What is Liver Cancer? What Are Its Stages?

Liver cancer occurs due to malignant tumors originating from the tissue of this organ. It is more commonly seen in regions where hepatitis B infection is widespread. In areas where hepatitis B vaccination is common, the incidence of this cancer is relatively lower. It is more frequently observed in men than in women and is also commonly associated with hepatitis B, hepatitis C, and cirrhosis.

Hepatocellular carcinoma, which develops from hepatocytes—the functional cells of the liver—accounts for approximately 90% of cases. The remaining 10% consists of cholangiocarcinoma tumors originating from the bile ducts within the liver. In addition, cancers that develop in other organs can metastasize to the liver. We will examine the causes and risk factors of liver cancer, as well as its treatment. First, let’s look at the symptoms.

Symptoms of Liver Cancer

In the early stages, liver cancer may not show any symptoms. This unfortunately reduces the chances of early diagnosis and treatment. Symptoms usually appear as the disease progresses. Common symptoms include:

• Unexplained weight loss
• Loss of appetite
• Nausea and vomiting
• Abdominal pain
• Swelling in the upper right abdomen
• Yellowing of the skin and the whites of the eyes (jaundice)
• Dark-colored urine
• Pale or clay-colored stools

Causes and Risk Factors of Liver Cancer

Although many studies have been conducted, the exact causes of liver cancer are not fully understood. However, several conditions are known to increase the risk. These include hepatitis B, hepatitis C, and hepatitis D infections. A history of jaundice is also considered an important factor.

Major risk factors include:

• Cirrhosis
• Aflatoxin (a toxin produced by Aspergillus flavus)
• Genetic predisposition
• Certain congenital and metabolic diseases
• Hemochromatosis, Wilson’s disease, and glycogen storage diseases
• Exposure to certain chemicals

How Is Liver Cancer Diagnosed?

Diagnosis requires various tests, particularly imaging techniques. Ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI) are highly effective in detecting liver tumors. Blood tests are also essential, especially for measuring alpha-fetoprotein (AFP) levels, which tend to rise in the presence of liver tumors.

Regular check-ups are crucial for individuals in high-risk groups. Early detection significantly increases the success rate of treatment.

How Is Liver Cancer Treated?

Once diagnosed, treatment should begin without delay, as untreated liver cancer can be life-threatening, with survival sometimes less than one year. Treatment usually involves a multidisciplinary approach including general surgery, radiology, gastroenterology, oncology, and radiation oncology.

Treatment options depend on the stage of cancer, its spread, and the patient’s overall health. Surgical removal of the tumor is one option. Other treatments include medication, radiotherapy, tumor ablation (freezing or destroying the tumor), alcohol injection into the tumor, and targeted therapies.

Liver transplantation is also a treatment option, especially in advanced cases. However, it is usually considered a last resort due to the difficulty of finding a suitable donor.

In some cases, curative treatment may not be possible. In such situations, palliative care is provided to relieve symptoms and improve quality of life. This may include surgery, chemotherapy, or radiation therapy alongside supportive treatments.

Stages of Liver Cancer

Liver cancer is generally classified into four stages:

• Stage 1

The tumor is confined to the liver and has not spread to other tissues or organs.

• Stage 2

There may be multiple tumors smaller than 3 cm, often with involvement of blood vessels.

• Stage 3

There are multiple tumors larger than 5 cm, or the cancer has spread to major blood vessels or lymph nodes.

• Stage 4

The cancer has metastasized to distant organs such as the lungs, bones, or lymph nodes.

How Is Liver Cancer Surgery Performed?

Surgical treatment may involve removing only the tumor or, in some cases, removing the entire liver followed by transplantation. The procedure is performed under general anesthesia, and the duration varies depending on the case. As mentioned earlier, liver transplantation is typically considered after other treatment options have been evaluated.