No one can live without the largest internal organ in the body, and liver cancer is one of the most important diseases that threaten the function of this organ. Therefore, treatment of liver cancer requires special care from the best doctors and the latest devices and treatment methods that Turkey provides.
Liver cancer is a leading cause of cancer death worldwide, responsible for more than 700,000 deaths each year.
What is the liver and what is its function?
The liver is one of the most important organs in the body and is the largest gland in the body. It is located in the upper right side of the abdomen.
The liver is made primarily of cells called hepatocytes, which are the main functional cells of the liver. It is also made up of other types of cells, including cells that line blood vessels and cells that line small tubes in the liver called bile ducts.
The bile ducts carry bile from the liver to the gallbladder or directly to the intestine.
This diversity in the cells that make up the liver is accompanied by a diversity of tumors that affect it, whether benign or malignant.
These tumors have different causes, are treated differently, and each has a different prognosis and survival rate.
The liver is divided into sections called lobes, whose function is to purify and filter the blood of toxins. The liver excretes harmful substances (some medicines, alcohol…) from the blood, which are later excreted from the body as waste.
And the liver does a lot more than you think, including::
Forming bile, and transporting it to the intestines to help digest fats.
Digestion and storage of other nutrients from foods such as sugar which is stored as glycogen which provides the body with energy when needed.
Manufacture of many substances used in many functions of the body, including clotting factors.
Overview of the liver to identify its surroundings and connections with nearby structures
What is liver cancer?
To treat liver cancer, we need to understand what cancer is and how it occurs. Cancer is a disease that occurs when abnormal cells grow too quickly and leave less space for normal cells. A loss in the function of the affected organ may occur if cancerous cells overwhelm healthy cells.
So when the uncontrolled growth of distorted (cancerous) cells occurs at the expense of any type of cells in the liver, liver cancer occurs with different types that will be mentioned later in the article.
Liver cancer is classified into primary and secondary based on where the cancer originated.
Primary liver cancer
It is cancer that begins in the tissues of the liver at the expense of the multiple cells that make up the liver, and it has several subtypes:
Hepatocellular Carcinoma (HCC)
This is the most common form of liver cancer in adults, accounting for 75% of all liver cancers.
Hepatocellular carcinoma can have different growth patterns:
In some cases, a single tumor begins to grow larger, only later in the disease does it spread to other parts of the liver.
While in other cases many small cancerous nodules start to appear throughout the liver, rather than just a single tumor, this is most often seen in people with cirrhosis.
Cholangiocarcinoma
About 10% to 20% of cancers that begin in the liver are at the expense of the cells lining the bile ducts.
The bile ducts outside or inside the liver may be involved.
Liver Angiosarcoma
It is a rare type of liver cancer that arises at the expense of the cells lining the hepatic blood vessels.
It is believed that exposure to certain chemicals such as vinyl chloride or thorotrast and some genetic conditions such as hereditary hemochromatosis increase the likelihood of developing this tumor.
They are rapidly developing tumors that spread quickly and are often very widespread in the liver and cannot be removed surgically, so radiotherapy and chemotherapy are preferred here.
Hepatoblastoma
A very rare type of liver cancer that affects children especially, usually in children under the age of 3 or 4 years.
Hepatoblastoma cells are similar to fetal liver cells.
Approximately 2 out of 3 children with these tumors are successfully treated with surgery and chemotherapy, and when the two treatments are combined with early detection of the tumor, the survival rate is greater than 85%.
The tumor becomes more difficult to treat if it has spread outside the liver.
Secondary liver cancer
It is cancer that started elsewhere in the body and spread to the liver, and it makes up the majority of cases of cancer diagnosed in the liver in America and vice versa in Asia and Africa.
This type is also called metastatic liver cancer.
The cancer in this type may be called based on the location of the primary cancer, such as colon cancer with liver metastasis, when the metastasis is from the colon.
Liver cancer causes and risk factors
Any factor that increases your risk of developing a disease is called a risk factor.
But this remains relative, the presence of one or more of the risk factors does not mean your inevitable affection and vice versa.
One of the most important risk factors for developing any cancer (including liver cancer) is advancing age, as the ability of cells to regenerate decreases, and there is a disturbance in the work of programmed cell death, which is responsible for destroying defective cells before their maturity or those that have expired.
Other risk factors for developing liver cancer include:
Chronic (long-term) infection with hepatitis B virus or hepatitis C virus
This liver inflammation (hepatitis) leads to cirrhosis and is responsible for making liver cancer the most common type of cancer in many parts of the world.
Cirrhosis
Cirrhosis is a disease in which liver cells are damaged and replaced by scar tissue.
People with cirrhosis have an increased risk of developing liver cancer. Most people who develop liver cancer already have some evidence of cirrhosis.
Aflatoxins
These carcinogens are made by fungi that contaminate unhealthy foods such as peanuts, wheat, soybeans, nuts, corn and rice.
Excessive drinking and smoking
Alcohol and smoking are one of the main causes of cirrhosis of the liver, which in turn increases the risk of developing liver cancer.
Non-alcoholic steatohepatitis
It is common in obese people, as fat builds up in the liver and may lead to inflammation and damage to hepatocytes.
rare genetic diseases
tyrosinemia
Alpha-1 antitrypsin deficiency
Delayed cutaneous porphyria
Glycogen storage diseases
Wilson's disease
hereditary hemochromatosis
Treating these diseases or taking a vaccination against some of them reduces the possibility of developing liver cancer.
Other less influential factors include:
obesity;
type 2 diabetes mellitus:In most cases, people with this disease are obese, which increases the risk of developing liver cancer.
Gender: males are affected more than females due to the quality of life and daily habits.
But in most cases diagnosed with liver cancer, the cause is unknown.
Symptoms of liver cancer
In the early stages, the disease is often asymptomatic, but as the disease progresses, various symptoms may appear, including:
Abdominal discomfort. Liver cancer pain is most commonly concentrated in the upper right abdomen, near the right scapula, and sometimes extends to the back, and a visible mass may appear in the same place.
Yellowing of the sclera and skin (jaundice).
Unexplained weight loss.
Chalky white stools.
Dark yellow urine.
Easy bruising and bleeding (due to a deficiency in the production of clotting factors).
Nausea and vomiting.
Fatigue and exhaustion.
To learn more about the different symptoms of liver cancer according to the stage of hepatoma, do not hesitate to Contact us, Bimaristan center will answer any questions you have.
Liver cancer diagnosis
It is difficult to diagnose liver cancer early because it often does not present with clinical signs or symptoms in the early stages.
However, frequent check-ups every 6 months to a year are recommended in high-risk patients.
To diagnose liver cancer, the following methods can be used:
Clinical examination and health history of the patient
An examination of the body to check general signs of health, including checking for signs of illness, such as lumps or anything else unusual.
A history of the patient's health habits, diseases, previous treatments, family and hereditary diseases will also be taken.
Titration of alpha-fetoprotein AFP in the blood
Usually alpha-fetoprotein produced only in the liver and yolk sac of babies before they are born, AFP production usually stops after birth.
But this test is not specific because this protein can be elevated in many cancers other than liver cancer, and it can also be elevated in non-cancerous cases.
Liver enzyme and function tests
They help determine the health of your liver by measuring the levels of proteins, liver enzymes and bilirubin in your blood.
Any increase in it can indicate liver damage or liver cancer.
Sonography
It is usually the first investigation requested in case of suspected liver cancer, and it shows the soft tissue structure at the site of imaging.
It also shows if there are densities or tumors growing in the liver.
CT Scan
This special type of X-ray takes detailed pictures of the organs. Several images are taken from several angles that give a clear detail of the viscera.
It can also give specific information about the size, shape, and location of any tumor in the liver or elsewhere in the abdomen, as well as nearby blood vessels.
It also helps oncologists to identify metastases to other organs if metastases are suspected.
Contrasts or dyes may be injected to make some organs more visible.
Computed Tomography (CT) imaging may also be used to precisely guide the biopsy needle at the suspected tumor (called a CT-guided needle biopsy).
If it turns out that you have liver cancer, a CT scan of your chest may be done to look for the possibility that the cancer has spread to the lungs.
MRI
As in CT Scan, it gives a clear detail of the structures to be examined, but this type of imaging uses radio waves and strong magnets instead of X-rays.
Sometimes this imaging can be used to distinguish between a benign and malignant tumor. It can also be used to check the blood vessels in and around the liver to look for any blockages, and it can help show whether the liver cancer has spread to other parts of the body.
liver biopsy
It is the best way to confirm the presence of cancer, specially when opinions differ after performing the above-mentioned investigations and tests.
But it may not be needed if the diagnosis is confirmed.
A biopsy is taking a sample of the tissue to be examined to the pathology laboratory and examining this sample to determine the presence of carcinogenesis or not.
One of the disadvantages of this method is that when the doctor inserts the biopsy needle into the tumor in the patient's liver, the tumor may be stimulated or open and spread to other organs, which makes patients who are candidates for surgery or liver transplantation before the biopsy not eligible for surgery because of the spread of the tumor as a result of biopsy.
There are several ways to obtain a biopsy with a fine needle or endodontic (wide).
Liver biopsy is the best diagnostic method for various liver diseases
Endoscopy can also be used to take a liver biopsy, and when there is difficulty, a surgical biopsy can be used.
Liver Cancer Staging
For the treatment of liver cancer, doctors make a general evaluation of patients with liver cancer and the tumor itself and determine the extent of its spread to the lymph nodes or nearby viscera, or if there are distant metastases, and all this helps to determine the most effective treatment method due to the diversity of treatment methods and protocols, whether new or old in Turkey.
The ability to perform surgery or the ability to remove the tumor is determined by a global assessment system called TNM Staging. Liver tumors are divided according to this system into stages:
Tumors that can be removed
If the patient is in good health for surgery, these cancers can be removed completely by surgery or treated with a liver transplant.
This includes most stage 1 cancers and some stage 2 cancers in the TNM system, in patients who do not have cirrhosis or other serious medical problems.
This type of tumor is found in only a small number of liver cancer patients.
Tumors that cannot be removed
This includes tumors that have not spread to nearby lymph nodes and have not metastasized, but have either spread throughout the liver or cannot be safely removed because they are close to the area where the liver meets the main arteries, veins and bile ducts.
Inoperable tumors due to localized disease
The cancer is small enough and in the right place to be removed, but the patient is not well enough for surgery.
This is often because the noncancerous part of the liver is not healthy (due to cirrhosis for example), and if the cancer is removed, there may not be enough healthy liver tissue to function properly.
Or the patient has serious medical problems that make surgery unsafe.
Advanced (metastatic) liver cancer
Tumors that have spread to lymph nodes or other organs are classified as advanced, and these tumors include stages IVA and IVB of cancers in the TNM system.
Most advanced liver cancers cannot be treated with surgery, and other treatment methods are used, and in most cases the treatment is to relieve symptoms and is not curative.
Liver cancer treatment in Turkey
The field of cancer treatment in general, and liver cancer in particular, has witnessed a great development in hospitals and treatment centers in Turkey, where the cure rate and survival rate have increased in an unprecedented way. Bimaristan Medical center is your first choice the best treatment in Turkey It directs you to the best internationally accredited hospitals and the best specialist doctors in Turkey.
Also Turkey has become the first and optimal choice for treatment, both in terms of physical or therapeutic terms, and a new treatment field has emerged called Interventional Radiology in Turkey Which is a quantum leap in the methods of treating cancer.
The choice of treatment, as we mentioned, depends on several factors, including the stage of the cancer and whether it has spread to other places, including the safety of liver function and whether there is cirrhosis in the liver…
Among the ways to treat liver cancer we mention:
Surgical treatment
Partial resection of the liver
It is surgery to remove part of the liver. This operation can only be done for people with good liver function who are healthy for surgery and who have a single tumor that has not invaded the blood vessels.
May be used to treat cancer in patients with cirrhosis, but only if there is no significant damage to healthy liver tissue (at least 35% of healthy liver tissue)
After a while, the removed part of the liver will grow back to its normal function.
Liver transplant
It is the complete removal of the liver and tranplanting a new one from a donor,Liver transplant may be the best method of treatment when it is impossible to remove the tumor alone.
First, it is a treatment that destroys tumor cells in liver tumors without removing them.
These techniques may be used in patients who have a small number of small tumors and when surgery is not a good option (often due to poor health or poor liver function).
The cure rate with this method is lower than surgery, but it can still be very beneficial for some people. These treatments are also sometimes used in patients waiting for a liver transplant based on a recent study.
This method of treating liver tumors may damage the bile ducts and major blood vessels if the tumor is close to them, which can lead to severe bleeding or infection.
It can be combined with angioembolization to get better results.
One of the best features of this treatment is that patients do not need to stay in the hospital after the operation as it is an endoscopic procedure and sometimes guided with the help of CT or Sonography.
There are several combination for this treatment including:
Radio-Frequency and Microwave Ablation
The use of microwaves or radiofrequency waves to heat the tumor and destroy it, which is explained in detail in the article Heat treatment for cancer in Turkey
Heat therapy is a quantum leap in Turkey due to its speed, efficiency and few side effects
Cryotherapy or Cryoablation
In Cancer treatment with cryotherapy The tumor is destroyed by freezing it with a thin metal probe. The probe is directed at the tumor and then very cold materials (argon or liquid nitrogen) are passed through the probe to freeze the tumor, which causes the death of cancer cells.
Ethanol (alcohol) therapy
This is also known as percutaneous ethanol injection (PEI) and is used to treat liver cancer and several other cancers.
In this procedure, concentrated alcohol is injected directly into the tumor to destroy cancer cells. Sometimes, repeated injections may be needed for better results.
Embolization therapy
It is the use of substances to block or reduce blood flow through the hepatic artery to the tumor.
When a tumor doesn't get the oxygen and nutrients it needs, it will stop growing.
The liver is characterized by having two sources of nourishment. Most of the normal liver cells have their nutrients from the portal vein, while the tumor is supplied by the hepatic artery, which maintains the nutrition of the normal hepatic tissue when the hepatic artery is embolized or closed.
This method is used for patients who cannot have surgery or ablation.
In the standard method, a catheter is inserted from the femoral artery into the hepatic artery and then small particles are injected to block the hepatic artery.
One of its advantages is that the patient does not stay in the hospital longer than the procedure period, or a day at most.
It can also be combined with several other treatments to get better results. and from these combination we mention:
Chemoembolization
Usually Chemoembolization is started as in the usual method of embolization, but before closing the artery we inject tumor-killing chemicals and then block the artery. This way the chemical stays close to the tumor for a longer period and is more useful in treating liver cancer.
Radioembolization
Similar to chemoembolization but instead of chemical drugs in Radioembolization doctors inject small pellets with a radioactive isotope that, after several days, emit radiation that kills the tumor, and these radiations do not travel long distances, as their effect remains confined to the tumor.
Radiotherapy
Radiation therapy is a cancer treatment that uses high-energy X-rays or other types of radiation to kill cancer cells or stop them from growing.
It is used as an aid to other treatments, to relieve symptoms, or if other treatments have failed.
The source of radiation can be external or internal, and modern treatment techniques have appeared to relieve side effects and damage to normal tissues adjacent to the tumor, such as Stereotactic Body Radiotherapy (SBRT) recently applied in the treatment of liver cancer, whereby liver tumors are targeted while reducing radiation to healthy tissues Proximal, this makes the treatment more effective and reduces side effects.
Chemotherapy
Chemotherapy is a powerful form of drug therapy that destroys cancer cells.
Most chemotherapy drugs do not have a significant effect in treating liver cancer, and this treatment has multiple side effects such as nausea, vomiting, fatigue and hair loss...
As this treatment attacks any cell that is constantly regenerating, not just tumor cells.
But recent studies have shown that a combination of drugs may be more beneficial than just one chemotherapy drug for liver cancer.
But even these combinations of drugs affect only a small number of tumors, and the response often does not last long, and most studies show that systemic chemotherapy does not help patients live longer.
Immunotherapy
Immunotherapy is a treatment that relies on the patient's immune system to fight cancer.
Substances made by the body or made in a laboratory are used to enhance, direct or restore the body's natural defenses against cancer. This cancer treatment is a type of biological therapy newly applied in the treatment of liver cancer.
Targeted therapy
Similar to chemotherapy, but the drugs or substances used here are directed at the cancerous cells, which reduces damage to healthy cells and reduces the side effects of treatment.
Some of the treatment methods and drugs in this area include:
Kinase inhibitors
Kinases are proteins on or near the cell surface that carry important signals to the cell's control center. Many targeted drugs used to treat liver cancer are inhibitors of these proteins.
These drugs block many kinase proteins, which normally help cancer cells grow.
Blocking these proteins often helps stopping cancer growth and helps treating liver cancer. Among these drugs we mention:
Sorafenib, Lenvatinib, Regorafenib, and Cabozantinib
One of these drugs may be used as a first-line treatment for liver cancer if it can't be treated with surgery or if it has spread to other organs.
Sorafenib may work best in people with liver cancer caused by hepatitis C.
These medications may be used to treat advanced liver cancer, usually if other treatments no longer help.
Common side effects of these medications can include fatigue, loss of appetite, hand and foot syndrome (redness and irritation of the hands and feet), high blood pressure, weight loss, diarrhea and abdominal pain.
Monoclonal Antibodies
Monoclonal antibodies are human-made proteins that are similar to those of the human immune system (antibodies).
Monoclonal antibodies used to treat liver cancer affect a tumor's ability to form new blood vessels, which it needs to grow past a certain size.
This new growth of blood vessels is called angiogenesis, so these drugs are often referred to as angiogenesis inhibitors.
Among these antibodies we mention:
Bevacizumab and Ramucirumab
Bevacizumab is a monoclonal antibody that targets vascular endothelial growth factor (VEGF) while Ramucirumab targets the VEGF receptor protein on cells, which can help stop the formation of new blood vessels and contribute to the treatment of liver cancer.
This medication may be used to treat advanced liver cancer, usually after other treatments have failed.
Liver cancer prevention
Prevention is better than a thousand cures, and many liver cancer patients develop it due to poor health habits or because they neglect to see a doctor and refuse to do regular checkups.
To avoid an increase in the incidence of liver cancer, you must follow the following methods:
Get vaccinated for hepatitis B.
Avoid drinking alcohol and smoking.
Stay away from public places and swimming pools that transmit infectious diseases such as hepatitis C.
Maintain good health and exercise to get rid of obesity.
If the condition is diagnosed earlier, the cure rate is higher, and with the development of treatment methods in the world and Turkey, the cure rate has increased.
Liver cancer affects an important and irreplaceable organ, so in the event of neglect, bad lifestyle change and lack of follow-up treatment, the condition can worsen and lead to death.
Cancer treatment methods vary according to the patient and the tumor, but surgery remains the best solution, and liver transplantation, especially in Turkey, has given encouraging results.
Late symptoms include: yellowing of the sclera and skin (jaundice), unexplained weight loss, chalky white stools, dark yellow urine, easy bruising and bleeding (due to a clotting factor disorder).
The percentage depends largely on the stage of the tumor (its degree, development and whether it has spread in the body), and the earlier cancer is detected, the significantly higher the cure rate.
Therefore, we recommend periodic examinations and the necessary investigations to detect cancer early, if it is present.
The 5-year survival rate for liver cancer is 20%-25% if medical attention is provided, compared to 3% 40 years ago, due to the recent development of therapeutic methods and medical tools.
Survival rates depend on several factors, including the stage of the disease. For 45% of people diagnosed with early-stage liver cancer, the 5-year survival rate is 30%.
Blood tests are usually not specific for liver cancer, and liver enzymes or alpha-fetoprotein tests can be done to help guide diagnosis.
