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Liver Cancer

Since 1980, liver cancer incidence in the US has more than tripled, and the disease is about 3 times more common in men than it is in women.

Since 1980, liver cancer incidence in the US has more than tripled, and the disease is about 3 times more common in men than it is in women.

Overview

Liver cancer is one of the leading causes of cancer-related deaths in the world: it is responsible for over 700,000 deaths annually. And in America, the rate of liver cancer mortality has increased by a little more than 2 percent each year since 20071https://www.cancer.org/cancer/liver-cancer/about/what-is-key-statistics.html.

The most common type of liver cancer in adults is known as hepatocellular carcinoma (HCC). It can manifest in two distinct types of growth patterns:

  • Sometimes it originates as a single tumor that gets bigger; only in the disease’s later stages does it spread to other parts of the liver.
  • A second type of growth pattern appears to begin as multiple small cancer nodules spread throughout the liver as opposed to as a single tumor. This type of growth is most frequently observed in individuals with cirrhosis, and is the most common growth pattern seen in the US.

(Source)

Common screening tests for liver cancer include ultrasounds, CT scans, and MRIs2https://www.cancer.org/cancer/liver-cancer/detection-diagnosis-staging/how-diagnosed.html. CT scans, however, expose you to potentially harmful radiation3https://www.fda.gov/radiation-emitting-products/medical-x-ray-imaging/what-are-radiation-risks-ct. Multiple studies have shown MRI to be the best of the three in detecting liver cancer4https://pubs.rsna.org/doi/10.1148/radiol.11110157 5https://www.sciencedirect.com/science/article/pii/S1542356510009456?via%3Dihub

Symptoms

It is often difficult to detect liver cancer early, as the disease’s symptoms are often not present until its more advanced stages6https://www.cancer.org/cancer/liver-cancer/detection-diagnosis-staging/detection.html. Additionally, some of liver cancer’s most common signs can be symptoms of other conditions7https://www.cancer.org/cancer/liver-cancer/detection-diagnosis-staging/signs-symptoms.html:

  • Appetite loss
  • Feeling full quickly
  • Itching
  • Jaundice 
  • Nausea and/or vomiting
  • Unintended weight loss 
  • Abdominal swelling
  • Fluid buildup in the abdomen
  • An enlarged liver or spleen
  • Abdominal pain 
  • Pain near the right shoulder blade
  • Fever 
  • Abnormal bleeding or bruising
  • Enlarged veins on the belly

Some liver tumors can also produce hormones that affect other organs. These can in turn lead to:

  • High cholesterol
  • Testicular shrinkage
  • Breast enlargement
  • High red blood cell count, which may lead to someone appearing flushed
  • High blood calcium levels, which may lead to confusion, constipation, nausea, weakness, or muscle problems
  • Low blood sugar levels, which may lead to fainting or fatigue

If you are having any of the above symptoms you need to talk to a doctor about the appropriate diagnostic work up. The Ezra scan is a screening test for asymptomatic individuals and it is not designed to diagnose existing or suspected cancers.

Causes

It is difficult for researchers to pinpoint precisely what causes liver cancer, though they do know that liver cancer originates in genetic changes or mutations found in the DNA of normal liver cells. Sometimes, these mutations can occur in oncogenes or tumor suppressor genes, which are the genes in charge of when cells grow, divide, or die. Such mutations can at least in part be responsible for cancer and can be inherited from one’s parents or be picked up randomly during one’s life. Furthermore, some liver cancer risk factors are known to sometimes cause changes specifically in liver cell DNA8https://www.cancer.org/cancer/liver-cancer/causes-risks-prevention/what-causes.html.

Some risk factors known to increase one’s chances of developing liver cancer are9https://www.cancer.org/cancer/liver-cancer/causes-risks-prevention/risk-factors.html:

  • Race/ethnicity: Pacific Islanders and Asian Americans have the highest rates of liver cancer in the US
  • Gender: liver cancer is more common in men than it is in women
  • Chronic viral hepatitis: this is the most common liver cancer risk factor worldwide. Individuals infected with Hepatitis B or C often develop liver cirrhosis, which causes liver cells to become damaged and replaced by scar tissue. Most individuals who develop liver cancer already present some evidence of liver cirrhosis.
  • Cirrhosis: as mentioned above, liver cirrhosis causes scar tissue to develop in the liver. While it can be caused by hepatitis, it can also be a result of other conditions, such as non-alcoholic fatty liver disease and primary biliary cirrhosis.
  • Obesity: being very overweight increases one’s risk of developing liver cancer, likely because it can lead to cirrhosis and fatty liver disease.
  • Tobacco use: smoking raises one’s risk of developing liver cancer. Former smokers have a lower risk than those who still smoke. Both groups, however, are at a higher risk than those who have never smoked.
  • Heavy alcohol consumption: this is a major cause of cirrhosis in America, which is related to a higher risk of developing liver cancer.
  • Aflatoxins: these carcinogens are produced by a fungus that can contaminate wheat, ground nuts, rice, corn, soybeans, and peanuts that are stored in warm, moist environments. Extended exposure to aflatoxins is a major risk factor for liver cancer.
  • Type 2 diabetes: this disease has been linked to a higher risk of developing liver cancer, especially in patients with other risk factors like chronic viral hepatitis and heavy alcohol consumption.
  • Anabolic steroids: these male hormones sometimes used by athletes to augment muscle mass and strength have been linked to a slight increase in one’s risk of liver cancer.

Detection

There is currently no industry standard for screening individuals who are at an average risk of developing liver cancer. However, your doctor may recommend you get screened every six months with an ultrasound and an alpha-fetoprotein (AFP) blood test if you’re at a high risk of the disease. AFP is a protein that’s measured in the blood of individuals who have liver cancer, but it isn’t a perfect test, as many patients with early iterations of the disease have normal levels of it. And AFP levels can be higher due to other cancerous and non-cancerous conditions10https://www.cancer.org/cancer/liver-cancer/detection-diagnosis-staging/detection.html

Three of the most common tests used to detect liver cancer are the ultrasound, CT scan, MRI, and angiogram. CT scans and angiograms, however, expose you to radiation that can be harmful11https://www.fda.gov/radiation-emitting-products/medical-x-ray-imaging/what-are-radiation-risks-ct 12https://www.mayoclinic.org/tests-procedures/coronary-angiogram/about/pac-20384904. Furthermore, MRIs do not contain radiation and studies have shown them to be the most effective technique in detecting malignant lesions in the liver13https://pubs.rsna.org/doi/10.1148/radiol.11110157 14https://www.sciencedirect.com/science/article/pii/S1542356510009456?via%3Dihub.

Diagnosis

If your doctor finds that you have liver cancer, there is a chance they will perform a biopsy to further analyze the tumor cells. However, they may choose not to do so because the previously performed imaging tests were accurate enough15https://www.cancer.org/cancer/liver-cancer/detection-diagnosis-staging/how-diagnosed.html.

Upon diagnosis, physicians generally assign a cancer a stage, in order to better inform its treatment. The most common staging approach used for liver cancer in the US is the TNM system:

  • T is for tumor: how big is the cancer? Are there multiple tumors in the liver? Has the cancer spread to nearby structures, such as the liver’s veins?
  • N is for nodes: has the cancer reached lymph nodes nearby?
  • M is for metastasis: has the cancer metastasized to distant lymph nodes or other body parts?

(Source)

Treatment

The best treatment for liver cancer depends on the nature of the disease and how far it has spread. Treatment options may include: embolization, surgery, ablation, chemotherapy, targeted therapy, immunotherapy, and radiation16https://www.cancer.org/cancer/liver-cancer/treating.html

Please consult with a physician on treatment options as necessary.

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