Liver cancer

Digestieve oncologie

The liver is a large organ located on the right side of the body, at the top of your abdomen. Cancer can develop in this organ. Liver cancer, also known as hepatocellular carcinoma (HCC), occurs when normal cells in the liver change into abnormal cells that grow. In HCC, the tumor originated in the liver. This is not the same as a liver metastasis caused by cancer elsewhere in the body (e.g. colon cancer with liver metastases, breast cancer with liver metastases, etc.).

Liver cancer is common in patients who have had other liver diseases such as liver cirrhosis, chronic hepatitis B, etc.

Symptoms

Liver cancer alone causes no or few symptoms. That is why liver cancer is sometimes only discovered at a late stage. If symptoms do occur, they depend on the location, size and number of growths on the liver. Possible symptoms of liver cancer include:

General weakness and tiredness
A sensitive, sore stomach on the right side of the abdomen
Lose weight and Decreased appetite
Bleeding in the abdomen because the tumour ruptures
Jaundice
Fever

Often, however, there are symptoms of an underlying liver disease such as cirrhosis (link to the liver cirrhosis webpage). Then, for example, patients may suffer from jaundice, a distended stomach, etc.

Causes

Liver cancer often develops as a result of chronic liver disease. Major risk factors for developing liver cancer include:

Liver cirrhosis
Liver infections such as hepatitis B (link to the HBV webpage), hepatitis C, non-alcoholic liver steatosis hepatitis, alcoholic hepatitis, etc.
Hemochromatosis

Examinations

Blood tests

A blood test is usually the first step in determining whether there is liver cancer or not. Certain liver tests can also be taken to monitor the function of the liver.

AFP

A specific blood test that is taken to detect liver cancer is the alpha photoprotein. This is a so-called “tumor marker”. Tumor markers are special proteins that are produced by a tumor. An increased tumor marker in the blood provides a first sign that cancer may be present. However, tumour markers are sometimes “falsely increased” or “falsely decreased”. “Falsely increased” means that the test has been increased but there is no tumor. “Falsely reduced” means that the test is normal, but there is still a tumour.

Radiological examination

To get an idea of exactly where the liver tumor is located, how big it is and how many liver tumors there are, images are taken. This can be done using an ultrasound, CT scan, MRI scan, PET scan, etc.

Liver biopsy

Despite the fact that the diagnosis can usually be made on the basis of blood tests and imaging, a biopsy is sometimes necessary in patients with no previous liver diseases (e.g. no liver cirrhosis if diagnosed with liver cancer, no chronic hepatitis B, etc.). A biopsy may also be necessary if the imaging shows a spot that is not sure could be malignant.

There are different types of liver biopsy:

Percutaneous liver biopsy
In this biopsy, the doctor pierces the skin, between the ribs, to remove a piece of liver. (link to folder) Since this biopsy is performed under ultrasound, the liver biopsy can be done directed to a location on the liver.
Transjugular liver biopsy
When there is too much risk of bleeding (e.g. When the patient takes a blood thinner that cannot be stopped, if the patient has a clotting disorder, etc.), a transjugular liver biopsy is chosen. This means that a small piece of liver tissue is removed via your blood vessels. This is to know more about a 'good' piece of liver tissue that does not have cancer. Only rarely is this type of liver biopsy used to take a sample of tissue from the suspicious site.
Biopsy during keyhole surgery.
In the case of keyhole surgery, it may happen that you choose to remove part of the injury. At the same time, treatment may already be chosen during keyhole surgery by burning the liver injury.

After the biopsy, the pieces of tissue go to the lab to be further examined. You will receive the results at the next consultation, which will be scheduled shortly afterwards.

Treatments

Liver cancer can be treated in various ways. Treatment depends on the stage of the cancer and what condition your liver was in before the liver cancer. The patient's general health and condition are also important in determining which treatment he or she will receive.

Operation

Liver cancer can sometimes be treated by surgery. This involves cutting away the part of the liver that contains the cancerous tumor. This can also happen during keyhole surgery.

Liver transplant

A liver transplant is an operation where a surgeon replaces your old liver with a new, healthy liver from another person. To do this, AZ Delta forwards patients to UZ Leuven or UZ Ghent. The examinations that precede a transplant can, however, take place in AZ Delta. The results will then be forwarded to the hospital where you will be transplanted.

Whether a patient with liver cancer is eligible for liver transplantation depends on the number of sites on the liver, size and general condition of the patient.

After the transplant, you can return to consultations alternately in AZ Delta and the hospital where you were transplanted.

After a transplant, you must take medication for life to suppress the immune system. The new liver is seen as something 'strange' in the body and your body could fight against this new organ. This medication will ensure that your own body will not fight against the new liver and the new organ will not be affected.

Ablation

Ablation is a procedure where cancer cells are killed by heat, via microwaves or radio frequency. Ablation can be used in various ways: via a puncture or a viewing operation.

Blocking the tumor's blood supply

Specialized doctors can do a procedure called “embolization” of the vein that supplies blood to cancer cells. This causes the cancer to stop growing because it no longer receives blood. Sometimes “embolization” is combined with topical administration of chemotherapy (chemoembolization) or radiation therapy (radioembolization).