Liver Oncology

Liver is one of the most important organs of the body and also the largest gland of the body. It has both secretory and excretory functions. It performs many vital metabolic and homeostatic functions. These are as follows:
Metabolic function:

Maximum metabolism of carbohydrates, proteins, fats, vitamins and many hormones take place in the liver.

Storage function:

Many substances like glycogen, amino acids, iron, folic acid and vitamins A, B12, and D are stored in liver.

Synthetic function:

Liver produces glucose by a process called gluconeogenesis. Important proteins like clotting factors, complement factors and hormone-binding proteins are secreted by liver. It also synthesizes steroids, somatomedin and heparin.

Secretion of bile:

Bile is a yellowy liquid that contains bile salts. These salts help in the emulsification of fats and consequently their absorption in the body. Liver secretes this bile which is stored in the gall bladder and secreted as and when needed. Bile also helps to carry away waste products and breakdown fats, which are excreted through feces and urine.

Excretory function:

Some chemical constituents are excreted by liver. This include substances like cholesterol, bile pigments, heavy metals (like lead, arsenic and bismuth), toxins, bacteria and virus.

Heat production:

Liver is the organ where maximum heat is produced due to a number of metabolic reactions. This heat helps in the thermoregulation required for normal functioning of the body.

Hemopoietic function:

During fetal stage, liver produces blood cells. In adults, it store vitamin B12 that is necessary for formation of blood cells and iron that is necessary for synthesis of haemoglobin. It also produces thrombopoietin that stimulates production of thrombocytes.

Hematopoietic function:

Liver is responsible for the destruction of the senile red blood cells once they have run the course of their life.

Inactivation of hormones and drugs:

Many hormones and drugs are subjected to reactions that render them inactive and safe, and later excreted from the body.

Defensive and detoxification functions:

Liver produces substances that stimulate the immune system to ward off the infection. It has a system of enzymes called the cytochrome P 450 which acts on xenobiotics and render them inactive and safe. Liver also contains the enzyme alcohol dehydrogenase that converts alcohol into less toxic substance. Almost half of the total alcohol consumed is rendered totally safe. This is the main reason why alcohol has such detrimental effects on liver. Fatty liver and ultimately liver cirrhosis are the consequences of chronic alcohol consumption. Liver cirrhosis can also lead to liver cancer. Thus one of the main functions of liver is detoxification.

Liver being do vital organ and being subjected to a lot of stress, there are high chances of developing cancer.

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NOTE: Above More accurate treatment cost estimates can be provided if medical reports are emailed to us or after the patient is examined by doctors after arrival at hospital in India and medical tests are done after admission.

Frequently asked questions about Liver Oncology

What are the types of Liver cancer?

There are both benign and malignant neoplasms of the liver. 

Benign neoplasms:

Cavernous hemangioma is the most common benign liver tumor and usually remains asymptomatic only discovered incidentally on imaging. It appears as a discrete red-blue, soft nodule, usually less than 2 cm in diameter.

Hepatocellular adenoma is a benign neoplasm that typically occurs in young women who take oral contraceptives and anabolic steroids. Multiple hepatocellular adenomas (termed hepatic adenomatosis when 10 or more tumors are present) can occur both in familial and acquired settings. If this adenomas rupture, massive abdominal bleeding occurs and becomes a surgical emergency.

Malignant neoplasms:

The malignant neoplasms in the liver can be primary or metastatic. The primary epithelial tumors are common with hepatocellular carcinoma and intrahepatic cholangiocarcinoma is the most prevalent. Hepatoblastoma is a rare hepatocellular tumor that occurs in pediatric children. Non-epithelial tumors like angiosarcoma are rare. 

The most common early childhood liver cancer is hepatoblastoma and it rarely occurs in children over 3 years of age. These tumors are associated with several syndromes, including familial adenomatous polyposis and Beckwith-Wiedemann syndrome. The clinical manifestations include abdominal swelling in an otherwise asymptomatic child. Symptoms that indicate liver dysfunction like jaundice and pruritus are seen in a subset of patients and about 20% of tumors will have metastasized to the lungs by the time of diagnosis. 

One of the most common cancers in geographic regions with high rates of hepatitis B infection is hepatocellular carcinoma and accounts for approximately 5.4% of all cancers worldwide. 

Intrahepatic cholangiocarcinoma is referred to the adenocarcinomas arising from the intrahepatic biliary tree while a similar tumor arising from the extrahepatic bile ducts is referred to as biliary adenocarcinoma. This type of cancer is very common in Southeast Asian countries such as Thailand, Laos, and Cambodia, where liver fluke infestation is endemic. 

The other primary hepatic malignant tumors that occur are:

  • Combined hepatocellular-cholangiocarcinoma
  • Angiosarcoma
  • Epithelioid hemangioendothelioma
What are the symptoms of Liver Cancer?

The symptoms of liver cancer depend on the type of cancer and also the stage at which is diagnoses and whether it is benign or metastatic. The main symptoms are:

  • Abdominal swelling or pain
  • Hepatomegaly (abnormal increase in liver size)
  • Jaundice
  • Pruritus
  • Fatigue and malaise
  • Nausea
  • Weight loss
Who Is at Risk for Liver Cancer?

The following factors may play role in the development of liver cancer:

  • Age over 50 years
  • A long-term hepatitis B or C infection 
  • Having two or more alcoholic beverages every day over many years may cause fatty liver or liver cirrhosis and can ultimately lead to the development of cancer
  • Exposure to aflatoxin is a risk factor. Aflatoxin is a toxic substance produced by a type of mold that can grow on peanuts, grains, and corn
  • Diabetes and obesity are also risk factors. People with diabetes tend to be overweight or obese, which can cause liver problems and increase risk for liver cancer.
How Is Liver Cancer diagnosed?

If the doctor suspects the presence of liver cancer, he/she may prescribe the following tests or procedures to confirm the presence

  • Liver function tests which measure levels of proteins, liver enzymes, and bilirubin in a person’s blood.
  • The presence of alpha-fetoprotein(AFP) in the blood can be a sign of liver cancer. This protein is usually only produced in the liver and yolk sac of babies before they’re born. AFP production normally stops after birth.
  • Abdominal CT scans and MRI scans to reveal the presence of growing tumor.
  • Liver Biopsy. This confirms the presence or absence of cancer and if present, can provide information whether the cancer is primary or metastatic and also the stage and extent of the disease.
How Is Liver Cancer treated?

Treatment for liver cancer varies. It depends on: the number, size, and location of the tumors in the liver, how well the liver is functioning, whether cirrhosis is present, whether the tumor has spread to other organs.

The specific treatment plan will be based on these factors. Liver cancer treatments may include the following:

  • Surgical resection of the tumor
  • Liver Transplant
  • Ablation
  • Chemotherapy
  • Radiation Therapy
  • Targeted Therapy
  • Embolization and Chemoembolization

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There are both benign and malignant neoplasms of the liver. 
Benign neoplasms:

Cavernous hemangioma is the most common benign liver tumor and usually remains asymptomatic only discovered incidentally on imaging. It appears as a discrete red-blue, soft nodule, usually less than 2 cm in diameter.

Hepatocellular adenoma is a benign neoplasm that typically occurs in young women who take oral contraceptives and anabolic steroids. Multiple hepatocellular adenomas (termed hepatic adenomatosis when 10 or more tumors are present) can occur both in familial and acquired settings.If this adenomas rupture, massive abdominal bleeding occurs and becomes a surgical emergency. Surgical resection is recommended for β-catenin–activated tumors as well as tumors 5 cm or larger due to the risk of hemorrhage and malignant transformation. For smaller tumors without β-catenin activation, close follow-up and cessation of exposure to oral contraceptive or anabolic steroids may suffice.

Malignant neoplasms:

The malignant neoplasms in the liver can be primary or metastatic. The primary epithelial tumors are common with hepatocellular carcinoma and intrahepatic cholangiocarcinoma is the most prevalent. Hepatoblastoma is a rare hepatocellular tumor that occurs in pediatric children. Non-epithelial tumors like angiosarcoma are rare. 

The most common early childhood liver cancer is hepatoblastoma and it rarely occurs in children over 3 years of age. These tumors are associated with several syndromes, including familial adenomatous polyposis and Beckwith-Wiedemann syndrome. The clinical manifestations include abdominal swelling in an otherwise asymptomatic child. Symptoms that indicate liver dysfunction like jaundice and pruritus are seen in a subset of patients and about 20% of tumors will have metastasized to the lungs by the time of diagnosis. Treatment includes surgical resection along with chemotherapy and the 5-year survival rate is approximately 80%.

One of the most common cancers in geographic regions with high rates of hepatitis B infection is hepatocellular carcinoma and accounts for approximately 504% of all cancers worldwide. The clinical manifestations are non-specific and include abdominal pain, fatigue, malaise, weight loss and hepatomegaly (abnormal increase in liver size). The treatment of choice in non-cirrhotic and cirrhotic but functioning livers is surgical resection. Liver transplantation is considered in livers with advanced cirrhosis. The overall outcome of treatment in hepatocellular carcinoma is usually poor because of underlying liver disease and the resistance of this cancer to conventional chemotherapy. 

Intrahepatic cholangiocarcinoma is referred to the adenocarcinomas arising from the intrahepatic biliary tree while a similar tumor arising from the extrahepatic bile ducts is referred to as biliary adenocarcinoma. This type of cancer is very common in Southeast Asian countries such as Thailand, Laos, and Cambodia, where liver fluke infestation is endemic. The clinical manifestations are those that are related to biliary obstruction. Treatment includes surgical resection followed by adjuvant chemotherapy. Because of frequent recurrences, the prognosis is poor and the 5-year survival rate is 20%-40% after surgical resection.

The other primary hepatic malignant tumors that occur are:

  • Combined hepatocellular-cholangiocarcinoma
  • Angiosarcoma
  • Epithelioid hemangioendothelioma
Read more..
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