Liver Cancer

The liver is a large organ located on the right side of the body, at the top of your abdomen. Cancer can develop in this organ. Liver cancer, also known as hepatocellular carcinoma (HCC), occurs when normal cells in the liver turn into abnormal cells that begin to grow. In HCC, the tumor originates in the liver. This is not the same as a metastasis in the liver that stems from cancer elsewhere in the body (e.g., colon cancer with metastases in the liver, breast cancer with metastases in the liver, etc.).

Liver cancer is common in patients who have had another liver disease, such as liver cirrhosis or chronic hepatitis B, for a long time.

Liver cancer itself causes few or no symptoms. That is why it is sometimes not detected until a late stage. If symptoms do occur, they depend on the location, size, and number of tumors in the liver. Possible symptoms of liver cancer include:

• General weakness and fatigue
• A tender, painful area on the right side of the abdomen
• Weight Loss: Reduced Appetite
• Bleeding in the abdomen caused by the tumor rupturing
• Jaundice
• Fever

Often, there are symptoms of an underlying liver disease such as liver cirrhosis (link to the liver cirrhosis webpage). In such cases, patients may experience, for example, jaundice, a swollen abdomen, etc.

Liver cancer often develops as a result of chronic liver disease. Major risk factors for developing liver cancer include:

• Cirrhosis of the Liver
• Liver inflammations such as hepatitis B (link to HBV webpage), hepatitis C, nonalcoholic fatty liver disease, alcoholic hepatitis, etc.
• Hemochromatosis

Blood Test

A blood test is usually the first step in determining whether or not a person has liver cancer. Certain liver function tests may also be performed to monitor liver function.

AFP

A specific blood test used to screen for liver cancer is the alpha-fetoprotein test. This is what is known as a “tumor marker.” Tumor markers are special proteins produced by a tumor. An elevated tumor marker level in the blood is an initial indication that cancer may be present. However, tumor markers can sometimes be “false-positive” or “false-negative.” “False positive” means that the test result is elevated, but there is no tumor. “False negative” means that the test result is normal, but a tumor is present.

Radiological Examination

To determine the exact location of the liver tumor, its size, and how many liver tumors there are, imaging tests are performed. These may include an ultrasound, CT scan, MRI scan, PET scan, etc.

Liver biopsy

Although the diagnosis can usually be made based on blood tests and imaging, a biopsy is sometimes necessary in patients with no history of liver disease (e.g., no liver cirrhosis at the time of a liver cancer diagnosis, no chronic hepatitis B, etc.). A biopsy may also be necessary if imaging reveals a lesion whose malignancy is uncertain.

There are several types of liver biopsies:

• Percutaneous Liver Biopsy
  : In this procedure, the doctor inserts a needle through the skin, between the ribs, to remove a small sample of liver tissue. (link to brochure) Because this biopsy is performed under ultrasound guidance, the needle can be directed precisely to a specific location on the liver.
• Transjugular Liver Biopsy
  When there is too high a risk of post-procedure bleeding (e.g., when the patient is taking a blood thinner that cannot be discontinued, when the patient has a coagulation disorder, etc.), a transjugular liver biopsy is performed. This involves removing a small sample of liver tissue through your blood vessels. The purpose is to obtain a sample of “normal” liver tissue that is free of cancer. This type of liver biopsy is rarely used to obtain a tissue sample from the suspicious area. 
• Biopsy during a diagnostic procedure.
  During a diagnostic procedure, the doctor may decide to remove a small sample of the lesion. At the same time, the doctor may also decide to treat the lesion during the procedure by cauterizing it.

After the biopsy, the tissue samples will be sent to the lab for further examination. You will receive the results at your next appointment, which will be scheduled shortly thereafter.

Liver cancer can be treated in various ways. The treatment depends on the stage of the cancer and the condition of your liver before the cancer developed. The patient’s overall health and physical condition are also important factors in determining which treatment he or she will receive.

Surgery

Liver cancer can sometimes be treated with surgery. During the procedure, the part of the liver containing the tumor is removed. This can also be done during laparoscopic surgery.

Liver Transplant

A liver transplant is a surgical procedure in which a surgeon replaces your old liver with a new, healthy liver from another person. AZ Delta refers patients to UZ Leuven or UZ Gent for this procedure. However, the pre-transplant tests can be performed at AZ Delta. The results of these tests are then forwarded to the hospital where you will undergo the transplant.

Whether a patient with liver cancer is eligible for a liver transplant depends on the number of lesions in the liver, their size, and the patient's overall condition.

After the transplant, you can alternate between follow-up visits at AZ Delta and the hospital where you received your transplant.

After a transplant, you must take medication for the rest of your life to suppress your immune system. The new liver is recognized as a “foreign” object in the body, and your body might try to reject this new organ. This medication ensures that your body does not reject the new liver, thereby protecting the new organ.

Ablation

Ablation is a procedure in which cancer cells are destroyed using heat, either through microwaves or radiofrequency. Ablation can be performed in various ways: through a puncture or via keyhole surgery.

Blocking the blood supply to the tumor

Specialists can perform a procedure called “embolization” on the vein that supplies blood to the cancer cells. This stops the cancer from growing because it no longer receives blood. Sometimes “embolization” is combined with the local administration of chemotherapy (chemoembolization) or with radiation therapy (radioembolization).

Chemotherapy

Chemotherapy is a general term for medications that kill cancer cells or stop them from growing.

Immunotherapy

This is a medication that doctors use to work with the body's own immune system to stop the cancer from growing.

Palliative Care

Palliative care involves slowing the progression of the disease as much as possible and alleviating symptoms. At this stage, a cure is often no longer possible.

Read more about liver cancer here [uptodate.com]

Read more about liver cancer here [mlds.nl]