The cancers that start in the liver are called liver cancer (primary liver cancer). It is important to distinguish these from secondary (metastatic) liver tumours, the treatment is entirely different. These tumours are common in India and other developing countries due to high prevalence of hepatitis B and C, and alcohol abuse.
The liver is the largest internal organ. It lies under your right ribs just beneath your right lung. It is divided into lobes.
There is more than one kind of primary liver cancer.
- Hepatocellular carcinoma
- Intrahepatic cholangiocarcinoma
Hepatocellular cancer (HCC) can have different growth patterns:
- Some begin as a single tumor that grows larger. Only late in the disease does it spread to other parts of the liver.
- A second type seems to start as many small cancer nodules throughout the liver, not just a single tumor. This is seen most often in people with cirrhosis (chronic liver damage) and is the most common patterns.
Experienced pathologists can distinguish several subtypes of HCC. Most often these subtypes do not affect treatment or prognosis (outlook). But one of these subtypes, fibrolamellar, is important to recognize. This type is rare, making up less than 1% of HCCs. This type is most often seen in women younger than age 35, and often the rest of the liver is not diseased. This subtype generally has a better outlook than other forms of HCC.
About 10% to 20% of cancers that start in the liver are intrahepatic cholangiocarcinomas. These cancers start in the cells that line the small bile ducts (tubes that carry bile to the gallbladder) within the liver. (Most cholangiocarcinomas actually start in the bile ducts outside the liver.)
Liver cancers are diagnosed by a variety of imaging tests such as CT scans, MRI scans, using a special technique known as triple phase studies. This will help the treating team to understand the involvement of the blood vessels and the bile ducts.
In addition, it is important for patients to undergo tests to understand the viral infections (Hepatitis B and C), functioning of liver etc. this will help them to design the treatment.
After liver cancer is diagnosed and staged, your cancer care team will discuss your treatment options with you.
In creating your treatment plan, important factors to consider include the stage (extent) of the cancer and the health of the rest of your liver. But you and your cancer care team will also want to take into account the possible side effects of treatment, your overall health, and the chances of curing the disease, extending life, or relieving symptoms. Based on these factors, treatment options may include:
- Surgery (removal part of liver (partial hepatectomy)
- Liver transplant in eligible patients with live related donors or cadaver transplants.
- Tumor ablation with radiofrequency ablation
- Tumor embolization (TACE and TARE)
- Radiation therapy specialized technique called stereotactic body radiotherapy (SBRT)
- Targeted therapy (some kind of tablets)
Depending on your situation, you may have different types of doctors on your treatment team. These doctors may include:
- A onco- surgeon or hepatic surgeon : a doctor who treats liver diseases with surgery.
- A radiation oncologist: a doctor who treats cancer with radiation therapy.
- A medical oncologist: a doctor who treats cancer with medicines such as chemotherapy.
- A gastroenterologist: a doctor who specializes in treating diseases of the digestive system, including the liver.
It is important to discuss all of your treatment options, including their goals and possible side effects, with your doctors to help make the decision that best fits your needs. Some important things to consider include:
- Your age and expected life span
- Any other serious health conditions you have
- The stage (extent) of your cancer
- Whether or not surgery can remove (resect) the cancer
- The likelihood that treatment will cure the cancer (or help in some other way)
- Your feelings about the possible side effects from treatment