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Make sure to tell your doctor if you have a history of long-term alcohol abuse or a chronic hepatitis B or C infection. Another diagnostic test available is a liver biopsy. A liver biopsy involves removing a small piece of liver tissue.
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In most cases, a needle biopsy is performed. During this procedure, your doctor will insert a thin needle through your abdomen and into your liver to obtain a tissue sample. The sample is then examined under a microscope for signs of cancer. A liver biopsy might also be performed using a laparoscope, which is a thin, flexible tube with an attached camera. The camera allows your doctor to see what the liver looks like and to perform a more precise biopsy.
The laparoscope is inserted through a small incision in the abdomen. If tissue samples from other organs are needed, your doctor will make a larger incision. This is called a laparotomy. If liver cancer is found, your doctor will determine the stage of the cancer. Staging describes the severity or extent of the cancer. It can help your doctor determine your treatment options and your outlook.
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Stage 4 is the most advanced stage of liver cancer. Your specific treatment plan will be based on these factors. Liver cancer treatments may include the following:. A hepatectomy is performed to remove either a portion of the liver or all of the liver. This surgery is usually done when the cancer is confined to the liver.
Over time, the remaining healthy tissue will regrow and replace the missing part. A liver transplant involves replacing the entire diseased liver with a healthy liver from a suitable donor. Medicines to prevent rejection are given after the transplant. Ablation involves the use of heat or ethanol injections to destroy the cancer cells.
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This numbs the area to prevent you from feeling any pain. Chemotherapy is an aggressive form of drug therapy that destroys cancer cells. The medications are injected intravenously, or through a vein. In most cases, chemotherapy can be given as an outpatient treatment. Chemotherapy can be effective in treating liver cancer, but many people experience side effects during treatment, including vomiting, decreased appetite, and chills. Chemotherapy can also increase your risk of infection. Radiation therapy involves the use of high-energy radiation beams to kill cancer cells.
It can be delivered by external beam radiation or by internal radiation.
Types of liver cancer
In external beam radiation, the radiation is aimed at the abdomen and chest. Internal radiation involves the use of a catheter to inject tiny radioactive spheres into the hepatic artery. The radiation then destroys the hepatic artery, a blood vessel that supplies blood to the liver. This decreases the amount of blood flowing to the tumor. When the hepatic artery is closed off, the portal vein continues to nourish the liver. They decrease tumor growth and help shut down blood supply to the tumor.
Sorafenib Nexavar has been approved as targeted therapy for people with liver cancer. However, targeted therapy can have significant side effects. Embolization and chemoembolization are surgical procedures. Your doctor will use small sponges or other particles to do this. This reduces the amount of blood flowing to the tumor. In chemoembolization, your doctor injects chemotherapy drugs into the hepatic artery before the particles are injected. The blockage created keeps the chemotherapy medications in the liver for a longer period. However, you reduce your risk for liver cancer by taking steps to prevent the development of conditions that can lead to liver cancer.
Adults who are at high risk for infection, such as those who abuse intravenous drugs, should also be vaccinated. The vaccination is usually given in a series of three injections over a period of six months. A liver cancer diagnosis can be overwhelming. You may want to speak with a counselor who can help you work through your emotions. Ask your doctor about support groups in your area. You can also find information on support groups on the National Cancer Institute and the American Cancer Society websites. Identifying your triggers can take some time and self-reflection. In the meantime, there are things you can try to help calm or quiet your anxiety….
Although HCC often does not cause symptoms, some people will develop mild to moderate pain in the upper abdomen and may feel full despite eating less food than usual early satiety.
Some may experience fatigue, unintended weight loss or have a mass that can be felt palpable in the upper abdomen. Less commonly, fever or diarrhea may be present. Usually, such symptoms occur later in the diseases course and indicate advanced disease. Some symptoms may occur if the cancer has spread to other areas metastasized. For example, bone pain may occur if the cancer has spread to the bones, or a person may have difficulty breathing dyspnea if the cancer has spread to the lungs. Some people with HCC may develop a paraneoplastic syndrome.
There is also a risk of a tumor rupturing, leading to bleeding into the peritoneum, which is the membrane that lines the abdomen and covers the abdominal organs intraperitoneal hemorrhage. The exact reasons why hepatocellular carcinoma develops is not fully understood.
It is a multifactorial disorder, which means that there are multiple factors that must occur before the disorder develops. There are risk factors that increase the chances of a person developing HCC. Most people have an underlying liver disorder including infection with hepatitis B or C viruses, scarring of the liver cirrhosis , a condition in which fat builds up in the liver non-alcoholic fatty liver disease , and a condition in which fat builds up in the liver along with inflammation and liver cell damage nonalcoholic steatohepatitis or NASH.
Heavy drinking is also a risk factor for HCC; excessive drinking is one of the main causes of cirrhosis and can also cause alcoholic fatty liver disease. Cigarette smoking is also a potential risk factor for HCC. Obesity and diabetes are modest risk factors, but the absolute risk is considered to be very low. Foods contaminated with aflatoxin also increase the risk of HCC; this is even true for people without an underlying liver disorder.
Aflatoxins are a type of toxin produced by fungi and may contaminate certain agricultural products. There are also several metabolic and genetic disorders that may increase the risk of developing HCC. These disorders include Wilson disease, hemochromatosis, autoimmune hepatitis, alpha-1 antitrypsin deficiency, and primary biliary cholangitis For more information on these disorders, choose the specific disorder name as your search term in the NORD Rare Disease Database.
Hepatocellular carcinoma is one of the most prevalent cancers in the world, but relatively rare in the United States. There are approximately six new cases of HCC per every , people in the general population of the U. The number of people who develop HCC in the U. In certain geographic regions in the world, HCC is much more common most likely due to increased frequency of hepatitis B infection or exposure to aflatoxins. One estimate places HCC as the fifth most common cancer that leads to death in the world. Primary means that the cancer started in the liver as opposed to secondary, in which cancer has spread to the liver from another area of the body.
Symptoms of the following disorders can be similar to those of hepatocellular carcinoma. Comparisons may be useful for a differential diagnosis. Certain other tumors such as a hepatoblastoma or hemangioma of the liver can be mistaken for HCC. A hepatoblastoma is a malignant form of cancer that most commonly affects infants and children.
A hemangioma is a non-cancerous benign tumor that consists of an overgrowth of blood vessels. Another benign tumor that can occur in the liver is focal nodular hyperplasia. A liver hemangioma and focal nodular hyperplasia are the two most common tumors of the liver. Because hepatocellular carcinoma does not cause symptoms early in the disease, getting a prompt diagnosis is difficult.
Since there are more effective treatment options the earlier the disease is identified, early diagnosis is very important. People who have a high risk of developing HCC should enter into a surveillance program. This program involves studying the liver through an ultrasound examination every six months. During an ultrasound, reflected sound waves are used to create an image of internal organs or structures such as the liver.
Such a program is the only effective way to detect and diagnose HCC in a timely fashion, so that curative treatment options can still be used.
Cancerous tumours of the liver - Canadian Cancer Society
People with hepatitis B or cirrhosis from any cause should be enrolled in such a surveillance program. Patients with hepatitis C who do not have cirrhosis are not typically screened for liver cancer. Doctors may then recommend advanced imaging techniques such as computed tomography CT scan or magnetic resonance imaging MRI to try and confirm a diagnosis of HCC. During CT scanning, a computer and x-rays are used to create a film showing cross-sectional images of certain tissue structures.
An MRI uses a magnetic field and radio waves to produce cross-sectional images of specific organs and bodily tissues. People who are not in a surveillance program may be diagnosed because they have liver disease and doctors discover that they have rising alpha-fetoprotein levels. This protein occurs in high levels in developing fetuses, but is usually not seen in high levels in children or adults. High levels of this protein might indicate liver cancer, especially in people who have underlying liver disease. Sometimes, doctors may need to take a tiny sample of liver tissue to be studied under a microscope to confirm a diagnosis of HCC.
This is called a liver biopsy. During a biopsy, a needed is passed through the skin to take a tiny sample of affected liver tissue. There is a risk of false negatives, so careful surveillance with imaging tests is still recommended even if the biopsy is negative. Because of these risks, liver biopsy is not routinely performed for people with typical imaging features of HCC. Hepatocellular carcinoma usually occurs in people who have an underlying liver disease or liver dysfunction.
Treatment may require the coordinated efforts of a team of specialists. Psychosocial support for the entire family is essential as well. Because people with HCC usually have an underlying liver condition, that condition needs to be monitored and treated as well. The underlying liver condition will greatly impact the longer-term survival of an affected individual. Physicians will stage HCC as part of developing a treatment plan.
Cancer staging is used to determine how far cancer has progressed in a person and where it is located within the body. The most commonly used staging system is the Barcelona Cancer of the Liver staging system which takes into consideration liver function, daily performance ability and the size and number of liver tumors.
Surgical resection is best undertaken by a hepatobiliary surgeon because they are experienced with liver surgery. Additionally, some people with small tumors may be candidates for a liver transplant. If surgery or a transplant is not possible, affected individuals may undergo radiofrequency ablation or microwave ablation.
Radiofrequency ablation is a procedure in which a small needle is inserted into the tumor and used to deliver high-frequency alternating current radiofrequency waves that destroys ablates affected tissue.