Liver Cancer Overview

Primary Liver Cancer

• Primary liver cancer originates within the liver, with hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (bile duct cancer) being the most common types.
• In 2018, approximately 42,220 cases of liver cancer and 30,200 deaths occurred in the US.
• Globally, liver cancer ranks as the 5th most common cancer and the 2nd leading cause of cancer mortality.
• Cirrhosis, particularly HCV-related cirrhosis, is a major risk factor for HCC in the US, followed by NAFLD.
• About 2% of cirrhosis patients develop liver cancer yearly.
• Lesions can be single or multiple, nodular or diffuse across the liver.
• Metastasis to the lungs is common.
• Tumors can infiltrate other organs (e.g., gallbladder), the peritoneum, or diaphragm.

Metastatic Liver Cancer

• Metastatic liver cancer (cancer spreading to the liver) is more prevalent than primary liver cancer.
• The liver's high blood flow and capillary network make it a frequent site for metastatic growth.
• Cancer cells from other parts of the body often reach the liver through the portal circulation.

Clinical Manifestations and Diagnosis

• Early liver cancer often shows no or subtle symptoms, frequently linked to underlying cirrhosis conditions.
• Manifestations may include hepatomegaly, splenomegaly, fatigue, peripheral edema, ascites, and portal hypertension complications.
• Late-stage symptoms include fever, chills, jaundice, anorexia, weight loss, palpable mass, and right upper quadrant (RUQ) pain.
• Diagnostic tools encompass ultrasound, CT scans, and MRIs. Advanced MRI techniques are now highly accurate for diagnosis and staging without biopsies, though they may still be necessary in ambiguous or treatment-guiding cases. Biopsy risks include bleeding and seeding along the needle tract.
• Serum α-fetoprotein (AFP) levels combined with ultrasound improve early stage HCC detection.

Prevention and Treatment

• Prevention focuses on managing chronic hepatitis B (HBV) and C (HCV) infections, as well as lowering alcohol consumption.
• Screening for high-risk individuals (e.g., those with cirrhosis) usually involves a combination of serum AFP and imaging (CT, MRI, or ultrasound).
• Treatment depends on cancer stage, tumor characteristics, blood vessel involvement, patient health, and underlying liver disease.
• Partial liver resection (hepatectomy) is the curative approach for some patients, but many are diagnosed too late for this option given the compromised state of liver function.
• Liver transplantation is a viable option for early-stage liver cancer with impaired function.
• Nonsurgical approaches include percutaneous ablation (using heat or chemicals via needles), chemoembolization (closing off blood supply to tumors with chemotherapy), radioembolization (using radioactive beads), and systemic therapy (drugs to slow tumor growth).
  • Ablation can be done percutaneously, laparoscopically, or via open incision, but is limited by the number and location of tumors; is usually for early-stage cancer.
  • Complications include infection, bleeding, dysrhythmias, and burns (from heat probes).
  • Embolization (TACE and TARE) inserts chemotherapy or radioactive material to block blood supply to tumors.
• Systemic therapies embrace chemotherapy and immunotherapies (monoclonal antibodies, tyrosine kinase inhibitors, and immune checkpoint inhibitors).
• Nursing care prioritizes patient comfort and addresses advanced liver disease complications.

Prognosis

• While liver cancer prognosis is generally poor, it's improving due to early screening programs.
• Cancer often progresses quickly, causing complications from the cancer and declining liver function.
• Without treatment, death often occurs within 6-12 months from hepatic encephalopathy or massive GI bleeding.