Erken dönemde özgün bir belirti vermeyebilen karaciğer kanseri, tanı aldığında tedavi planlaması için geç kalınmış olabilir bu yüzden karaciğer kanseri mutlaka erken teşhis edilmelidir. İlerledikçe nedensiz kilo ve iştah kaybı, karnın sürekli şiş olması, sıvı birikimi, halsizlik, sarılık gibi belirtiler gösteren karaciğer kanserinde; tümörün çıkarılması veya karaciğer nakli gibi tedaviler söz konusudur.
What is Liver Cancer?
Malignant (malignant) tumors originating from the liver’s own cell are called primary liver cancer and are called hepatocellular (liver cell) carcinomas because they arise from the liver’s own cells. It is one of the most common and life-threatening tumor types. If a person’s liver is healthy, the risk of developing this type of cancer is very low. Those with liver disease, individuals with structural disorders of the liver (cirrhosis or cirrhosis background) are at risk of liver cancer. Liver cancer is one of the most common cancers in the world, and it should be diagnosed early because it is life-threatening. The main treatment is the removal of the cancerous tissue. Since the liver is sick and the person is barely able to function, it is very difficult to remove only the tumor part in the liver. Liver transplantation stands out as an important treatment method for liver cancer patients.
What are the Symptoms of Liver Cancer?
Liver cancer does not have a very specific finding in the early stages, so the cancer has usually reached large sizes when diagnosed. Often, symptoms such as weight loss, loss of appetite, weakness, fatigue, jaundice, and fluid collection in the abdomen are observed, and sometimes there may be a feeling of pain and fullness in the upper right side of the abdomen. It is possible to confuse the case, since cancer is usually caused by a chronic liver disease (eg: cirrhosis) and these diseases usually give similar findings. Although liver cancers rank 6th among cancer types in the world, it would not be wrong to say that cirrhosis-related diseases are more common in our country. Therefore, patients with chronic hepatitis and early stage cirrhosis should be followed up with radiological ultrasound and, if necessary, MR and CT methods at 6 months to 1 year periods against the risk of tumor development.
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What Causes Liver Cancer?
Among the causes of liver cancer; There are hepatitis B virus infections, hepatitis C and hepatitis D virus infections, aflatoxin (aspergillus flavus poison), cirrhosis, genetic congenital metabolic diseases, hemochromatosis, Wilson’s disease, glycogen storage disease, chemicals (Nitrites, hydrocarbons, solvents). The liver is the body’s factory; It is a center that affects all systems, a part of the blood tank and defense system. The group with the highest risk for liver cancer is those with hepatitis. Since liver cancer does not show symptoms in the early stages, the possibility of early diagnosis is low. 80 percent of these cancers develop more in people with cirrhosis, so patients need to be followed closely. Patients with hepatitis B and C are 200 times more likely to develop liver cancer than those who are not at risk. While hepatitis B can be prevented by vaccination, it is known that the treatments developed for hepatitis C also give very positive results. Cirrhosis occurs as a result of damage to liver cells by alcohol, hepatitis, immune system related causes, etc. 5 percent of cirrhosis patients have a risk of developing liver cancer, and obesity is among the important risks as it can trigger liver fat and cirrhosis.
What are the Stages of Liver Cancer?
For the treatment planning of liver cancer, staging should be done first, and this staging usually consists of four stages.
Stage 1: tumor tissue is located in the liver and has not affected any other organ or structure.
Stage 2: small tumoral formations are located within the liver tissue, or a malignant tumor tissue is determined as having reached the blood vessels.
Stage 3: more than one large tumor has affected the liver tissue. or a large tumor is detected that has invaded a large vessel.
Stage 4: In liver cancer at this stage, the liver cancer has now metastasized and spread to other parts of the body.
How is Liver Cancer Diagnosed?
In some cases, liver cancer may not show any symptoms until the advanced stage, and as the cancer progresses, symptoms such as unexplained weight loss, constant swelling of the abdomen, fluid accumulation, loss of appetite, and constant weakness and jaundice may occur. Individuals experiencing such complaints should consult a doctor as soon as possible. Because today, all kinds of development in the liver can be detected by imaging methods. Patients at risk should be followed up with ultrasonography, which is the cheapest and easiest method. Computed tomography (CT), magnetic resonance imaging (MR), angiography are among the other methods to be applied. Sometimes several of these imaging methods can be used together to strengthen the diagnosis and alpha feto protein (AFP), a tumor marker, can be determined in the blood. A high level of this test is significant for cancer, but it should be kept in mind that it can be normal even in those who are known to have cancer. A normal result does not mean that there is no tumor. In some cases, a needle biopsy from the liver can be applied for diagnosis, but this is not a common method. Whether a biopsy should be performed or not should be decided by physicians who are experienced in these issues and deal with liver disease, namely gastroenterology specialists and/or surgeons.
How Is Liver Cancer Treated?
The results of untreated liver cancer lead to negative pictures, the expected life expectancy in these cases is 6-9 months, and the most effective method is surgical removal of the tumor. Surgical treatment depends on the stage of the tumor and whether it has spread, and the degree of liver disease if the patient has it. In a liver cancer that has spread beyond the liver, surgery is not needed. The success of the surgery is also related to the diameter of the tumor, postoperative survival is much better in patients with a diameter of <5cm compared to those with a tumor >5cm, and the expected 5-year survival after surgical excisions performed under ideal conditions (<5cm, single, no invasion) is 60%. In cases where surgery cannot be performed, techniques such as radioembolization, chemoembolization, chemotherapy, alcohol injection, radiofrequency ablation can be performed by the Interventional Radiology Specialist, and in appropriate cases, these can be used together with surgery. In surgery, care should be taken to ensure that the remaining liver is of sufficient quality and size for the patient to maintain a healthy life. If surgical removal of the tumor in the liver is inappropriate, treatment can be achieved with liver transplantation. There are many reasons that lead the patient to liver transplantation, and liver tumors are among them. If the tumor meets the appropriate criteria, the most ideal treatment in terms of results is liver transplantation. With liver transplantation, the diseased liver, which has a potential risk of tumor development, is completely removed and replaced with a healthy liver, and the risk of tumor recurrence is less in transplant patients.
Frequently asked Questions
In order to prevent liver cancer, it is necessary to be protected from hepatitis viruses and to be vaccinated against hepatitis B virus before it is too late. Excessive alcohol consumption should be avoided as it can cause cirrhosis and liver cancer in the long term. By reducing the risk of obesity and diabetes with a healthy diet, the risk of fatty liver, cirrhosis and liver cancer will also be reduced.
The types of interventional radiological applications in cancer treatment and their effectiveness have increased in recent years thanks to the developing technology. At the beginning of these treatments are radiofrequency (RF) and microwave (MW) ablation treatments, which can be defined as burning the tumor with a needle inserted into the tumor under the guidance of skin imaging. chemoembolization and radioembolization (Yittrium 90) treatments, which reach the tumor from blood vessels with angiographic techniques, block the vessels in a way that cuts off the nutrition of the tumor, and also give high-dose chemotherapeutic or radioactive isotope-loaded drugs. These techniques, which can provide complete treatment in early stage small tumors, can be used to slow the spread of the tumor, stop it or shrink the tumor in patients in whom other treatments cannot be applied due to its advanced stage.
Treatment of liver metastases depends on where the spread is (from which organ cancer it belongs to), the extent of the event (how many metastases are in the liver), the location of the metastases in the liver, and whether they have spread elsewhere other than the liver. lymphomas in particular can be treated with some combination of chemotherapy, and breast and lung cancers benefit partially from chemotherapy. In terms of the treatment of liver metastases, metastases of large intestine (colorectal) cancer should be kept separately. Colorectal cancers often metastasize to the liver, and surgical removal of metastases in the liver is also very important in terms of treatment.
The liver is a large organ that filters the blood, so cancer cells that enter the bloodstream remain stuck in this organ and continue to grow. Especially since the blood coming from the digestive system (intestines) first passes through the liver, liver metastases of cancers belonging to these regions are frequently seen. In cancers of organs such as the large intestine, stomach, pancreas, biliary tract, small intestine, metastases to the liver, as well as metastases from breast cancer, lung cancer and lymphomas are seen.
