Liver Cancer

2023 Author: Wallace Forman | [email protected]. Last modified: 2023-11-27 18:19

To decide which therapy to use, a malignant tumor is classified according to certain criteria. A common classification in diagnosis is the so-called TNM system of the Union for International Cancer Control (UICC). The tumor is classified according to its size (T), the involvement of lymph nodes (N) and the presence of distant metastases (M).

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">What are the causes?

What are the symptoms of liver cancer?
How is the diagnosis made?
How is liver cancer treated?
Whom can I ask?
How are the costs going to be covered?

What are the causes?

In 80 to 90 percent of cases, liver cancer originates in the liver cells and is therefore called liver cell carcinoma (hepatocellular carcinoma, HCC). In ten to 20 percent of cases, the cancer develops from the cells of the bile ducts in the liver (bile duct carcinoma, cholangiocellular carcinoma).

A number of risk factors increase the risk of developing liver cancer. These include:

Liver cirrhosis: In Europe, the vast majority of all cases of HCC occur in patients with pre-existing liver cirrhosis.
Viral liver inflammation: Hepatitis B and hepatitis C are the most important risk factor. Carriers of the hepatitis B virus are up to a hundred times more likely to develop liver cell carcinoma.
non-alcoholic fatty liver;
Hemochromatosis: abnormal iron storage in the organism;
Cigarette smoking;
Alcohol abuse;
Poisons: especially aflatoxin (poisons in molds), vinyl chloride (PVC monomer) or arsenic;
anabolic steroids;
Liver Cancer in the Family.

Most liver cell carcinomas can be prevented by preventing hepatitis B and hepatitis C, as well as cirrhosis. Furthermore, drug treatment for hepatitis B and C can reduce the risk of liver cirrhosis and liver cancer.

What are the symptoms of liver cancer?

Liver cancer rarely causes symptoms in the beginning and is therefore often only found during routine examinations. The first uncharacteristic signs of liver cancer usually only appear at an advanced stage of the disease.

The following symptoms can occur with liver cancer, among others:

Pressure pain in the upper abdomen,
a palpable swelling under the right costal arch,
Loss of appetite,
Nausea,
increased temperature with unknown cause,
Weakness, tiredness and decreased performance,
unwanted weight loss,
increasing yellowing of the skin and eyes (jaundice),
Increase in waist size, ascites (ascites).

In many cases, the tumor remains confined to the liver even in advanced stages. This can lead to an increasing loss of functional liver tissue. With increasing growth - depending on its location within the organ - liver cancer can also break through the connective tissue capsule of the liver and attack nearby tissue (e.g. the peritoneum) or lymph nodes. Individual cancer cells can also reach distant organs such as the lungs, adrenal glands, bones and brain via lymph vessels and blood vessels and form metastases there.

How is the diagnosis made?

If liver cancer is suspected, a doctor will clarify whether it is a benign change or cancer, what type of tumor is present (histology) and where the tumor is located. The size, number and spread of the tumors are used to assess how far the disease has progressed or whether metastases have already formed. At the beginning there is a detailed interview (anamnesis) and a physical examination.

Blood tests provide information about the function of individual organs such as the kidneys, liver, heart and lungs. An examination for hepatitis viruses and the measurement of the tumor marker alpha-fetoprotein (AFP) are also carried out. In addition, imaging examinations such as ultrasound, computed tomography, magnetic resonance tomography and X-rays are used. A biopsy can be performed during a laparoscopy or under ultrasound guidance with a fine needle (“fine needle biopsy”). The tissue sample is then examined histologically.

The so-called tumor grading also evaluates the degree of malignancy, usually in three stages (grade 1 to 3). In addition, liver function is an important criterion for treatment planning. Different options are available depending on the overall findings.

How is liver cancer treated?

Surgery: One method of treating liver cancer is to have part of the liver removed. The aim of this operation is to completely remove the tumor and thus cure the disease. This is only possible if the function of the remaining liver is excellent and the tumor is limited to the liver and can be removed from healthy tissue with a sufficient safety margin. Patients who have had their liver partially removed have a good chance of living five years or more from the time the diagnosis is made (so-called five-year survival rate).
Liver transplantation: If liver cirrhosis is present in addition to liver cancer, liver transplantation is the treatment of choice in the early stages of the tumor. However, it can only be carried out in a relatively small number of patients. The five-year survival rates are up to over 90 percent, depending on the stage of the cancer and the time of the transplant.
Local ablative therapy concepts: The tumor is destroyed by injecting alcohol or by exposure to heat. These therapies can be cured in early tumor stages.
- Percutaneous ethanol or acetic acid injection (PEI): Under ultrasound or CT control, 95 percent alcohol (ethanol) is injected into the tumor using a fine needle. This causes the tumor tissue to die, but the surrounding liver tissue is largely spared. The treatment is often carried out in several sessions and can be repeated after a few months.
- Radiofrequency or laser-induced thermotherapy: A probe is inserted into the tumor, also under ultrasound or CT control, and the tissue is heated with radiofrequency waves or laser light. This can destroy tumor tissue three to five centimeters in diameter. The treatment is often carried out in several sessions. Methods based on a similar principle of action are microwave ablation, irreversible electroporation and cryotherapy.
Soothing (palliative) therapies: They are used when a cure is no longer possible due to the advanced state of the disease. Most patients who are diagnosed this late live only a few weeks to a few months afterwards. However, there are a number of procedures that can extend survival and improve quality of life.
- Chemoembolization: A cytostatic drug is injected into the liver through a catheter inserted into the hepatic artery. At the same time, small particles that dissolve again are used to temporarily close the blood vessels leading to and from the liver tumor in order to increase the length of time the drug remains. This method can be combined with thermotherapy or ethanol injection. This can often reduce the size of the tumor and extend its life.
- Chemotherapy: Local forms of treatment are often not effective in the case of large or multiple tumor foci that are distributed over the liver. Chemotherapy can be done instead. However, liver cell carcinoma does not respond well to conventional cytostatics. In patients with extensive hepatocellular carcinoma (HCC) and at the same time good liver function, however, it has been shown that oral administration of the drug sorafenib can extend life. Positive study data are also available for regorafenib and tivantinib. Further substances are being tested in clinical studies.
- Selective internal radiotherapy (SIRT): This relatively new procedure (also called transarterial radioembolization, TARE) is a local radiation treatment of liver tumors from the inside.
- External radiation therapy: For large, localized liver carcinomas, external radiotherapy can be performed. It is currently being further developed within the framework of studies and is often combined with drug therapy.
- Pain treatment: In advanced stages of the disease, tumor pain can be largely alleviated by means of pain tablets, morphine plasters and pumps, etc.

Aftercare

Follow-up care means regular visits to the doctor for individual advice and monitoring of recovery. It is important to recognize the side effects of treatment and to carry out targeted rehabilitation. It is particularly important to recognize a possible recurrence of the disease (relapse) at an early stage. Depending on the stage of the disease and the type of therapy carried out, the doctor will create an individual follow-up plan in which it is determined at what intervals check-ups should be carried out.

Note In the event of complaints, you should not wait for the follow-up appointments but contact your doctor immediately!

Whom can I ask?

The prognosis for liver cancer depends very much on the tumor stage at the time of diagnosis or the possible therapy. It can range from complete healing in the early stages to very short survival in an advanced late stage that is no longer accessible to treatment. A specialist in internal medicine should be consulted immediately if there are complaints that suggest a liver disease. If risk factors for liver cell carcinoma are present, regular liver examinations (ultrasound, etc.) should be arranged. In particular if there is already cirrhosis of the liver, an ultrasound examination of the liver should be carried out every six months in order to detect any hepatocellular carcinoma that may develop as early as possible.

How are the costs going to be covered?

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The e-card is your personal key to the benefits of the statutory health insurance. All necessary and appropriate diagnostic and therapeutic measures are taken over by your responsible social insurance agency. A deductible or contribution to costs may apply for certain services. You can obtain detailed information from your social security agency. Further information can also be found at: