of various  liver diseases .

Causes of cirrhosis of the liver are usually chronic  hepatitis B  or  hepatitis  C and  alcohol abuse . Because alcohol is broken down in the body by the liver, excessive alcohol consumption can cause serious damage to the organ. In the case of hepatitis infections, the duration of the disease primarily determines the extent of the damage.

People who suffer from cirrhosis of the liver should have their liver examined regularly so that possible liver cancer can be detected at an early stage.

Risk factors for the development of liver cancer

Liver cirrhosis is the main cause of liver cancer. However, there are a number of other factors that can promote the development of the disease. These include, among others:

  • Hemochromatosis  (iron storage disease)
  • Tyrosinemia (metabolic disorder in the liver)
  • Chronic hepatitis B without liver cirrhosis (risk depends on viral load)
  • Leberfibrose
  • alcoholic and non-alcoholic  fatty liver
  • Exposure to chemical substances such as those found in solvents and pesticides
  • Taking sex hormones such as anabolic steroids
  • in Germany the intake of mold toxins through the consumption of moldy food (aflatoxin) is rather rare

Recognize symptoms of liver cancer

Symptoms of liver cancer often only become apparent when the disease is relatively advanced. In the advanced stage, however, the prognosis is usually rather unfavorable. To increase the chances of recovery, you should seek medical advice as soon as you experience symptoms that could indicate HCC.

The first signs of such a disease are usually non-specific. They include:

In the further course, water accumulation ( ascites ) can occur in the abdominal cavity. Fluid retention can also occur in the legs.

Liver cell cancer can also cause symptoms such as yellowing of the eyes and skin ( jaundice ), significant, unwanted weight loss and swelling under the right costal arch. A visible, spider web-like widening of the blood vessels on the skin surface (spider nevi) can also be an indication of a liver disease such as liver cancer. In such a case, a doctor should definitely be consulted and the cause of the symptoms clarified.

Diagnosis of liver cancer

If liver cancer is suspected, various tests must be carried out. As a rule, a detailed  discussion is first held  about the type and duration of the symptoms and any risk factors that may be present.  A possible enlargement of the liver and the presence of accumulations of water are then determined by means of a  palpation examination . If the findings are conspicuous, an ultrasound examination and a blood test are carried out.

The tissue structures of the liver can be precisely imaged by means of an  ultrasound examination  . This means that even small tumors can be visualized.

The primary aim of the  blood test  is to determine the concentration of the tumor marker alpha1-fetoprotein (AFP). Tumor markers  are produced in the body in response to the formation of malignant cells. However, they also occur in the body of healthy people.

If the suspicion of cancer cannot be eliminated or confirmed with certainty, further examinations are necessary:

  • Magnetic resonance imaging ( MRI ) provides more precise information about the size and location of the tumor.
  • Computed tomography (CT) of the chest can be used to determine whether metastases have formed in adjacent organs.
  • Whether it is actually liver cell cancer can ultimately only be determined by a histological examination. A tissue sample is taken from the liver and then examined under a microscope (biopsy).
  • An examination of the stomach ( gastroscopy ) and/or the intestine ( colonoscopy ) may be necessary if there is a secondary liver tumor and the original tumor is suspected to be in the stomach or intestine.

stages in liver cancer

Liver cancer stages are subdivided according to the criteria of the “Union Internationale contre le cancer” (International Union Against Cancer, UICC for short). Important are the T criteria (tumor size), the N criteria (lymph node involvement, Latin “nodus”, near the tumor) and the M criteria (distant metastases, e.g. metastases in the lungs or in the brain).

According to this classification, stage 1 is, for example, only a single tumor without involvement of  lymph nodes , blood vessels or metastasis. In stages 2 and 3a to 3c there is one or more tumors and, depending on the stage, additional damage to surrounding vessels or organs. In stages 4a and 4b, there are also metastases in the lymph nodes or distant metastases.

Another way of classification is the so-called Barcelona classification (BCLC stages), according to which the stage is evaluated based on the spread to blood vessels or organs outside the liver, the size of the tumors and the bilirubin levels and the presence of portal hypertension.

treat liver cancer

The treatment of liver cancer is based on the one hand on the stage – the number, size and location of the tumor or tumors are therefore decisive, but also whether metastases are present. On the other hand, the age and state of health of the person concerned also play a decisive role in the choice of treatment method. The condition of the liver is also important for the therapy, i.e. whether cirrhosis of the liver is present or not.

Basically, there are various therapy options available for the treatment of liver cancer. Individual methods can also be combined with one another. Possibilities include:

  • Surgery: This involves partial removal of the liver or a liver transplant.
  • Local therapy methods: These range from sclerotherapy of the tumor to heat treatment or contrast agent therapy to internal irradiation of the liver.
  • Drug therapy: These include chemotherapy and antibody or immunotherapy.
  • Palliative therapy: With this form of therapy, the focus is no longer on curing the disease, but on improving the quality of life.

Surgery to treat liver cancer

If surgery is even possible, surgery is currently the treatment option that is most often used to completely cure liver cancer.

Smaller tumors in particular can usually be easily removed by surgery, this is known as  liver resection.  In addition to the diseased tissue, surrounding healthy tissue is also removed to reduce the chance of cancer cells remaining in the body. With a partial liver removal, it is important that enough healthy liver tissue remains in the body to continue to be able to maintain the function of the liver.

For people with cirrhosis of the liver, a  liver transplant is  a better option. Because if part of the diseased liver is removed, it is possible that the remaining liver tissue will not be sufficient to  detoxify the body  and liver failure will result. A good general condition and the exclusion of certain concomitant diseases are prerequisites for the operation. Medication must then be taken over a long period of time to prevent the donor organ from being rejected.

Local therapeutic methods in liver cancer

The aim of local therapeutic procedures is to slow down the progression of the disease, to prolong survival time and to alleviate accompanying symptoms. Such treatment methods are used when surgery is not possible. They are also used to bridge the waiting time until a transplant.

In  radiofrequency ablation (RFA)  or  microwave ablation (MWA)  , the tumor cells are destroyed by a laser or high-frequency vibrations and then removed. Multiple sessions may be needed to completely remove the tumor. These procedures can be used if the tumor or tumors are no larger than three centimeters.

In transarterial  chemoembolization (TACE)  , a cytotoxin and a vaso-occlusive agent are injected into the branches of the hepatic artery that supply the tumor. Due to the lack of care, the tumor shrinks. This procedure is therefore often used before an operation. With this method, the liver continues to be supplied via a second access – the portal vein. If this is closed, the treatment method cannot be used.

The procedure of internal radiation, the so-called selective internal radiotherapy (SIRT) , which is based on contrast agent therapy, is relatively new  .  Small beads to which a radioactive substance is bound are introduced directly into the vessels that supply the liver. Since the radiation only has a range of up to one centimetre, healthy tissue is not or only slightly affected by the radiation. The small beads also ensure that the vessels supplying the tumor are blocked. This is also an embolization procedure (artificial closure of blood vessels) which, although not aimed at healing, slows down the growth of the tumor and can reduce its size.

Drug therapies for liver tumors

Chemotherapy   is used relatively rarely for liver cancer in Germany . It is generally carried out when metastases have already formed or when no other therapy can be considered. In contrast to the local methods presented so far, chemotherapy has an effect throughout the body. The drugs used in chemotherapy – the so-called  cytostatics  – primarily attack cancer cells. However, other rapidly dividing cells are also attacked, for example the hair root and mucous membrane cells. However, the effectiveness of chemotherapy in liver cancer is limited. The same applies to radiation therapy.

In addition, there are active ingredients that intervene in the  metabolism  of the tumor and thus specifically combat it. These are so-called  tyrosine kinase inhibitors,  also known as tyrosine kinase inhibitors (TKI). These are taken in the form of tablets and are used when surgery cannot be performed. Sorafenib is often used to prolong the average survival time in patients with advanced cancer. There are also the active ingredients lenvatinib and cabozantinib. All drugs can have side effects such as  high blood pressure  or severe gastrointestinal problems.

A relatively new therapy option is treatment with  antibodies  . Similar to tyrosine kinase inhibitors, these intervene in the metabolism of the tumor and prevent the formation of new blood vessels. This leads to the death of affected tissue. In Germany, ramucirumab and bevacizumab have been approved for the treatment of hepatocellular carcinoma.

 Checkpoint inhibitors are used in immunotherapy  . These cause the  immune system to  recognize tumor cells and thus fight them. The PD-L1 inhibitor atezolizumab, which is used in combination with the antibody agent bevacizumab, has been approved in Germany so far.

Palliative Therapie

If the cancer can no longer be cured due to the advanced stage, palliative therapy is used to try to keep the quality of life as high as possible. It is mainly used for end-stage liver cancer. Palliative care focuses specifically on relieving pain and eliminating other ailments.

Liver cancer: life expectancy and chances of recovery

The diagnosis of liver cancer usually comes as a  shock to those affected . The question of the probability of survival and the chances of recovery often arises. How good the chances of recovery are and how high the life expectancy is depends above all on the stage at which the cancer is discovered: the size and location as well as the number of tumors are decisive for the prognosis. The earlier the disease is diagnosed, the better the chances of recovery.

Overall, the prognosis for liver cancer is not good: the  average 5-year survival rate  is about 15 percent. However, this value differs significantly according to stage and gender:

  • Stage 1: women 62 percent, men 54 percent
  • Stage 2: women 42 percent, men 25 percent
  • Stage 3: women 17 percent, men 15 percent
  • Stage 4: Females 2 percent, males 2 percent

The question of whether it is primary or secondary liver cancer is also decisive for the chances of  recovery  . In the secondary form, life expectancy depends largely on how the causative cancer progresses. If there is primary liver cancer that can be removed by surgery (liver resection), the life expectancy for over 50 percent of patients is more than five years.

However, in many of those affected, the liver cancer is already so advanced at the time of diagnosis that the chances of recovery are slim. Especially if the cancer has already formed metastases, this significantly reduces the probability of survival. If palliative therapy takes place under these conditions, the average life expectancy is between six and ten months. Without such therapy, life expectancy is lower.

With regard to life expectancy forecasts, however, it must be noted that these are statistical average figures that can always vary from person to person.

Is liver cancer curable?

Basically it can be said that in most cases liver cancer can only be cured by surgery or by destroying the tumor cells as part of an ablation (using heat or high-frequency vibrations).

Whether these procedures can be used depends on the stage of the disease and the general state of health of the person concerned.

Liver cancer: follow-up care is important

After an illness has been overcome, aftercare is of central importance. In the follow-up examinations, doctors support those affected with physical or mental problems. They also check whether concomitant diseases have occurred as a result of the therapy. If this is the case, they must be treated accordingly.

However, the most important goal of follow-up care is to detect the possible recurrence of liver cancer at an early stage and to initiate appropriate treatment. As a rule, such a follow-up examination should be carried out every six months.

incidence of liver cancer

While liver cancer is one of the most common types of cancer in Africa and Southeast Asia, the disease has so far been relatively rare in Germany and other western industrialized countries – albeit with an upward trend. In Germany, around 9,500 people developed liver carcinoma in 2019. Men are affected more frequently than women. The average age at the time of illness is 71 to 75 years.

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