Liver Cancer

Liver cancer is divided into two main groups as primary (cancers originating from the liver) and metastatic (tumors arising as a result of liver spread of a tumor in another organ).

Metastatic tumors of the liver are usually multiple and 80% of them are related to tumors originating from the digestive system. Primary liver tumors are usually hepatocellular carcinomas, with cholangiocarcinoma, hepatoblastoma and angiosarcoma being rarer types. The success of treatment in primary liver cancer depends on early diagnosis, and the 5-year survival rate in patients who can undergo surgical resection is around 30%.

Hepatocellular carcinoma (HCC)

Hepatocellular carcinoma (HCC) is a type of cancer that is becoming increasingly common and is usually diagnosed at an advanced stage. It ranks 6th among all cancers and approximately 600,000 people die from this cancer every year in the world.

The annual number of new patients in Europe and the USA is 2-4/100.000. It is 2 times more common in men than women. Its incidence is increasing in Asia and South Africa and reaches 100/100000.

The distribution of Liver Cancer in the world is parallel to the epidemiology of Hepatitis B. While the disease is generally seen around the age of 50-60 in western countries, it occurs at younger ages (25-35) in Asia and Africa, where the disease is more common.

What Causes HCC Formation?

The annual rate of HCC carcinoma development in patients with liver cirrhosis is around 5%, and 1/3 of these patients develop HCC. Therefore, patients infected with hepatitis B and hepatitis C virus and patients with chronic liver disease due to other causes should be followed up for HCC development with ultrasonographic examination and blood alphafetoprotein (AFP) measurement twice a year.

• Hepatitis B Virus
• Hepatitis C Virus
• Alcoholic Cirrhosis
• Hepatic Adenoma
• Aflatoxins
• Wilson’s Disease
• Herbal alkaloids
• Oral Contraceptives
• Androgenic Steroids
• Vinyl Chloride
• Contrast Substances (Thorotrast)

What Are the Symptoms of HCC?

Weight loss, weakness, anorexia, pain in the right upper quadrant of the abdomen and fever are the main findings of the disease. Abdominal fluid collection (ascites) and liver enlargement may occur. Sudden weight loss and the appearance of jaundice, especially in a patient with liver cirrhosis, should suggest the development of HCC.

How Is Liver Cancer Diagnosed?

The majority of patients with liver cancer have elevated serum levels of alpha-fetoprotein (AFP), a tumor marker. If the level of AFP measured in the blood is above 10, the patient should be examined for HCC. Liver function tests (Alkaline phosphatase, GGT, bilirubins, LDH) may increase at varying rates (See Liver function tests). Sudden elevations in LDH and alkaline phosphatase levels in a patient with chronic liver disease should suggest HCC and blood AFP level should be checked with liver imaging.

Display Methods

To view the lesion in the liver; Ultrasonography (US), Computed Tomography (CT) and Magnetic Resonance (MR) imaging methods are used. US is used as a screening test especially in high-risk groups. With US, the tumor in the liver and its spread to the great vessels of the liver (vena porta and vena hepatica) can be shown. In addition, fine needle biopsy can be performed under US for diagnosis, but nowadays this method is used less and less due to the advanced imaging methods and the risk of transplanting into the biopsy path. MRI is the best method to show the spread of the tumor to other structures in the liver. Hepatic Angiography is used in suspicious cases and to detect anatomical variations.

Staging in HCC

The following staging systems are used in the staging of HCC. Staging allows the decision to be made about the choice of treatment to be administered to the patient.

Liver Cancer Treatment

Surgical removal of the tumor (Liver Resection):

Surgical treatment (resection) is only possible in 10-20% of patients in HCC, since patients usually present at an advanced stage.

Although it is recommended that patients with a tumor diameter less than 5 cm be evaluated for surgical treatment, the generally accepted view is that the tumor diameter is 2 cm or less for resection.

For resection, the tumor should be limited to the liver, there should be no distant metastases, no thrombosis in the portal or hepatic veins, and liver capacity should be sufficient. Because most patients with HCC have underlying cirrhosis and the risk of developing decompensation in the remaining liver after resection, careful evaluation is required for resection before surgery.

The minimal liver size that should remain after resection should be 25% of the liver in the presence of normal liver and 50% of the liver in cirrhotic liver. Unfortunately, the incidence of tumor recurrence (recurrence) after resection in patients with cirrhosis is around 50-70% within 5 years.

This is mostly due to the spread of the primary tumor in the liver (70-80%), and a small part to the newly formed tumors (de novo tumor) (30-40%). Only 30% of patients survive for 5 years after resection.

The best survival in tumors detected early is achieved with liver transplantation. 5-year survival in patients with transplantation when the patient has a suitable donor is higher than all other methods (70%)

When the patient cannot be operated on, there are also chemotherapy or radiotherapy methods (TAKE, TARE) performed by entering the vessel feeding the tumor from the inguinal angiography.

In addition, known radiofrequency ablation or microwave treatments, which are burning treatments, are also applied for patients who are not suitable for surgery.

Chemotherapy drugs used today contribute to survival for a few months.