My husband’s father, uncle, and aunt passed away after experiencing liver cancer a couple of years. Saying about liver cancer, you might think about poor lifestyle choices such as diabetes, overweight, over consumption of fatty, alcohol drinking or smoking. However, none of these people were involved in the most common risk factors above. We all were shocked about their fatal disease because they ate balanced diets and lived in healthy environment, and they did not experience any signs or symptoms until it had been diagnosed due to tiredness and digestive problems. I would like to learn more on the causes, symptoms, and treatments of this disease as I have seen it dramatically influences our family members’ lives.
Normal Anatomy and Physiology of the Liver
The liver is the human body’s largest internal organ that lies behind the diaphragm in the upper right quadrant of the abdomen (McKinley, OLoughlin, & Bidle, 2016, p.1078). It has hundreds of functions to support the essential processes such as: drug detoxification; metabolism of carbohydrates, lipids, and proteins; and the production of digestive enzymes (McKinley et al., 2016, p.1078-1081). It plays a key role in maintaining homeostasis by taking in glucose during the absorptive state and releasing glucose into the bloodstream during the post-absorptive state of metabolism (McKinley et al., 2016, p.1078-1081). Carrying out these tasks make it a such important organ that is vital to our overall health.
Effects of Liver Cancer to Homeostasis
Damage to the liver results in serious impacts on the entire human body. When liver cells are cancerous, they divide relentlessly and grow into tumors, invading healthy tissues as well as spreading to other organs (‘Liver Cancer Facts’, n.d.). Tumor cells would interfere the homeostatic balance as they cease producing and releasing glucose (Ohio State University Medical Center, 2012). Also, cancer makes liver not to function correctly leading to bilirubin, fluid, and toxic substances build-up that affects other organs in the body (The American Cancer Society medical and editorial content team, 2016).
Types of Liver Cancer
There are two categories of liver cancer: primary and secondary.
Primary Liver Cancer
Primary liver cancer is the cancer that originate in the liver formed in the liver itself. The most common types of primary liver cancer are hepatocellular carcinoma - also called HCC, hepatocellular cancer, or hepatoma - and intrahepatic cholangiocarcinoma (also called ICC).
- Hepatocellular carcinoma (HCC) - that represents 85% of the primaries - starts from liver cells called hepatocytes. This type is more common in people who have liver damage (such as by the hepatitis B or C virus or by alcohol abuse) or metabolic syndrome (such as diabetes, obesity, and hyperlipidemia). Hepatic adenomas, also known as benign tumors, can also cause HCCs in some cases (‘Liver Cancer Facts’, n.d.).
- Intrahepatic cholangiocarcinoma (ICC): this is the second common form of primary liver cancer, which occurs within the bile ducts. People who have chronic liver disease such as cirrhosis, choledochal cysts, or sclerosing cholangitis are more likely to get ICC (‘Liver Cancer Facts’, n.d.).
- Other uncommon types of primary liver cancer: hepatoblastoma (occurs in children), biliary cystadenocarcinoma (usually found in women), and fibrolamellar hepatocellular carcinoma (affects those younger than age 40) (‘Liver Cancer Facts’, n.d.).
Secondary Liver Cancer
Secondary liver cancer is caused by the cancerous cells that grow from other parts of the body then spreads (metastasizes) to the liver and forms new tumors here; and these tumors are called liver metastases. People with breast, bowel, or lung cancer are more likely to develop this category of liver cancer (‘What Is Secondary Liver Cancer?’, 2017).
The exact cause is not known, but there are a variety of the risk factors that lead to liver cancer. Illnesses such as hepatitis B or C and hemochromatosis are largely to blame as they often lead to cirrhosis - scarring of liver tissues that prevents flood flow through liver. Over time, the scarring will grow, takeover of the healthy cells and therefore damage the function of the liver. Having alcohol abuse (leading to cirrhosis), diabetes, obesity, low immunity (such as those with AIDS), smoking would raise the risk. Males tend to consume larger quantities of alcohol and smoking more than females, thus having higher risk of liver cancer because the liver is damaged more easily. Environmental factors such as prolonged exposure to arsenic or aflatoxin (toxic substance in drinking water and food) can also be contributors. Hemochromatosis is inheritable, and those with family members having liver cancer will have higher risk of liver cancer (Nordqvist, C., 2017, December 5).
The symptoms of liver cancer do not clearly show until the disease has reached certain stages. Some typical symptoms are: uncontrollable weight loss, loss of appetite, vomiting, pain in the right upper quadrant, a buildup of fluid in the abdomen, quickly to feel full even after eating very little food, lump under the ribcage on the right side, jaundice, dark urine, liver or spleen enlargement, fever, pruritus, cirrhosis or cirrhosis gets worse (‘Liver Cancer Facts’, n.d.).
Due to similar symptoms with other diseases, liver cancer is hard to diagnosed in early stages, therefore delay its detection. Once discovered, the doctors need to determine its stage, the size and location of the tumor as well as whether it has spread to other organs (‘Liver Cancer Facts’, n.d.).
The stage depends on: number and size of tumors, whether blood vessels have been infected, and whether lymph nodes or other organs have been infected (Mayo Clinic Staff, 2019).
Some tests to diagnose liver cancer include: blood tests (to measure the levels of liver protein or certain enzyme to look for any sign of cancer); imaging tests like ultrasound, computed tomography (CT), or magnetic resonance imaging (MRI) scan can detect cancer; liver biopsy (take tumor’s sample using a needle through skin or surgery then examine the sample under a microscope).
According to ‘Liver Cancer Facts’, stages of liver cancer can be categorized from I (earlier) to IV (later) (one to four). Specifically:
- Stage I: only one tumor in the liver;
- Stage II: one tumor that has advanced to blood vessels, or multiple tumors which are smaller than 5cm;
- Stage III: multiple tumors with at least one larger than 5cm or growing to veins like portal and hepatic, growing to liver’s outer cover or nearby organs except gall-bladder;
- Stage IV: cancer has spread to other organs and the lymph nodes.
The statistics show that, for those are diagnosed, the 5-year survival rate heavily depends on how early the disease has been detected: stage I or II: 31%; stage III: 11%; stage IV: 2% (Cancer.Net Editorial Board, 2019). Notes that, even in later stages, treatments are also available to help maintain a good quality life for the patient. Surgery, if can be done, usually brings a good result (Cancer.Net Editorial Board, 2019).
There is a wide range of treatments for liver cancer. The target is to remove the tumors (for people whose have good liver function and the tumors are within the liver and small), replace the liver (transplant for those with early-stage liver cancer), or kill the cancer cells using different therapies depending on the stage and severity of the disease (for those who cannot get surgery or whose cancer has spread) (Mayo Clinic Staff, 2019). According to Mayo Clinic, the typical therapies are:
- Localized treatments: the cells of the tumors will be destroyed by applying heat to them, freezing them, injecting alcohol to them, or even injecting drugs to the tumor area.
- Chemotherapy: instead of injecting drugs to tumor area locally, this method injects drugs to the entire body, but the drugs are aimed to kill rapidly-growing cells.
- Targeted drug therapy: these drugs help block the abnormalities of cancer cells and eventually kill them; however, additional test may need to be done first to confirm the efficiency of these drugs on each patient.
- Radiation therapy: using high-powered energy beam (e.g., X-rays) to kill cancer cells at small areas in the liver, that might help control symptoms for advanced liver cancer or if other treatments cannot help (Mayo Clinic Staff, 2019).
To lower liver cancer risk, there are some strategies that might help, including avoiding excessive alcohol use, getting Hepatitis B vaccine, avoiding hepatitis C virus by practicing safe sex (because there is no vaccine against hepatitis C), watching your body weight, preventing and treating diabetes as well as hemochromatosis (Nordqvist, C., 2017, December 19).
There are about 42,000 cases have been diagnosed with primary liver cancer in the U.S. in 2019, and, of those, about two-third are men (Cancer.Net Editorial Board, 2019). The number of liver cancer patients keeps increasing, and compared to 1980, it has increased three times, that could result in the death of about 31,000 people this year in the U.S. (Cancer.Net Editorial Board, 2019). Liver cancer is ranked the fifth in cancer death for men and the seventh for women (Cancer.Net Editorial Board, 2019). This disease has a high mortality rate and being on the rise, thus knowing the facts will help rise our awareness to avoid risk factors. To bring awareness and raise funds for liver cancer research, October is chosen as the Liver Cancer Awareness Month, and emerald green is the color of liver cancer ribbon (Johnson, J., 2018, October 24).
This research also gives me an insight at what happened to my husband’s father, uncle, and aunt. Although they lived healthy lifestyles, they might be affected by unknown causes such as infection with the hepatitis B and C viruses or ate aflatoxin-tainted foods. Furthermore, I realize how important to detect the disease early because it decides the survival rate of the patient and gives patients the best chance to be supported and treated.
- Cancer.Net Editorial Board. (2019). ‘Liver Cancer: Statistics’. Cancer.net. Retrieved April 27, 2019, from https://www.cancer.net/cancer-types/liver-cancer/statistics
- Johnson, J. (2018, October 24). 'Cancer Ribbon Colors: A Guide.' Medical News Today. Retrieved from https://www.medicalnewstoday.com/articles/323448.php.
- ‘Liver Cancer Facts’. (n.d). Seattle Cancer Care Alliance. Retrieved April 26, 2019, from https://www.seattlecca.org/diseases/liver-tumors-cancer/liver-cancer-facts
- Mayo Clinic Staff. (2019). ‘Liver Cancer - Diagnosis & Treatment’. Mayoclinic.org. Retrieved April 27, 2019, from https://www.mayoclinic.org/diseases-conditions/liver-cancer/diagnosis-treatment/drc-20353664
- McKinley, M. P., OLoughlin, V. D., & Bidle, T. S. (2016). Anatomy & Physiology: An Integrative Approach (2nd ed). New York, NY: McGraw-Hill Education.
- Nordqvist, C. (2017, December 5). 'Everything You Need to Know About Cirrhosis'. Medical News Today. Retrieved from https://www.medicalnewstoday.com/articles/172295.php.
- Ohio State University Medical Center. (2012). ‘Liver Cancer Cells Stop Making Glucose as They Become Cancerous’. ScienceDaily. Retrieved April 26, 2019, from http://www.sciencedaily.com/releases/2012/07/120730141635.htm
- Torborg, L. (2018). A Medical Illustration of Liver Cancer. [Digital Image]. Retrieved from https://newsnetwork.mayoclinic.org/discussion/mayo-clinic-q-and-a-treatment-for-liver-cancer/
- The American Cancer Society medical and editorial content team. (2016). ‘Managing Symptoms of Advanced Cancer’. Cancer.org. Retrieved April 27, 2019, from https://www.cancer.org/treatment/understanding-your-diagnosis/advanced-cancer/managing-symptoms.html
- ‘What Is Secondary Liver Cancer?’ (2017). Cancer Research UK. Retrieved April 27, 2019, from https://www.cancerresearchuk.org/about-cancer/secondary-cancer/secondary-liver-cancer/about