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Liver tumors (liver cancer) are increasing in the western world, but are still relatively rare. However, liver cell cancer in particular is one of the five most common cancers worldwide. Most often, the disease is discovered late because complaints only appear in the advanced stage. This considerably limits the chances of recovery. In principle, early detection is the most important prerequisite for a good forecast. Appropriate therapy options are individually adapted and offer the possibility of extending survival or, in some cases, even achieving complete healing. Preventive measures against liver diseases (such as hepatitis infections and cirrhosis) and a healthy lifestyle reduce the risk of developing the disease.
Malignant tumors of the liver are summarized under the term liver cancer or liver carcinoma. It is important to differentiate between cancers that also originate in the liver (primary liver cancer) and malignant metastases that start in the liver from other cancers. Basically, primary tumors are less common in the liver than metastatic cancer cells.
Most of the primary diseases (around sixty-four percent) are so-called liver cell carcinomas, also called hepatocellular carcinoma (HCC). As the name suggests, the tumor develops directly from the liver cells (hepatocytes). However, other tissue structures in the liver can also be affected. If cells of the bile ducts in the liver are the starting point for degeneration, it is a so-called cholangiocellular carcinoma (CCC). This is the case for approximately every fourth primary tumor disease. If the origin is in the blood vessels, one speaks of an angiosarcoma of the liver.
Overall, liver cancer is relatively rare, but due to the very poor prognosis, the disease is one of the most common causes of cancer deaths. According to data from the Robert Koch Institute in 2013 and 2014, around nine thousand one hundred new cases occur each year in Germany, whereby nearly eight thousand cases are fatal. Men get this cancer more often than women. It is assumed that the number of illnesses will continue to increase. So far, the increasing alcohol abuse and increased diseases due to obesity (metabolic syndrome) and infections with the hepatitis B and C virus have been the main reasons for the increase.
This article focuses on liver cell carcinoma, the most common primary type of liver cancer.
An early diagnosis is often difficult because there are usually no symptoms at the beginning and even the first signs in the advanced stage are rather non-specific. In particular, possible symptoms that may occur with a liver tumor disease, but can also have other harmless causes, are the following:
- Stomach pain,
- Pressure and pain in the right upper abdomen, which can also radiate (flank pain),
- Swelling under the right costal arch,
- Loss of appetite,
- Nausea and vomiting,
- Weight loss,
- increased temperature or fever,
- general poor performance,
- Yellowing of the skin (jaundice) with itching and yellow eyes,
- Dark urine color and light-colored bowel movements.
If a tumor in the right upper abdomen is already palpable, the disease is already well advanced and usually accompanied by other complaints, such as ascites (abdominal dropsy) and cachexia (pronounced, pathological weight loss).
Persistent irritation of an organ through inflammation is a factor that obviously causes cells to degenerate faster. As a result of hepatitis B or hepatitis C infection, there is an increased risk of developing hepatocellular carcinoma. This also applies to hepatitis B infections in newborns.
Chronic hepatitis B or C infections or even heavy alcohol abuse often lead to liver shrinkage (liver cirrhosis). This liver disease is considered the most important risk factor or the most common trigger for liver cancer and is responsible for the development of liver cell carcinoma in more than ninety percent of cases.
But other liver diseases can also promote the development of liver tumors, such as fatty liver. This can be due to diabetes, for example, or can occur in the presence of an existing metabolic syndrome, which is associated, among other things, with increased blood lipid levels or a strong obesity.
Other factors that can cause liver cancer include smoking and poisoning. The molds ingested through food (such as Aspergillus flavus) that contain, for example, the poison Aflatoxin B1. In addition, certain oral contraceptives, anabolic steroids and chemical substances, such as the previously used contrast agent Thorotrast, are considered to be cancer-friendly.
But also hereditary metabolic diseases such as hemochromatosis (iron storage disease) or an alpha-1-antitrypsin enzyme deficiency can increase the risk of liver cancer.
Early detection of the disease offers the greatest chance of a cure, but this often proves to be difficult. In general, there is no special screening procedure for liver cancer. However, early detection examinations every six months are recommended for particularly vulnerable people. These are people with cirrhosis (Child-Pugh stage A or B), chronic hepatitis infection or fatty liver hepatitis.
During the preventive examinations, the liver is examined using ultrasound to detect possible tumors. Color-coded duplex sonography or contrast agents are also used for more precise results. The determination of certain tumor markers (alpha 1-fetoprotein) only plays a subordinate role due to the insufficient informative value.
If there is suspicion of liver cancer, further diagnostic procedures are used. First, as with any medical examination, a medical history and physical examination is carried out. Blood tests mostly focus on the detection of possible hepatitis infections and the tumor markers mentioned, but these in themselves are not a more reliable diagnostic criterion.
If a liver tumor was detected on the ultrasound images, further imaging methods are used for more precise diagnostics. Those affected are usually examined using magnetic resonance imaging (MRI) or sometimes using computed tomography (CT). The exact position and extent of the tumor can be determined and possible metastases in other parts of the body can be identified.
If uncertainties remain after the above-mentioned findings, a tissue sample (biopsy) of the tumor can also be taken using a liver puncture in order to carry out further microscopic examinations on the basis of this sample. Here, benign and malignant cell formations can be distinguished from one another. If the results show that the liver is metastatic and not a primary tumor, further examinations are carried out to find the original cancer. The first step is usually a close look at the gastrointestinal tract.
Depending on the stage of the disease, age and general health, various therapy options are available, which can also be used in combination. New, effective therapeutic measures are the subject of many research approaches.
Surgical removal of the tumor can promise a cure, but is often not possible due to existing cirrhosis of the liver, since in most cases the remaining tissue can no longer perform the vital functions. Another option is complete removal of the liver with subsequent liver transplantation under certain conditions. However, this therapeutic measure is also considered in very few patients.
Local tumor-destroying measures
Methods with the aim of killing the cancer cells are, for example, multiple injections of ethanol or acetic acid, which are injected directly into the tumor. However, these applications have been almost completely replaced by the newer and more effective method of radio frequency ablation. The tumor tissue is burned under high heat, so to speak. This methodology has a chance of success, especially for tumors of three to five centimeters.
In addition, local ablation procedures that have been used less frequently so far may represent a treatment option. These include, for example, microwave ablation and irreversible electroporation. In some cases, such interventions can provide temporary relief and bridge the time to a liver transplant. Few special centers recently also offer the possibility of tumor destruction using high-intensity focused ultrasound (HIFU), a relatively safe and effective form of treatment for small tumors under three centimeters.
If the patient only has liver cancer and surgical and local ablation methods are excluded, a relatively new procedure may offer a further treatment option. This is selective internal radiation therapy (SIRT). The tumors are irradiated locally and the blood vessels that nourish the tumor are closed by precisely placing the smallest radioactive beads in the supplying vessels of the liver.
For larger, delimited carcinomas, external radiation treatments are suitable, some of which are combined with SIRT. Clinical studies examine these and other innovations in therapy options, as well as the possibility of proton therapies.
Drug procedures and chemotherapy
Sorafenib is a new drug that blocks the binding sites (receptors) for tumor growth factors and thus (temporarily) prevents cancer from spreading. International research results have shown longer liver function and survival of treated patients. Lenvatinib and regorafenib are other approved preparations with the same function and effectiveness. However, there is a general consensus that a preserved liver function and a good general condition are the basic requirements for this form of therapy. Current studies are concerned with the development of other novel drugs.
Experience has shown that in the most frequently diagnosed and advanced liver cell carcinomas, conventional chemotherapy is not promising in the vast majority of cases. For this reason, cytostatics such as doxorubicin are only used in individual cases and after careful consideration, and only if the affected person does not have cirrhosis of the liver.
In some special cases, chemo-embolization offers a special therapy option, whereby chemotherapy is combined with vascular occlusions. Small plastic particles are introduced into blood vessels so that the tumor is no longer supplied, and a chemotherapeutic agent is also added locally, which also fights the tumor.
Medicines for pain control are of further importance. Contrary to the freedom from complaints at the beginning of the disease, pain usually occurs in the later stage of the disease. Most sufferers get painkillers or, if the symptoms are very strong, morphine.
Chances of recovery
If liver cancer is found at an advanced stage, the chances of recovery are unfavorable. And even if a liver carcinoma can initially be treated effectively, it does not infrequently lead to another cancer (recurrence) and the treatments lead to an extension of life, but not to a complete recovery. Therefore, early detection examinations are the most important prerequisite for a possible cure. However, since the diagnosis is usually only made at a later stage, the average five-year survival rate after diagnosis is only around ten percent.
Preventive measures and natural home remedies
A healthy and low-fat diet together with a substantial absence of alcohol and nicotine minimize important risk factors for the development of cancer. It has also been scientifically proven that regular coffee drinking protects against the most common form of liver cancer. But regular physical activity also helps to reduce the risk of cancer. All of these measures help to put less strain on the liver and make it more resistant to diseases, and to prevent risky obesity and obesity.
In addition, drugs (statins) that work against high blood lipid levels (cholesterol) and are indicated for those affected in this context have proven to be an effective way of preventing liver cancer. With liver cancer, which is due to hepatitis infections, vaccinations (even in childhood) show a good protective effect.
Natural home remedies for liver detoxification or for liver regeneration are also suitable for maintaining the functionality of the "detoxification organ" and prevent various liver diseases. (tf, cs)
Author and source information
This text corresponds to the requirements of the medical literature, medical guidelines and current studies and has been checked by medical doctors.
Dr. rer. nat. Corinna Schultheis
- Herold, Gerd and co-workers: internal medicine. Self-published by Gerd Herold, 2019
- dkg-web (ed.): ONKO internet portal - basic information on liver cancer (access: July 24, 2019), krebsgesellschaft.de
- Robert Koch Institute (ed.): Cancer in Germany for 2013/2014, 11th edition (2017), krebsdaten.de
- Guideline program oncology (publisher: German Cancer Society, German Cancer Aid, AWMF): Diagnostics and therapy of hepatocellular carcinoma, long version 1.0, as of May 2013, AWMF register number: 032-053OL, leitlinienprogramm-onkologie.de
- Malek, Nisar P., Schmidt, Sebastian, Huber, Petra, Manns, Michael P., Greten, Tim F .: Diagnosis and treatment options for hepatocellular carcinoma, in: Deutsches Ärzteblatt International, issue 111/7 (2014), aerzteblatt.de
ICD codes for this disease: C22ICD codes are internationally valid encodings for medical diagnoses. You can find e.g. in doctor's letters or on disability certificates.