For most people, liver cancer may not sound like a familiar type of cancer. Many people underestimate the importance of carrying out periodic checks of the liver and making efforts to detect liver cancer early. Though liver cancer is no less dangerous than various other types of cancer.
What is liver cancer?
Liver cancer occurs when normal cells in the liver turn into abnormal cells and grow out of control. The liver is a large organ located in the abdominal cavity on the right, just below the diaphragm. There are several types of liver cancer, the most common being hepatocellular carcinoma. Other types of liver cancer are intrahepatic cholangiocarcinoma and hepatoblastoma.
Not all cancers that affect the liver are liver cancer. This can happen because cancer starts from other organs of the body such as the colon, lung or breast, which then spreads to the liver. This type of cancer is called secondary liver cancer or metastatic cancer and is named after the organ in which the cancer cells first appeared.
Liver cancer is the fourth leading cause of death from cancer in Indonesia (Globocan, 2018). Most people have no signs and symptoms in the early stages of primary liver cancer. When signs and symptoms appear, the patient has come for treatment in an advanced stage. Even though liver cancer can be found early by conducting early detection of liver cancer.
What are the symptoms and signs of liver cancer?
In the early stages it is usually asymptomatic. When signs and symptoms appear, sufferers may feel:
- Unexpected weight loss
- Loss of appetite
- Upper abdominal pain
- Nausea and vomiting
- Feeling tired and lacking energy
- Stomach enlarges and feels bloated
- There is a lump in the upper right abdomen
- Icteric (yellow skin and eyes)
- Pale white stools like chalk
What are the causes of liver cancer?
The most common cause of liver cancer is not clearly known. However, in some cases the cause is known, such as:
- Chronic hepatitis B
- Chronic hepatitis C
- Alcohol
- Nonalcoholic steatohepatitis (NASH)
What are the risk factors for liver cancer?
Factors that can increase the occurrence of primary liver cancer include:
- Chronic Hepatitis B or Hepatitis C infection.
- Liver cirrhosis
- Inherited liver diseases such as Hemochromatosis and Wilson's disease.
- Diabetes
- Obese or too fat
- Non-alcoholic fatty liver disease (Nonalcoholic fatty liver disease)
- Exposure to mold poison (aflatoxin) – found in food that is stored for a long time in hot and humid air
- Excessive alcohol consumption
- Prolonged use of anabolic steroids
- Sharing needles (including injecting drug users)
What is the correlation between liver cancer and hepatitis?
On blood tests of patients with liver cancer, 65% of them are positive for Hepatitis B. Most people with Hepatitis B infection will recover, and a small number will develop into a chronic (chronic infection). About 10% of these chronic infections develop into liver cancer. People with Hepatitis B infection in Indonesia are quite high, reaching 7.1% of the entire population of Indonesia (Riskesdas, 2017).
How to prevent liver cancer and hepatitis?
Liver cancer and hepatitis can be prevented by various steps and precautions, including:
- Avoid risk factors
- Doing healthy living behavior
- Eat fresh food
- Avoid consuming preserved foods
- Avoid foods that contain aflatoxin
- Avoid consuming alcoholic beverages
- Hepatitis Vaccination
How is the examination for early detection of liver cancer?
There are at least four tests that need to be done to diagnose liver cancer, namely:
- Physical examination by a doctor
- Ultrasound Examination of the Heart
- Hepatitis marker laboratory tests, namely HBsAg, Anti HCV, and anti HBS
- AFP (Alpha Feto Protein) tumor marker laboratory tests
How is liver cancer diagnosed?
Procedures and examinations performed to diagnose liver cancer include:
- Blood test.
Blood tests will reveal abnormal liver function - Radiological examination.
Recommended radiological examinations can be in the form of ultrasound (USG), CT scan and MRI - Biopsy or taking a sample of liver tissue for examination.
Taking this tissue to confirm the diagnosis of liver cancer. During a liver biopsy procedure, the doctor will insert a thin needle through the skin and into the liver to obtain a tissue sample. Then the liver tissue is given to a laboratory to be examined under a microscope to look for cancer cells.
After liver cancer is diagnosed, the doctor will determine the stage of the cancer. Cancer stage is determined by looking at the size, location and spread of cancer cells
How is liver cancer treated?
Treatment of liver cancer is adjusted to the stage of cancer as well as age, general health condition and patient's choice. Treatment for liver cancer includes:
- Tumor removal surgery. For cases of liver cancer with a small tumor size and the patient's liver function is still in good condition, the doctor will recommend surgery to remove the liver cancer and a small portion of healthy liver tissue.
- Liver transplant surgery. During liver transplant surgery, the cancerous part of the liver is removed and replaced with a healthy liver from a donor liver. Liver transplant is an option for a minority of people with early-stage liver cancer.
- ablation therapy. Ablation therapy is a procedure that can kill cancer cells in the liver and is not a surgical procedure. Ablation therapy can be done using heat, laser, radiation therapy, or by injecting alcohol directly into the cancer.
- Blocking the cancer's blood supply. This procedure is known as an "embolization" to block the blood vessels that deliver blood to the cancer. Embolization procedures can be in combination with chemotherapy (chemoembolization) or radiation (radioembolization).
- Chemotherapy
- Immunotherapy
This is information regarding risk factors, how to detect early, diagnose, and treat liver cancer. Knowing and understanding a bit of information related to liver cancer can help you and those around you to find the best treatment course of action. Don't forget to consult your liver problem as soon as possible with a trusted doctor.
This article was written by dr. Tjhang Supardjo , M. Surg, FCCS, Sp.B, FCSI, FInaCS, FICS who is a Surgical Specialist (Heart Disease, Gallbladder, Spleen and Pancreas) at OMNI Hospital Alam Sutera.
Dr. Expertise Tjhang Supardjo, M. Surg, FCCS, Sp.B, FCSI, FInaCS, FICS
- Treat liver disease & cancer
- Treat pancreatic disease & cancer
- Dealing with diseases, stones & bile cancer
- Treat spleen disease
- Laparoscopic surgery (minimally invasive technique)
- TACE/ TACI/ PTCD/ RFA/ Liver Dialysis
- Liver transplant
Education Dr. Tjhang Supardjo, M. Surg, FCCS, Sp.B, FCSI, FINaCS, FICS
- Doctor Profession, Faculty of Medicine, Trisakti University, Jakarta
- General Surgeon, Zhejiang University, Hangzhou, China
- Hepatobiliary-Pancreatic Surgery & Liver Transplantation Subspecialty, Zheijiang University, Hangzhou, China
- General Surgery Adaptation, UNPAD-RSHS Bandung
- Hepatology Institute, Eastern Hepatobiliary Hospital (EHBH) Shanghai, China
- Hepatobiliary Interventional Center (TACE, TACI, PTCD, RFA), Zhejiang University, Hangzhou, China
- Artificial Liver Supporting System (Liver Dialysis) Center, Zhejiang University, Hangzhou, China
- Living Donor Liver Transplantation, ASAN Medical Center, Seoul, Korea
- Pancreatic Cancer & Surgery, Kyoto University, Japan
For further information, contact Andy: +62 811-1225-277