Liver cancer – Symptoms and causes

Liver cancer rarely causes discomfort at the beginning of its growth. The person concerned initially does not notice anything. Small asymptomatic liver tumors have so far often been found by chance during routine examinations, but in the near future they will hopefully be identified predominantly by targeted sonographic screening. The first, usually unspecific signs of liver cancer usually appear only at the advanced stage of the disease. But then it can be too late for a complete healing.

The following symptoms may occur:

Pressure pain in the upper abdomen
a palpable swelling under the right costal arch
Loss of appetite, nausea or increased temperature of unexplained cause
Weakness, reduction in performance
unwanted weight loss
Increased yellowing of the skin (jaundice) and itching
If you observe such symptoms, it does not mean that you have a tumor. All of these complaints can also have relatively harmless causes. But they can also be an indication of cancer. Therefore, clarify the cause of such complaints as quickly as possible and do not push the doctor visit in any case!

Because: The prerequisite for a successful treatment of the disease is a timely diagnosis. In early stages, liver cancer can either be removed by surgery or “overcooked” by radiofrequency ablation and the disease can be cured. Unfortunately, many people affected by the cancer at the time of diagnosis so far advanced that a cure is hardly possible. But even with advanced tumor disease, a quick diagnosis can help to increase the chance of survival and to make the remaining life span bearable and liveable.

Symptoms of liver cancer
Liver cancer (liver carcinoma) initially often causes more general, nonspecific symptoms . In early stages of the disease usually no complaints occur; therefore, the diagnosis of liver cancer is often made late. This worsens the prognosis.

Possible symptoms of liver cancer are:

Pressure pain in the right or middle upper abdomen
nausea
anorexia
Weakness, decreased efficiency
elevated temperature without apparent cause
inexplicable weight loss
palpable swelling under the right costal arch (occasionally)
The liver produces bile, which drains through the biliary tract into the digestive tract. Tumors of the liver or bile ducts can hinder this outflow. This causes the bile to accumulate. Then the typical symptoms of jaundice (jaundice) show up: The white of the eyes, and later also the skin and mucous membranes, are becoming increasingly yellow. In addition, the urine is darker than usual, the chair, however, lighter than usual. In addition, the skin may itch .

Ailments such as nausea, abdominal pain or loss of appetite can have many causes and are not necessarily an indication of liver cancer. Nevertheless, if you notice such symptoms for a long time, you should consult a doctor. He can rule out or confirm whether it is actually liver cancer.

Causes of liver cancer
The exact causes of liver cancer are unknown. An important risk factor is cirrhosis of the liver . Cirrhosis of the liver (“shrinking liver”) is a severe liver damage often caused by years of alcohol abuse . The most common form of primary liver cancer, liver cell cancer (hepatocellular carcinoma), is almost always the result of liver cirrhosis .

About 9 out of 10 patients with liver cell cancer have liver cirrhosis.

Risk Factor: Infection with hepatitis viruses
Even without liver cirrhosis, the risk of liver cell cancer is significantly increased if a person suffers from chronic, ie permanent liver inflammation ( hepatitis ) by viruses . Especially an infection with the hepatitis B virus can promote liver cancer. Anyone who has been infected with hepatitis B at birth has a higher risk of developing liver cancer during their lifetime than someone who becomes infected later.

Chronic hepatitis C infection is also a risk factor.

Risk Factor: Chronic liver inflammation due to fatty liver
Another risk factor for liver cancer is fatty liver , which can lead to chronic liver inflammation. A fatty liver can have various causes. Above all, alcohol , diabetes mellitus and severe overweight play a role in the development.

Other risk factors
Other factors that increase the risk of liver cell cancer include, among others

liver-damaging substances such as aflatoxin B1 in the diet (poison of the fungus Aspergillus flavus , which grows on cereals, peanuts and other foods in a humid climate)
Hereditary diseases of the metabolism, eg iron storage disease (hemochromatosis), Wilson’s disease
Taking certain sex hormones (eg anabolic steroids )
Occupational exposure to chemical substances such as solvents or pesticides
Causes of bile duct cancer
The causes of the less common bile duct carcinoma ( bile duct cancer , cholangiocarcinoma) are not fully understood. However, certain diseases increase the risk. These include

Cysts of the bile duct (choledochal cysts),
initially benign tumors of the bile ducts (adenomas),
Bile duct stones ,
a rare chronic inflammation of the bile ducts (so-called primary sclerosing cholangitis , PSC) as well as
Liver disease caused by chronic infections with parasites such as liver flukes (especially in countries like China and Japan).
Also, smoking and advanced age appear to increase the risk of cancer of the liver and bile duct cancer.

Diagnosis of liver cancer
In case of suspected liver cancer (liver carcinoma), some examinations are necessary. If cancer was actually found, it’s important to find out

whether the tumor originally originated from the liver (so-called primary liver cancer) or
whether it is liver metastases (so-called secondary liver cancer).
At the beginning there is the detailed conversation between doctor and patient. For example, the doctor asks

Type and duration of complaints,
Pre and concomitant diseases and after
possible risk factors for cirrhosis such as chronic hepatitis or alcohol abuse .
This is followed by a thorough physical examination : Among other things, the doctor scans the liver and other organs of the abdomen through the abdominal wall. Other initial investigations include:

Ultrasound ( ultrasonography ): In the ultrasound, the doctor can look atthe liver, bile ducts and gallbladder, kidneys and spleen. He can also examine the lymph nodes. The ultrasound examination is risk-free and painless.
Blood collection and laboratory tests : On the basis of the blood picture, the doctor can recognize on the one hand possible evidence of cancer. On the other hand, the doctor can use the blood levels to determine how well the liver works. In addition, hepatitis viruses can be detected or excludedin the blood. A specific tumor marker in the blood is often elevated in various types of cancer: alpha-fetoprotein (AFP). A reliable statement whether liver cancer is present or not, the AFP value does not allow alone. Even during pregnancy , AFP is often naturally elevated.
Further investigations
If the suspicion of liver cancer is confirmed, further investigations are useful to confirm the diagnosis and determine how far the tumor has spread. These include:

Computed tomography (CT) with the administration of a contrast agent
Contrast Media Ultrasound (KMUS)
Magnetic Resonance Imaging (MRI) with a contrast agent
If it is unclear whether it is primary liver cancer or liver metastases, the doctor will, if necessary, perform a gastroscopy (gastroscopy) and / or a colonoscopy (colonoscopy). So he can find out if a cancer in the stomach or intestine has spread to the liver. During the examination, the doctor introduces a flexible optical instrument, an endoscope , into the stomach or intestine . It is equipped with a light source and a camera. On a connected screen, the doctor can then closely examine the stomach or intestinal mucosa.

A 100% certainty that it is liver cancer, can finally confirm only a histological examination of the abnormal liver areas under the microscope. The removal of liver tissue using a fine needle (so-called fine needle aspiration), however, involves the risk that tumor cells settle in the branch canal of the needle and spread in the body. Therefore, if there are any prospects of completely curing the liver cancer, doctors refrain from fine needle aspiration.

If bile duct cancer is suspected , mirroring the bile ducts with an endoscope can provide clarity (so-called endoscopic retrograde cholangiography, ERCP). In cancer of the bile ducts, a specific tumor marker in the blood is increased: the so-called Ca 19-9 (Cancer antigen 19-9, cancer = cancer). Therefore, the doctor takes blood and examines it for this protein. The determination of the tumor marker alone is not suitable for diagnosis.

Therapy of liver cancer
The most important forms of treatment for liver cancer (liver carcinoma) are:

Surgery (partial removal of the liver )
liver transplantation
Destruction of the tumor with different methods
Which therapy is best for liver cancer depends on several factors, in particular of
the size of the tumor,
the location of the tumor,
the spread of the tumor,
the condition of the liver,
the age of the patient and
the health status of the patient.
Last but not least, the individual wishes of the patient in the choice of treatment are important. The task of the doctor is to show his patients the different treatment options and to describe possible advantages and disadvantages of the respective treatment.

Surgery (partial liver removal, liver resection)
Whether liver surgery is an option depends, among other things, on how well the liver is still working. Therefore, the doctor checks the liver function before deciding for or against surgery.

The operation is the method of choice for liver cancer, if the liver tissue is still quite healthy, so there is no advanced cirrhosis . Especially smaller tumors can be operated on with good results, which improves the prognosis of the disease.

As part of the operation, the surgeon removes the part of the liver where the tumor is located. In addition, it removes surrounding healthy tissue. This increases the likelihood that no cancer cells will remain in the body. Doctors also call this “healthy removal”.

liver transplantation
Especially for people with liver cirrhosis , liver transplantation can lead to better results than partial liver removal.

Since a liver transplantation is a great and stressful procedure, it is only suitable for people whose general condition is good and who suffer from as few or no comorbidities as possible.

After liver transplantation, the patient must take long-term medication that prevents rejection of the donor liver. The immune system of the body would otherwise attack the body’s foreign organ.

Destruction of the tumor

If it is not possible to eliminate the tumor by surgery, it is possible to destroy individual liver tumors on the spot. This method can be used in different situations if it is not possible to partially remove the liver by surgery:

as sole therapy for small tumors with the aim of healing,
as a treatment to bridge the time to a liver transplant or to reduce the size of the tumors and thus enable the intervention,
as a palliative therapy, that is, to improve the quality of life of the person affected, if a cure is not possible
Radiofrequency ablation
The radiofrequency ablation (radiofrequency) is the standard procedure when it comes to destroy a liver cancer tumor and then to cure the patient.

In this method, the doctor delivers a catheter or applicator to the focus of the disease in the liver. Radiofrequency waves are used to heat the tumor. The doctor then removes the tumor using special instruments. Depending on the findings, several sessions may be necessary.

In addition to radiofrequency ablation, there are other methods to destroy a tumor and cure the patient, such as ablation using ultrasound (microwave ablation). The effect of these methods, however, is less well studied.

When the cancer is no longer curable
If liver cancer can not be completely removed by surgery or transplantation due to its extent, the treatment is no longer aimed at healing.

In the foreground of the therapy is then to maintain the quality of life of the patient or to improve, for example by

the removal of individual cancers,
Methods that delay cancer growth,
an effective pain therapy or
the treatment of other conditions caused by the tumor.
The doctor will consider together with his patient whether and what kind of therapy makes sense.

Delay cancer growth: Arterial treatment
With the help of so-called arterial treatment, the cancer can not be cured, but its growth can be delayed.

Healthy liver tissue is supplied via a vein, the so-called portal vein. In contrast, tumors in the liver are dependent on the hepatic artery . This feature is exploited by physicians in arterial treatment by targeting the hepatic artery.

Too often used methods include:

transarterial chemoembolization (TACE): In this method, the physician clogs the vessel leading to the tumor. Thus, the tumor can not be supplied with nutrients – his cells die off. If the doctor additionally injects a cell poison into the blood vessel , this increases the effect. The trans chemoembolization may be done before surgery to shrink the tumor.
Selective internal radiotherapy (SIRT): In this fairly new procedure, the liver is locally irradiated from the inside. For this, the doctor brings very small, enriched with a radioactive substance beads directly into the blood vessels that supply the liver.
Therapy with drugs (systemic therapy)
If the cancer has already spread in the tissue or even formed metastases, a local treatment is not enough. If this is the case, the doctor may administer medicines containing the active ingredient sorafenib , which act on the whole body. These drugs could slow down the growth of cancer cells.

Sorafenib can be taken as a tablet. In liver cancer (hepatocellular carcinoma), which can no longer be cured, the drug can extend the life expectancy of the patient a bit. To include possible side effects of sorafenib

diarrhea
Fatigue and weakness due to the lack of red blood cells
Coagulation disorders due to lack of platelets
Infectiousness due to the lack of white blood cells
inflammatory swelling on hands and feet
Supplementary therapy procedures
The treatment of liver cancer not only aims to eliminate the tumor or inhibit its growth. Rather, it is also about alleviating complaints and ensuring the quality of life as long as possible. Some examples:

Treatment of pain : Especially in the advanced stage many sufferers have to struggle with pain. Depending on how severe the pain, different painkillers can be helpful.
Treatment of chronic fatigue (fatigue): Many patients are affected by fatigue during treatment . A special exercise training can alleviate the symptoms.
Water in the abdomen : Through the tumor, water can form in the abdominal cavity (so-called ascites ). The water narrows the internal organs. Using a puncture, the doctor can derive the ascites.
Itching : If the bile ducts are narrowed and bile accumulates, it can cause severe itching . For a short time remedy, for example, can create ointments. They contain cortisone or locally numbing.
Psychological support : Cancer not only affects the body but also the psyche. Help in crisis situations and counseling are provided by psycho-oncologists, who are specially trained in the psychological treatment of cancer, but also pastors.
Liver cancer: course
forecast
The sooner liver cancer (liver carcinoma) is detected, the better the chances of recovery.

The life expectancy of liver cancer depends mainly on the number, size and location of the tumors and their extent in the body. It also plays a major role, whether it is a primary, that is, originally from the liver outgoing cancer, or liver metastases .

If primary liver cancer can be operated on, after 5 years on average about 20 to 50 out of 100 patients still live. After a liver transplant , 40 to 70 out of 100 patients still live after 5 years.

Liver cancer often remains undetected for a long time. In many cases, at the time of diagnosis, he has progressed so far that a cure is unlikely. If liver cancer has already spread metastases (mostly in the bones , lungs , adrenal glands and brain ), this worsens the prognosis. If the cancer is no longer curable, those affected live for an average of six to twelve months. However, these figures are averages – so it is possible that some patients survive much longer.

aftercare
Even if the tumor was successfully eliminated, the patient should go to the aftercare regularly.

Aftercare has the goal

Recognize a recurrence of liver cancer early and act accordingly (eg initiate therapy),
to identify , treat and alleviate any consequences of the operation and local procedures and concomitant diseases ; and
to support those affected in their physical, mental and social problems .
Typically, liver cancer patients should be followed up for a period of two to six months using MRI ( Magnetic Resonance Imaging ). In addition, long-term semi-annual physical examinations make sense. These include an ultrasound scan of the abdomen and liver and a blood sample .

Prevent liver cancer
The most common form of primary liver cancer, liver cell cancer (hepatocellular carcinoma), usually arises on the basis of liver cirrhosis . The best way to prevent liver cancer is therefore to prevent liver cirrhosis.

In more than half of the cases, liver cirrhosis develops through years of alcohol abuse . Alcoholism can lead to so-called fatty liver hepatitis, thereby multiplying the risk of liver cirrhosis. No alcohol to drink an effective method of liver cirrhosis and liver cancer therefore is accordingly submissions.

Hepatitis B vaccination

Another risk factor for liver cancer is infection with hepatitis viruses. The Standing Vaccination Commission (STIKO) at the Robert Koch Institute in Berlin recommends vaccination against hepatitis B viruses for all infants and toddlers . Even the most vulnerable adults, such as medical staff, drug addicts and those with frequently changing sexual partners recommend the institute the vaccine. Relatives of patients with hepatitis B may also take the opportunity to protect themselves by vaccination. There is no vaccine against hepatitis C so far.

To reduce the likelihood that acute liver inflammation will turn into chronic hepatitis, anyone who suffers from hepatitis B or C should receive timely treatment. Under certain circumstances, this prevents a long-term course of the disease.

Regular examinations for risk groups

If you belong to one of the at-risk groups and suffer from cirrhosis of the liver, for example, you should be examined at regular intervals. For example, the doctor will perform an ultrasound scan and determine the tumor marker AFP. Get advice from your doctor.