Liver cancer - Causes, symptoms and treatment. MF.

Liver cancer is a malignant liver tumor that develops from its structures under the influence of various causes, causing disruption of the body and, in the absence of treatment, leading to the death of the patient. The proportion of liver cancer in the total mass of cancer patients is gradually increasing, primarily due to the increase in the incidence of chronic forms of viral hepatitis. Not every hepatitis passes into a chronic form, usually the proportion of cases is about 5-15%, but among them most of them are carriers of the virus that do not have clinical signs of the disease.

Causes of liver cancer

A direct link has been established between the development of liver cancer and chronic hepatitis, especially B, C and D, as well as with the asymptomatic carriage of these viruses. Cancer develops gradually, for at least 20 years or more from the moment of infection with hepatitis, after the process passes through the stage of cirrhosis. Several times more sick men. Much faster cancer occurs when a combination of several forms of hepatitis( B and C, C and D and so on).The basis of the development of cancer is the mechanism of direct damaging action of the virus on liver cells, the constant long-term presence of the virus in them, resulting in chronic inflammation of cells and intercellular spaces, bile ducts, disruption of their work. The reserves of our liver are not infinite, and, depending on the aggressiveness of the virus, healthy cells gradually die off and are replaced by a rough scar tissue( this is called cirrhosis), which is the substratum of cancer development.

Another cause of liver cancer is chronic alcoholic hepatitis and its outcome is alcoholic cirrhosis of the liver.

Recently, a link has been found between the development of liver cancer and the product of the life of certain mold fungi( aspergillus) - aflotoxin. Mushrooms affect rice, wheat, nuts, and are also found in meat of domestic animals that eat contaminated foods. Aflotoxin is a strong poison. The risk of developing liver cancer when eating contaminated foods increases more than 7 times. Most common fungus is found in Africa and China.

In the origin of liver tumors, such as cholangiocarcinoma, the leading role belongs to parasites - flatworm trematodes. A person becomes infected with helminths when eating poorly processed fish. Often found this disease in the coastal areas of the Russian Federation, Kazakhstan, China, Thailand. The parasite is located directly in the bile ducts of the sick person, constantly feeding on bile, blood of the liver, secreting the products of vital activity, irritating substances and causing inflammation of the bile ducts. With the passage of time, this leads to the development of bile duct tumors.

There are two types of liver cancer:

- cholangiocarcinoma - from the bile duct;
- hepatocellular carcinoma - directly from the hepatic cells( hepatocytes, from the Latin "hepar" - the liver).

In addition, the liver can be affected by secondary tumors( metastases).Metastases are screenings from the main tumor of another organ( for example, the breast, intestines, lungs, ENT organs, prostate, and others) that have the structure of the original tumor and are capable of growing, disrupting liver function. In some cases, metastases can reach huge sizes( more than 10 cm) and lead to the death of patients from poisoning with the products of the life of the tumor and disrupting the liver( liver failure).Most often, metastases arise from tumors of the intestine, which is associated with the specificity of the outflow of blood from this organ: all blood from the abdominal cavity first enters the liver, as in a natural filter, since this organ has a very small and highly developed vasculature, tumor cellssettle in it from the bloodstream and begin to grow, forming colonies - metastases. The liver can metastasize a malignant tumor of any organ.

Symptoms of liver cancer

There are no specific symptoms for liver tumors, so they are often confused with other, non-specific diseases of this body( cholelithiasis, cholecystitis, cholangitis), or exacerbations of a chronic process( eg, hepatitis), these patients are treated for a long time and, often,late stage. Clinical changes appear only if the tumor reaches significant dimensions or presses on nearby structures. The first signs may not pay attention to patients: causeless weakness, fatigue, weight loss, decreased appetite, changes in stool: a tendency to diarrhea, and also pulling pain in the right hypochondrium. The pain can be associated with the growth of the tumor, as a consequence - the extension of the liver capsule, which contains many nerve endings, as well as the increase in the size of the body with multiple lesions or attachment of inflammatory phenomena.

When the disease progresses, there is a violation of the liver function: the processing of bile and secretion of it into the intestines, which leads to a change in skin color - jaundice, up to bright yellow color, mucous( oral cavity, eye proteins), permanent itching, dry skin andmucous membranes, the appearance of stool disorders. Body temperature rises from small( 37.5 C) to high figures( 39 C), which become permanent in nature, can be noted. With a visual examination of such patients, one can detect an increase in the lower edge of the liver, bulging it from under the costal arch, soreness, and in some cases the tumor itself, which looks like a large, dense, tuberous and immovable node.

Both photos illustrate distant tumor nodes of the liver( on a cut)

A number of studies are leading to the detection of liver tumors:

1) ultrasound examination of the abdominal cavity - with its help it is possible to suspect the malignancy of the tumor, determine its size, structure and presence of metastases in nearby lymphaticnodes.

2) The next step after ultrasound is spiral computed tomography of the abdominal cavity with contrasting or nuclear magnetic resonance imaging( MRI).It gives an idea of ​​the exact size of the tumor, the possibilities of its surgical removal, the presence of metastases, and also quite reliably confirms the nature of malignancy.

Computer tomography of the liver-tumor nodes are indicated by arrows

Computer image of the liver with metastases in the right lobe

3) Further, as a rule, the tumor is punctured: under a local anesthesia, a thick needle is pierced the skin and under ultrasound guidance the needle is inserted into the tumor, a small piece is takentissue for histological examination. This is done in order to confirm the malignant nature of the tumor and accurately determine its shape.

4) Perform additional general clinical studies: a general blood test, urine, blood from the vein. The latter is the most important: gives an idea of ​​liver function and its reserves: the level of bilirubin, specific enzymes( AST, ALT), proteins and other indicators. Knowledge of it is necessary for planning an operation, it is impossible to take a patient with a very high performance of the latter - the risk of complications is high.

5) In the case of liver cancer, a certain clue may be given by so-called oncomarker-specific proteins, which are produced by the tumor in large quantities, by measuring their level, one can confirm or disprove a particular tumor of the body. Specific for the liver is the alpha-fetoprotein-protein, found in the blood in early childhood, it is absent in adults and is significantly elevated in liver cancer.

Treatment of liver cancer

Only liver cancer is treated by surgery: as with any malignant tumor, only complete removal of the tumor can provide hope for a cure. Operations on the liver are performed in large surgical clinics, they are rather difficult and traumatic. In malignant tumors, as well as metastases, liver resection is most often performed: removal of the affected liver part of the liver, that is, in some cases - half of the organ. The liver has the property to quickly restore its original size, and after half a year the mass of the remaining fraction approaches the initial one.

Type of liver after removal of tumor nodes

If it is impossible to remove a part of the body, liver transplantation may be the solution to the problem.

Other methods of treating tumors, such as chemotherapy or radiation therapy, are practically not used, since liver cancer is not sensitive to almost all of the known antitumor drugs, as well as to irradiation. Drug therapy is possible only in a very small group of patients( absence of cirrhosis, low bilirubin level), although this does not significantly affect survival rates. Recently, certain prospects for drug therapy for hepatocellular cancer have been associated with the emergence of Nexavar( sorafenib), originally registered for the treatment of metastatic renal cell carcinoma, and in September 2008 for treatment of HCC.

If the tumor can not be removed: it is very large and is located close to large vessels or a multitude of them and they occupy both lobes of the liver, a restorative treatment is used to alleviate the patient's condition and prolong his life in the most comfortable conditions: adequate nutrition,substances intravenously, vitamin therapy, painkillers and so on.

In large scientific centers, the introduction of chemotherapy drugs directly into large vessels near the tumor is used, this is done in order to reduce the tumor in size, sparing the whole organism as much as possible, that is, directly affecting the tumor. In some cases this leads to prolongation of patients' life.

Without treatment, liver cancer very quickly leads the patients to death.

As an auxiliary, restorative treatment, if desired, you can use a variety of vitamins and herbal tea( chamomile, yarrow, sea buckthorn oil), which have a local anti-inflammatory and wound-healing effect. It is not necessary to use cholagogue preparations, they make the already stressed liver strain. It is strictly forbidden during the treatment to use such folk remedies as tinctures of mushroom, hemlock, celandine and other poisonous substances! All of them have a pronounced toxic effect and poison the body, the protective forces of which are undermined by an oncological disease, further exacerbating the patient's condition.

Possible complications of liver cancer can be:

- suppuration and disintegration of the tumor( high fever, abdominal pain, weakness, refusal to eat, signs of suppuration by ultrasound);
- bleeding from the tumor, in some cases leading the patients to death;
- an obstacle to the outflow of bile as a result of the overlap of large bile ducts with the tumor and, as a consequence, the development of jaundice with poisoning of the body by the products of bile acid destruction;
- an obstacle to the outflow of blood from the abdominal cavity organs due to tumor compression of large vessels of the abdominal cavity and, as a consequence, the accumulation of fluid in the abdomen - ascites.

Prognosis and survival in liver cancer.

The incidence of liver cancer is 0.7% of all cancers. There is a high incidence in African countries where more than 50% of the population is infected with hepatitis C and B viruses, among them liver cancer accounts for about 50% of tumor pathology.2 times more often sick men, the average age of the sick - 50 years. The right side of the liver is more often affected, in 5-13% of cases, liver damage is bilateral.

Liver cancer ranks 5th in frequency of occurrence in men and 8 in women among all tumor pathologies. In Russia, the incidence is 4.7-5 per 100,000 population and is gradually decreasing. The direct cause of liver tumors, infection with hepatitis C and B viruses, they occur in 80% of patients.

Approximately 60-90% of cases of cancer occur against the background of liver cirrhosis, with cancer developing in 5% of patients with cirrhosis. About 1/3 of the patients with liver cancer are subject to surgery.

Liver cancer can be both primary( about 25%) and metastatic( about 75%).Among the latter, the most frequent are metastases of colon cancer( 50%).Among such patients operations are subject only to no more than 10%.The number of patients with metastases of other tumors in the liver( cancer of the breast, stomach, lungs, etc.) subject to surgical treatment, even less - no more than 5%.

On the prognosis of liver tumors, factors such as the number and size of tumor nodes, the presence of intra-organ metastases( in the liver itself), the volume of the operation, the characteristics of the tumor itself( the presence of a capsule, growth in the blood vessels of the liver), the presence of a history of viral hepatitis, the degree of concomitant cirrhosisliver or its absence. For example: it is proved that the survival of patients is inversely proportional to the volume of the performed operation: with small traumatic interventions, the results are much better than when removing half of the liver. Depending on the number of tumor nodes in the liver, the results may be different: for a single tumor node, about 40-52% survive, with 31-38% survival at two sites, more than 3-12-18% of patients surviving for 5 years. In hepatocellular cancer, a relapse within 5 years may have up to 70% of patients.
But even with a favorable outcome of surgery, the survival rate for liver cancer is not more than 40%.

Prevention of liver cancer

Prevention of liver cancer is the observance of the principles of a healthy lifestyle: alcohol refusal, preventive vaccinations against hepatitis B. When infecting with hepatitis - compliance with all prescriptions of the doctor, sparing regimen and diet, as well as the use of special drugs designed to destroyvirus, i.e., creation of maximum conditions ensuring recovery of the patient. Patients who are still carriers of hepatitis viruses and who have periodic exacerbations of the disease must constantly monitor the liver, regularly take tests, perform ultrasound, and if necessary, a computerized tomography of the abdominal cavity.

Consultation of an oncologist on liver cancer:

1. Is cirrhosis a cancer?
No cirrhosis is a chronic disease that is the outcome of a long-term ongoing inflammatory process in the body( viral or alcoholic nature).Patients with cirrhosis can live many years, they all have a risk of developing liver cancer.

2. Is liver transplantation used for cancer?
Yes, in some cases, even when the patient suffers from viral hepatitis. The condition for this is: finding a suitable donor, the impossibility of performing liver resection( removing part of it) and a good general condition of the patient, the absence of metastases.

3. In what terms does liver cancer develop in patients with chronic viral hepatitis?
Usually the terms are long - more than 20 years, but when several viruses are combined in one patient, for example C and D, the cancer can develop much faster - for five or more years.

Doctor-surgeon-oncologist Barinova Natalya Yurevna