Liver cancer refers to uncontrolled cell growth inside or on the surface of the liver. Liver cancer is the third most common type of cancer worldwide.
Primary liver cancer means that the tumour starts in the liver. The most common type of primary liver cancer is called hepatocellular carcinoma (HCC). Patients who have underlying chronic liver disease (such as chronic hepatitis B or C, or conditions caused by alcohol abuse or a build-up of too much iron) and develop cirrhosis (scarring of the liver) are most likely to suffer from this kind of cancer.
When the cancer results from cancerous cells spreading to the liver from other parts of the body, it is referred to as metastatic liver disease.
Generally, liver tumours are discovered during routine screening or when they cause symptoms because of their size or location. Common symptoms include weakness, fatigue, weight loss and loss of appetite. Other possible symptoms are fever, night sweats and pain in the abdomen, but these occur less frequently.
Patients with chronic liver disease generally have symptoms of advancing cirrhosis, such as jaundice (meaning the skin and whites of their eyes turn yellowish), itching, an enlarged spleen, severe weight loss and weakness, as well as bleeding in the upper gastrointestinal tract, caused when blood is re-routed through blood vessels in the stomach and gullet, which then swell and split.
In most cases, a biopsy will be necessary to determine the exact type of cancer and to judge its aggressiveness. These are now commonly carried out with image-guided, minimally invasive techniques that involve inserting a needle directly into the liver through the abdominal wall in the stomach area.
Other specific options are available depending on the exact type of liver cancer involved, such as testing blood for tumour markers or using imaging techniques.
Both traditional surgery and interventional techniques play a role in treating liver cancer. If you have HCC, your surgical options include removing all or part of the liver and liver transplantation. However, many patients do not qualify for this treatment for various reasons.
Interventional alternatives include several percutaneous thermal ablation techniques, meaning that a needle is inserted into the liver tumour under image guidance, through which extreme temperatures are delivered to destroy the tumour.
Types of percutaneous thermal ablation techniques include radiofrequency ablation (which uses radiofrequency energy), microwave ablation (using microwave heat), cryoablation (in which a gas is used to freeze the tissue), or electroporation (using a powerful electrical field using high-voltage direct current).
In some cases, the liver tumour has an unusually high number of blood vessels attached to it. This increases the risk of bleeding, making it harder to remove the tumour. A treatment called transarterial chemoembolisation can relieve the pain and suffering caused by these tumours. In this procedure, an interventional radiologist delivers a high dose of a cancer-killing drug directly into the tumour.
Another possible treatment is radioemboliastion, a similar technique to transarterial chemoembolisation that is used to extend and improve the quality of patients’ lives. During this procedure, an interventional radiologist injects radioactive microspheres directly into the tumours, a targeted approach that destroys them or slows down their growth rate.
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Radiofrequency ablation may be indicated as the primary treatment for hepatocellular carcinoma – HCC and liver metastases if the patient is unfit for surgery or in the treatment of post-resection recurrence.