Basic Function: The liver is a vital organ

Wide range of functions, including detoxification, glycogen storage, protein synthesis, and production of
biochemicals necessary for digestion, decomposition of red blood cells

It produces bile, an alkaline compound which aids in digestion via the emulsification of lipids

What Is Liver Cancer?

Primary liver cancer is a disease in which malignant (cancer) cells form in the tissues of the liver. Cancer
that forms in other parts of the body and spreads to the liver is not primary liver cancer. The liver is one
of the largest organs in the body. It has two lobes and fills the upper right side of the abdomen inside
the rib cage. The main functions of the liver include the following:

- to make bile to help digest fat that comes from food

- to store glycogen (sugar), which the body uses for energy
- to filter harmful substances from the blood so they can be passed from the body in stools and
urine

PATHOPHYSIOLOGY OF LIVER CANCER

 Chronic Exposure to
Factors /Initiating
Vasodilation
Chronic irritation of liver

Increased blood flow

Chronic liver injury Prolonged inflammation
Increased heart rate
Cell mutation
Stimulation of liver
Rapid uncontrolled
proliferation of anaplastic

angiogenesis
FEVER
Tumor growth in liver

Altered liver
Liver stretches to
function
accommodate
the growing
Compress blood
vessels ad nerve
endings
a

Types of liver cancer

hepatocellular carcinoma- Cancer of the liver of hepatocellular carcinoma is the primary cancer of
the liver.

- HCC is the most common type of liver cancer

- Most cases of HCC are secondary to either a viral hepatitis infection (hepatitis B or C) or cirrhosis
(alcoholism being the most common cause of hepatic cirrhosis)
- Abdominal pain, especially in the right upper quadrant, N/V, or fatigue, loss of appetite, weight
loss,
- Ascites, easy bruising from blood clotting abnormalities and jaundice

intrahepatic cholangiocarcinoma- occurs in the parts of the bile ducts within the liver and is sometimes
classified as a type of liver cancer. Hilar cholangiocarcinoma occurs in the bile ducts just outside of the
liver. This type is also called perihilar cholangiocarcinoma.
hepatoblastoma - is a rare tumor (an abnormal tissue growth) that originates in cells in the liver. It is
the most common cancerous (malignant) liver tumor in early childhood. Most hepatoblastoma tumors
begin in the right lobe of the liver.

Signs and symptoms of liver cancer

Most people don't have signs and symptoms in the early stages of primary liver cancer. When signs
and symptoms do appear, they may include:

- Losing weight without trying

- Loss of appetite
- Upper abdominal pain
- Nausea and vomiting
 - General weakness and fatigue
- Abdominal swelling
- Yellow discoloration of your skin and the whites of your eyes (jaundice)
- White, chalky stools

Causes
Liver cancer happens when liver cells develop changes (mutations) in their DNA. A cell's DNA is the
material that provides instructions for every chemical process in your body. DNA mutations cause
changes in these instructions. One result is that cells may begin to grow out of control and eventually
form a tumor — a mass of cancerous cells.

Sometimes the cause of liver cancer is known, such as with chronic hepatitis infections. But sometimes
liver cancer happens in people with no underlying diseases and it's not clear what causes it.

Risk factors
Factors that increase the risk of primary liver cancer include:

Chronic infection with HBV or HCV. Chronic infection with the hepatitis B virus (HBV) or hepatitis C virus
(HCV) increases your risk of liver cancer.

Cirrhosis. This progressive and irreversible condition causes scar tissue to form in your liver and
increases your chances of developing liver cancer.

Certain inherited liver diseases. Liver diseases that can increase the risk of liver cancer include
hemochromatosis and Wilson's disease.

Diabetes. People with this blood sugar disorder have a greater risk of liver cancer than those who don't
have diabetes.

Nonalcoholic fatty liver disease. An accumulation of fat in the liver increases the risk of liver cancer.

Exposure to aflatoxins. Aflatoxins are poisons produced by molds that grow on crops that are stored
poorly. Crops, such as grains and nuts, can become contaminated with aflatoxins, which can end up in
foods made of these products.

Excessive alcohol consumption. Consuming more than a moderate amount of alcohol daily over many
years can lead to irreversible liver damage and increase your risk of liver cancer.

Prevention
Reduce your risk of cirrhosis

Cirrhosis is scarring of the liver, and it increases the risk of liver cancer. You can reduce your risk of
cirrhosis if you:

Drink alcohol in moderation, if at all. If you choose to drink alcohol, limit the amount you drink. For
women, this means no more than one drink a day. For men, this means no more than two drinks a day.

Maintain a healthy weight. If your current weight is healthy, work to maintain it by choosing a healthy
diet and exercising most days of the week. If you need to lose weight, reduce the number of calories you
eat each day and increase the amount of exercise you do. Aim to lose weight slowly — 1 or 2 pounds
(0.5 to 1 kilograms) each week.

Liver Cancer Stages

Liver cancer stages range from stage I (1) through IV (4). As a rule, the lower the number, the less the
cancer has spread. A higher number, such as stage IV, means cancer has spread more.

AJCC Stage Stage grouping Stage description*

IA T1a A single tumor 2 cm (4/5 inch)
or smaller that hasn't grown
N0 into blood vessels (T1a).

M0 It has not spread to nearby

lymph nodes (N0) or to distant
sites (M0).
IB T1b A single tumor larger than 2cm
(4/5 inch) that hasn't grown
N0 into blood vessels (T1b).

M0 The cancer has not spread to

nearby lymph nodes (N0) or to
distant sites (M0).
II T2 Either a single tumor larger than
2 cm (4/5 inch) that has grown
N0 into blood vessels, OR more
than one tumor but none larger
M0 than 5 cm (about 2 inches)
across (T2).

It has not spread to nearby

lymph nodes (N0) or to distant
 sites (M0).
IIIA T3 More than one tumor, with at
least one tumor larger than 5
N0 cm across (T3).

M0 It has not spread to nearby

lymph nodes (N0) or to distant
sites (M0).
IIIB T4 At least one tumor (any size)
that has grown into a major
N0 branch of a large vein of the
liver (the portal or hepatic vein)
M0 (T4).

It has not spread to nearby

lymph nodes (N0) or to distant
sites (M0).
IVA Any T A single tumor or multiple
tumors of any size (Any T) that
N1 has spread to nearby lymph
nodes (N1) but not to distant
M0 sites (M0).
IVB Any T single tumor or multiple tumors
of any size (any T).

It might or might not have

Any N spread to nearby lymph nodes
(any N).

M1 It has spread to distant organs

such as the bones or lungs (M1).

TX: Main tumor cannot be assessed due to lack of information.

T0: No evidence of a primary tumor.

NX: Regional lymph nodes cannot be assessed due to lack of information.

Liver cancer classification
Formal staging systems (such as those described before) can often help doctors determine a patient's
prognosis (outlook). But for treatment purposes, doctors often classify liver cancers more simply, based
on whether or not they can be cut out (resected) completely. Resectable means able to be removed by
surgery.

Potentially resectable or transplantable cancers

If the patient is healthy enough for surgery, these cancers can be completely removed by surgery or
treated with a liver transplant. This would include most stage I and some stage II cancers in the TNM
system, in patients who do not have cirrhosis or other serious medical problems. Only a small number of
patients with liver cancer have this type of tumor.

Unresectable cancers

Cancers that have not spread to the lymph nodes or distant organs but cannot be completely removed
by surgery are classified as unresectable. This includes cancers that have spread throughout the liver or
can’t be removed safely because they are close to the area where the liver meets the main arteries,
veins, and bile ducts.

Inoperable cancer with only local disease

The cancer is small enough and in the right place to be removed but you aren’t healthy enough for
surgery. Often this is because the non-cancerous part of your liver is not healthy (because of cirrhosis,
for example), and if the cancer is removed, there might not be enough healthy liver tissue left for it to
function properly. It could also mean that you have serious medical problems that make surgery unsafe.

Advanced (metastatic) cancers

Cancers that have spread to lymph nodes or other organs are classified as advanced. These would
include stages IVA and IVB cancers in the TNM system. Most advanced liver cancers cannot be treated
with surgery.
Diagnosing liver cancer
Your healthcare provider may suspect you have liver cancer if they find liver cancer signs and symptoms
during your physical examination. They may order the following tests to learn more:

Blood tests: Healthcare providers may do blood tests for cancer, such as a liver function test, to check
on liver enzymes, proteins and other substances that show whether your liver is healthy or damaged.
They may test for alfa-fetoprotein (AFP). High AFP levels may indicate liver cancer.

Ultrasound (sonography): This test provides pictures of your soft tissue structures. Healthcare providers
use ultrasound to look for liver tumors.

Computed tomography (CT) scan: This special type of X-ray takes detailed images of your liver,
providing information about liver tumor size and location.

Magnetic resonance imaging (MRI): This test produces very clear images of your body using a large
magnet, radio waves and a computer.

Angiogram: This test helps healthcare providers examine your liver’s blood vessels. During this test, your
healthcare provider injects dye into an artery so they can track blood vessel activity and look for
blockages.

Biopsy: Healthcare providers remove liver tissue to look for signs of cancer. Biopsies are the most
reliable way to confirm a liver cancer diagnosis.

Your healthcare provider may do the following tests if they think you may have IHC:

Endoscopic retrograde cholangiopancreatography (ERCP): ERCP uses an endoscope and a catheter

(thin, flexible tubes) to examine your bile ducts.

Percutaneous transhepatic cholangiography (PTC): A PTC creates X-rays of your bile ducts like an ERCP.
Instead of an endoscope and catheter, your healthcare provider delivers contrast dye by inserting a