Liver Cancer – A Difficult Fight Against a Devastating Disease

Liver cancer is one of the most common tumours. More than 90% of cases are hepatocellular carcinoma, which can be difficult to treat. Unfortunately, many people are diagnosed with liver cancer at advanced stages of the disease, making treatment more difficult and less effective.

There are several types of liver tumours, including fibrolamellar carcinoma, cholangiocarcinoma, angiosarcoma, hemangiosarcoma or hepatoblastoma, the latter of which can occur in children under 3 years of age. Liver tumours can also arise as a result of metastases from other organs, such as breast, colon or gastric cancer.

Statistics show that liver tumours are the 6th most common cancer worldwide. In Europe, it affects about 10 in 1000 men and 2 in 1000 women. In the United States, the annual number of diagnosed cases is estimated at 25,000 for men and 11,000 for women. Every year, about 19,000 people lose their battle with the disease, and others battle it every day.

One of the main causes of liver cancer is hepatitis B or C virus infection, which is common in some parts of the world. Diagnosis of this disease is often delayed because symptoms can be mistaken for other conditions such as fatigue, abdominal pain or weight loss.

LIVER CANCER CAUSES: DISCOVER THE BIGGEST RISK FACTORS!

Have you ever heard of liver cancer? This type of cancer can be very dangerous and can occur at any age. But what causes it?

Well, genetic mutations in liver cells are the main cause of liver tumours. In children with hepatoblastomas, Beckwith-Wiedemann syndrome and hemihypertrophy caused by chromosome 11 mutation may also be risk factors.

But let’s talk more about the risk factors that can contribute to hepatocyte DNA mutations and primary liver cancer in adults. In the following, you will discover the main causes of liver cancer.

CHRONIC HEPATITIS B AND/OR C VIRUS INFECTION

Infection with liver viruses type B and C is considered chronic when the course of the disease is longer than 6 months and results in hepatocyte dysfunction. Worldwide, Hepatitis B Virus (HBV) is responsible for about 50% of all hepatocarcinomas, while Hepatitis C Virus (HCV) is implicated in 25% of liver cancers.

INFECTIOUS, ALCOHOLIC OR DRUG-INDUCED CIRRHOSIS OF THE LIVER

Cirrhosis of the liver can occur due to infectious diseases such as hepatitis or due to chronic alcohol or drug use. However, this disease can be extremely dangerous and can increase the risk of liver cancer.

LIVER PATHOLOGIES SUCH AS HEMOCHROMATOSIS WILSON AND ALPHA-1-ANTITRYPSIN DEFICIENCY

Wilson’s hemochromatosis is an inherited disease that causes iron from food to be stored in the liver. Alpha-1-antitrypsin deficiency is the 3rd most common hereditary disorder in Caucasians and is implicated in the aetiology of liver cirrhosis through the deposition of abnormal proteins in hepatocytes.

DIABETES MELLITUS AND METABOLIC SYNDROME ASSOCIATION

One of the risk factors for developing liver cancer is diabetes and associated metabolic syndrome.

It is important to understand that diabetes is not just a problem of regulating blood sugar levels, but can have serious consequences for the whole body, including the liver. People with diabetes are more at risk of developing hepatic steatosis, a condition in which the liver fills with fat, which can lead to liver cancer.

Diabetes-associated metabolic syndrome, characterised by obesity, hypertension and dyslipidaemia, is also a major risk factor for the development of liver cancer.

PRESENCE OF NON-ALCOHOLIC LIVER STEATOSIS

Non-alcoholic hepatic steatosis is a condition in which the liver accumulates excess fat, which can lead to inflammation and liver damage. This condition is often associated with obesity, diabetes and metabolic syndrome. Studies show that people with non-alcoholic fatty liver disease are more likely to develop liver cancer.

AFLATOXIN EXPOSURE

Aflatoxins are toxic substances produced by certain types of moulds, such as Aspergillus flavus and Aspergillus parasiticus. These moulds can grow on cereals, peanuts, ground nuts and rice, and exposure to aflatoxins can increase the risk of liver cancer. In addition, aflatoxins may be present in the breast milk of mothers who eat foods contaminated with these toxins.

LONG-TERM ADMINISTRATION OF ANABOLIC STEROIDS

Anabolic steroids are a class of hormones that are used to increase muscle mass and athletic performance. However, long-term anabolic steroid use may increase the risk of hepatocellular adenomas, which have an increased risk of malignancy and progression to cellular hepatocarcinoma.

GENDER

Liver cancer is 4 to 8 times more common in males. However, researchers are not sure of the reasons for this gender difference. It is possible that male sex hormones play a role in the development of liver cancer.

HEPATOBLASTOMAS IN CHILDREN: RISK FACTORS AND PREVENTION

Hepatoblastomas are rare liver tumours that occur mainly in children under five years of age. They are more common in boys and are characterised by the formation of immature liver cells (hepatoblasts) that multiply abnormally. At present, the exact causes of hepatoblasts are not fully known, but several risk factors have been identified that may contribute to the development of the condition.

Renal dysplasia and Meckel’s diverticulosis

Studies have shown that children with renal dysplasia and Meckel’s diverticulosis are more susceptible to developing hepatoblasticomas. This is because these conditions are associated with congenital liver malformations.

Family history of polypomatosis and adenocarcinoma

Children whose first- or second-degree relatives have had familial polypomatosis and adenocarcinoma are more likely to develop hepatoblastomas. This is a strong indicator that the disease is linked to genetic factors.

Preterm birth or intrauterine growth retardation

Babies who are born prematurely or with intrauterine growth retardation have an increased risk of developing hepatoblastomas. This is because their immune system is not strong enough and cannot fight abnormal cells.

HBV infection in the neonatal period

Hepatitis B virus (HBV) infection in the neonatal period may increase the risk of hepatoblastoma. It is important for mothers to be tested for HBV during pregnancy and, if necessary, receive treatment to prevent transmission of the virus to the baby.

Gestational exposure of the mother to gonadotropins, alcohol consumption in pregnancy and taking oral contraceptives for long periods of time

Exposure to gonadotropins, alcohol consumption during pregnancy and taking oral contraceptives for long periods of time may increase the risk of hepatoblastoma in children. It is important for mothers to avoid these risk factors during pregnancy.

Association with other conditions

Hepatoblastomas can be associated with other genetic conditions such as neurofibromatosis type I, trisomy 18, thyroid disease, galactosemia, alpha-1-antitrypsin deficiency and Li-Fraumeni syndrome.

DIAGNOSIS OF LIVER CANCER

Therefore, the diagnosis of liver cancer is essential for the early treatment of this disease and is determined by the gastroenterologist with the help of information obtained from clinical examination and clinical investigations as well:

Laboratory tests for tumour markers

One of the most common ways to diagnose liver cancer is through laboratory tests. These include determining serum values of specific tumour markers, such as alpha fetoprotein (AFP), which are present in the patient’s blood early in the development of liver cancer.

In patients with liver cancer, AFP levels may be elevated, which may suggest liver cancer. However, elevated AFP levels can also be caused by other liver conditions such as cirrhosis.

Liver ultrasound

Liver ultrasound is another method of diagnosing liver cancer. This can help identify structural changes in the liver caused by tumour processes at this level. In addition, ultrasound can help determine the size and position of the tumour, as well as assess the presence of other liver disease.

Nuclear magnetic resonance (NMR) or computer tomography (CT) scan

Both MRI and CT are advanced methods of diagnosing liver cancer. They can provide detailed images of the liver structure and help identify tumours smaller than those visible by ultrasound.

MRI and CT scans can also help identify the presence of metastases in other organs and tissues.

Liver biopsy

Liver biopsy is a minimally invasive procedure in which samples of liver tissue are collected for cytological examination. This can be performed under ultrasound or CT guidance, depending on the position of the tumour.

Liver biopsy can help confirm the diagnosis of liver cancer and assess the degree of malignancy of the tumour.

TREATMENT OF LIVER TUMOURS

Treatment of liver cancer is determined by the stage of the tumour, the existence of metastases and the patient’s general health. Treatment options are varied and include:

• Partial hepatectomy, a surgery that removes the primary tumor from the liver. This method is recommended for patients without liver cirrhosis and who have a single well-defined tumour in the liver parenchyma.
• Liver transplantation is an option for patients with irreversibly impaired liver function, but without secondary metastases and other associated conditions that could damage the transplanted organ.
• Local treatments use radiofrequency, microwaves or cryotherapy to destroy cancer cells with heat or liquid nitrogen. They are performed under local anaesthesia and ultrasound guidance.
• Injection of pure alcohol – ethanol into the tumour can be used to destroy cancer cells.
• Chemoembolisation is a form of chemotherapy that involves injecting drugs into the liver artery. This method can be used as an alternative to radiotherapy or systemic chemotherapy.
• Radiotherapy is another treatment method used to destroy liver cancer tumour cells. It uses ionising radiation and is indicated for patients who cannot benefit from other therapies or who have not had a favourable outcome after other treatments. However, it is important to note that radiotherapy can also affect healthy tissue around the tumour, which can lead to side effects.

Targeted drug therapy focuses on abnormal cancer cells and aims to effectively destroy tumour tissue. This method is particularly indicated for patients with certain genetic defects in tumour cells and involves prior laboratory testing of the efficacy of the therapy on biopsied tumour tissue.

Immunotherapy stimulates the immune system to fight tumour cells. This method can be used to help patients fight liver cancer through specific changes it induces in the synthesis of certain proteins by tumour tissue. In this way, the immune system can more easily recognise structural tumour cells and initiate specific binding processes to them for further destruction.

Systemic chemotherapy is a method of treatment using substances that destroy cancer cells with an accelerated rate of multiplication. This method can be used both in the early stages of the disease and in cases where liver cancer has spread to other parts of the body.