🧬 Liver Cancer

What is Liver Cancer?

The liver is the body's largest internal organ, located on the upper right side of the abdomen. It filters blood, produces bile for digestion, and detoxifies chemicals and drugs.

Liver cancer occurs when cells in the liver grow abnormally and form a mass (tumour). There are two broad categories:

• Primary liver cancer — Cancer that originates in the liver itself. The most common form is Hepatocellular Carcinoma (HCC).
• Secondary (metastatic) liver cancer — Cancer that started elsewhere in the body (e.g., colon, breast) and spread to the liver. This is more common than primary liver cancer.

Causes and Risk Factors

Liver cancer is closely linked to chronic liver disease. Key risk factors include:

• Hepatitis B or C infection — The most significant risk factor for HCC in the Philippines. Chronic hepatitis causes ongoing liver inflammation that can eventually lead to cancer.
• Liver cirrhosis — Scarring of the liver from any cause (hepatitis, alcoholism, fatty liver disease) significantly raises the risk.
• Excessive alcohol consumption
• Non-alcoholic fatty liver disease (NAFLD) — Linked to obesity and type 2 diabetes
• Aflatoxin exposure — A toxin found in mouldy peanuts and corn
• Family history of liver cancer

Symptoms

Liver cancer often does not cause symptoms in early stages. When symptoms appear, they may include:

• Unexplained weight loss
• Loss of appetite
• Upper abdominal pain, especially on the right side
• Nausea or vomiting
• General weakness and fatigue
• Abdominal swelling (ascites — fluid accumulation)
• Yellowing of the skin and eyes (jaundice)
• White, chalky stools
• Fever that doesn't resolve

Diagnosis

If liver cancer is suspected, your doctor may order:

• Blood tests — Including AFP (alpha-fetoprotein), a protein that may be elevated in liver cancer
• Ultrasound — A painless scan to look for tumours in the liver
• CT scan or MRI — Detailed imaging to assess tumour size, location, and spread
• Liver biopsy — In some cases, tissue removal for definitive diagnosis
• Hepatitis B/C testing — To understand the underlying cause

Staging

Several staging systems are used for liver cancer. A simplified overview:

• Very early / Early stage: Single small tumour, liver function preserved. Surgery (resection) or ablation may be curative.
• Intermediate stage: Multiple tumours but no spread outside liver. TACE (transarterial chemoembolisation) is commonly used.
• Advanced stage: Spread to blood vessels or distant organs. Targeted therapy (e.g., Sorafenib, Lenvatinib) and immunotherapy are primary options.
• Terminal stage: Severe liver dysfunction. Treatment focuses on comfort and quality of life.

Treatment Options

Surgical Resection

Removal of the tumour and a margin of healthy tissue. Most effective for early-stage tumours when liver function is preserved and the patient is otherwise healthy.

Liver Transplantation

For patients meeting specific criteria (Milan criteria), a liver transplant offers the possibility of cure by removing both the tumour and the damaged liver.

Ablation Therapies

Minimally invasive procedures that destroy tumour cells without surgery:

• Radiofrequency Ablation (RFA) — Uses heat from radio waves to destroy cancer cells
• Microwave Ablation (MWA) — Similar to RFA but uses microwave energy
• HIFU (High-Intensity Focused Ultrasound) — Uses focused ultrasound waves to heat and destroy the tumour, entirely non-invasive
• Cryoablation — Freezes cancer cells to destroy them

TACE — Transarterial Chemoembolisation

A procedure in which chemotherapy drugs are delivered directly to the tumour through the blood vessels that supply it, followed by blocking those vessels (embolisation) to cut off the tumour's blood supply. Widely used in China for intermediate-stage HCC.

Targeted Therapy

Drugs like Sorafenib (Nexavar) and Lenvatinib (Lenvima) slow tumour growth by blocking specific proteins that cancer cells need to grow.

Immunotherapy

Checkpoint inhibitors like atezolizumab combined with bevacizumab have shown strong results in advanced HCC and are now standard first-line treatment in many centres.