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Liver Cancer Surgery

 

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Overview

Liver is located in the right upper corner of the abdominal cavity and it is confined by diaphragm in the upper margin, lower ends of ribs of right hemithorax in the lower margin and stomach in the left margin. It has two lobes; right and left lobes.

 

The gall bladder that plays a very significant role in the digestive system is just beneath the lower surface of the liver. The bile synthesized by the liver is drained into and stored in the gall bladder through tiny canals.

 

Comparing to other cancers, liver cancer is relatively rare. Although various types of cancers develop in the liver, most liver cancer cases originate from native cells of the liver (hepatocyte). The most common one is hepatocellular cancer, but there are also other types, such as cholangiosarcoma and hepatoblastoma. However, secondary or metastatic cancers, namely cancers that originate in and spread from other organ, are more common than primary cancers of the liver.

 

Liver diseases may progress to very serious conditions and can result in death, if they are left untreated. Liver is an organ that fulfills very important functions in the body. Some of these functions are listed below:

  • Storage of certain nutrients
  • Processing fats into energy, when needed by the body
  • Production of bile – a substance that helps the digestion,
  • Protein synthesis,
  • Support to coagulation of blood,
  • Production of other substances needed by the body,
  • Detoxification of alcohol, drugs and toxic substances, such as body waste.

 

Risk Factors:

The risk factors that are known to cause liver cancer are as follows:

 

Chronic Hepatitis B and/or Hepatitis C infection

Diabetes Mellitus

Cirrhosis

Exposure to aflatoxine in foods

Family history

Age

Heavy alcohol consumption

Abnormal fat deposition in liver

Smoking

Exposure to certain chemical substances

 

Types

Hepatocellular carcinoma: It is the most common type of liver cancers. It accounts for up to 85% of primary liver cancer cases. It is more prevalent in advanced ages and men.

Other types of liver cancer include cholangiosarcoma that begin in cells of the bile ducts, angiosarcoma (or hemangiosarcoma) that begin in blood vessels of the liver and hepatoblastoma that is very rare and usually affects children.

 

Symptoms:

As is the case with most of other cancers, liver cancer is also asymptomatic in early stages. Following symptoms may develop in advanced stages. In this case, you should necessarily visit your doctor.

  • Weight loss with no clear reason
  • Lack of appetite,
  • Pain in right upper corner of the abdominal cavity
  • Tiredness and fatigue,
  • Yellow discoloration of skin and sclera
  • Fullness and feeling of swelling after meal,
  • Pale or clay-colored stool (putty stool)
  • Itching,
  • Chronic hepatitis or sudden exacerbation of cirrhosis,
  • Fever and abnormal sweating.

 

Prevention:

As is the case for all other cancers, prevention of liver cancer is also to eliminate or minimize manageable risks. It is substantially important to maintain healthy weight, consume alcohol reasonably, decrease use of chemical substances, vaccination for hepatitis (Hepatitis B), avoid factors that cause hepatitis C, such as tattoos, unprotected sex and illicit drugs and minimize the risks that may cause liver injury, such as cirrhosis.

 

Diagnosis:

Routine health examination and physical examination that is done when one visits a doctor for a complaint are the first step in the diagnosis of liver cancer. Palpable liver in the abdominal exam, jaundice of skin and eyes, abnormal abdominal convexity and resultant effacement of belly button as well as loss of hair in abdominal skin point to a problem in the liver.

 

If the imaging studies (Ultrasound, CT, MRI, PET) that are ordered to investigate findings suspicious for liver cancer show a mass, provisional diagnosis is made.

 

Blood tests may also give clues that may reveal out the abnormalities in functions of liver.

 

The definitive diagnosis of the liver cancer requires biopsy. A thin needle is inserted into the liver under guidance of an imaging modality, mostly ultrasound, and biopsy specimen is taken and examined.

 

Treatment:

After diagnosis of the liver cancer is established, the next step is to determine the stage. Your doctor will determine stage (I to IV) of your cancer based on a set of very strict criteria.

 

When the liver cancer is diagnosed, your doctor will first determine size, location, spread and stage of the cancer.

 

Generally cancer phases are symbolized with Roman numbers I to IV. Stage IV is the most advanced stage of cancer. Treatment is planned specific to person regarding the phase, age, general health condition and personal preferences.

 

Among the treatment options of the liver cancer are chemotherapy, ablation, embolization, targeted treatment, radiotherapy and surgery. While these treatments are used to cure the tumor, they can be used to increase quality of life and to ease the severity of the symptoms in advanced stages. Moreover, the treatment options can be used together or alone.

 

Chemotherapy

Chemotherapy uses drugs to cure cancer. The active ingredients in these drugs kill cancer cells. Chemotherapy drugs can be administered intravenously or by mouth. If the drug is administrated through a vein, a thin tube, called a catheter, is inserted into a large vein and chemotherapy drug is delivered from this catheter throughout the course of the treatment.

 

One or more chemotherapy medicines may be administered according to the response of the cancer to the treatment and the type of cancer. After chemotherapy is given for a certain period, treatment is paused. After the completion of this defined “break” period, treatment resumes. Each of these periods is called cycle.

 

Side effects of chemotherapy are secondary to the chemotherapeutic agent and dose. Most common side effects seen in chemotherapy drugs include; malaise, nausea, vomiting, mouth sores, hair loss and inflammation in the digestive system. Side effects caused by chemotherapy will also be treated by your doctor. In case of the side effects become severe to threaten your health, your doctor may advise to suspend the treatment or to take another chemotherapy medicine.

 

Targeted Therapy

Targeted therapies are newer anti-cancer treatments compared to chemotherapy. These medicines target specific abnormalities that are present in cancerous cells. Before these medicines are started, cancer cells are first analyzed in laboratories to determine whether they have particular mutations or not.

 

Radiotherapy

Radiation therapy aims to kill cancer cells by using high-powered energy beams.

 

If the radiation source is out of the body and beams are directed to cancer, this treatment is called external radiotherapy.  On the other hand, if the radioactive agent is put into the area that cancer is present by a needle or catheter, method is called internal radiotherapy (brachytheraphy).

 

Although radiation therapy can also be used as first order therapy of cancer, generally it is used to kill cells that are not removed by surgery. In the first-line treatment, mostly radiotherapy and chemotherapy are administered together and this treatment is also known as chemoradiotheraphy. It plays an important role in relieving or eliminating pain, shortness of breath and chronic cough in advanced stage cancers.

 

If the liver cancer is very small in size, stereotactic radiotherapy (radiosurgery) may be useful in killing cancer cells by focusing radiation beams precisely on the tumor. In some cases, radiosurgery may remove the requirement for traditional surgery. However, patient selection is a very important issue for radiosurgery.

 

The side effects of radiotherapy take place in a very wide range depending on the body region where the radioactive rays are transmitted.

 

Local treatments

Local therapies including but not limited to ablation – killing cancer cells by heating or freezing them-, chemoembolization – injecting chemotherapeutic agent(s) into cancer cells- or injecting alcohol into the tumor can be instituted depending on type, size and location of tumor.

 

Surgery:

Surgery is the definitive treatment for the liver cancer. Your surgeon may remove the tumor along with a small amount of tissue around the tumor, if the tumor is small, more than one tumor exists, sufficient amount of liver tissue will remain after the surgery and location of tumor allows a surgical procedure. Again, removal of one lobe of the liver is a surgical option.

 

For patients with liver that is almost entirely affected by the cancer, the only surgical option is liver transplant. Liver of the patient is completely removed and the donor (living or deceased) liver is transferred to the patient.

 

Asking your questions about the treatment of liver cancer, your life after treatment, rehabilitation, pain management, clinical studies and all the questions in your mind about the liver cancer to your doctor will help you for an informed participation to your treatment and alleviating your concerns.