Liver Cancer: A diagnosis often too late
Cancer of the liver: understanding
What is liver cancer?
Liver cancer is a malignant tumor characterized by the development of one or more cancerous nodules in the liver.
The liver is an essential organ for the functioning of the organism and cannot be supplemented. On the other hand, only a quarter of the liver is sufficient to ensure its main functions and the liver has very important regeneration capabilities that allow it to resume a normal function from a small fraction of its mass. Finally, it is possible to consider liver grafts.
In the vast majority of cases, these nodules develop in a diseased liver, due to a chronic condition that has caused liver fat overload ("fatty") or generalized scarring ("cirrhosis"). These diseases can be alcoholism, a fatty in type 2 diabetes, chronic viral hepatitis or iron overload during hemochromatosis.
Liver cancer remains "silent" for a long time, i.e. without causing clinical signs, making it difficult to diagnose early. As a result, people with whom this cancer is finally discovered often suffer from advanced forms, which are more difficult to treat.
The number of liver cancers diagnosed each year is declining significantly, especially as a result of the number of people treated against hepatitis C.
What are the different types of liver cancers?
• "Hepatocellular carcinoma", or "Hepatocarcinoma", is the most common form of primary liver cancer (90% of primary liver cancers). It originates in the cells that form most of the liver (called "hepatocytes"). Hepatocellular carcinoma is most commonly developed in people with damaged liver, such as in the case of cirrhosis (liver scarring), alcoholic, viral or toxic. It can take the form of a single tumor that can become very large if not detected early. "Fibrolamellaire carcinoma" is a variant that appears mainly in women aged under 40 years.
• Other forms of primitive liver cancer are rarer: when a cancer originates in a bile duct inside the liver, it is referred to as "intrahepatic bile duct Cancer" or "cholangiocarcinoma". The bile ducts are the tubes that carry the bile, which contributes to the digestion of fats, from the liver to the small intestine.
It is also possible to observe "soft tissue sarcomas" ("Angiosarcoma", "Leiomyosarcoma", "Fibrosarcoma", "Malignant histiocytoma", "Rhabdomyosarcoma"), but also cancers developed from liver vessel cells (" Hémangioendothéliome epithelioid "), from endocrine cells (" neuroendocrine tumor "), from immune cells such as non-Hodgkin's lymphoma (usually a diffuse large B cell non-Hodgkin's lymphoma or T lymphoma hepatosplenic)...
• "Hepatic metastases," which are secondary liver tumours, are much more common than primary liver cancer. Liver metastasis refers to cancer that originated in another organ of the body and spread to the liver. In this case, the tumor in the liver is composed of cells of the type where the cancer originated, and not of hepatic cells. For example, colorectal cancer often spreads to the liver: it is referred to as "colorectal cancer with hepatic metastasis", and this secondary cancer would be treated as colorectal cancer, not as a primary liver cancer. Cancers that often "metastasize" to the liver are mostly pancreatic cancers, breast, gallbladder and bile ducts, colorectal cancer, cancer of the stomach, esophagus, lung, skin ("melanoma"), ovary, eye, and Neuroendocrine.
What are the signs of liver cancer?
At the onset of the disease and for a long time, liver cancer does not cause any problems and there is no sign. The liver is, in fact, a large organ with large compensating capacities and it can function normally even if it contains a large tumor.
The signs appear when the tumor grows and causes complications, for example if it obstructs the bile ducts.
In addition, the signs are not specific for liver cancer and other diseases, including cirrhosis, can cause the same signs as liver cancer. This is the pain of the belly (which can radiate to the right shoulder), nausea and vomiting, loss of appetite, a sensation of "overeating", even after a light meal (called "Early satiety"), diarrhea, a Constipation, weight loss, bulge under the ribs to the right, prominent swelling of the abdomen (caused by fluid accumulation called "ascites"), swelling of the feet and legs caused by fluid accumulation (called "edema"), Fatigue with weakness.
What are the risk factors for liver cancer?
When the liver cells are attacked prolongally, they die and are replaced by fibrous tissue: it is "fibrosis".
"Cirrhosis" is the terminal phase of fibrosis and is the most important risk factor for liver cancer. It appears when the healthy tissue of the liver is replaced by scar tissue. The circulation of the blood in the liver is then blocked, which prevents the organ from functioning normally. Cirrhosis is not only caused by alcoholism and other factors may also cause cirrhosis: chronic hepatitis B and C, accumulation of fat in the liver in relation to obesity.
In addition, smoking can be associated with other factors to increase the risk of liver cancer: most cancers are attributable to many risk factors.
Aflatoxin is a kind of "mycotoxin" (toxin produced by mould and fungi). It can contaminate different foods including cereals such as maize, rice and wheat, oilseeds such as peanuts, soybeans and sunflower, spices such as chili pepper, black pepper and ginger, nuts like almond, walnut, Pistachio and Brazil nuts or food from animals fed with aflatoxin-contaminated grain.
Vinyl chloride is used in the plastics industry to manufacture polyvinyl chloride (PVC) which is used in many products. "Hemochromatosis" (iron overload) is a hereditary disease in which the organism stores a higher amount of iron than normal. This excess iron accumulates in various tissues, especially in the liver. When the liver stores too much iron and the condition is not treated, the organ may suffer damage (cirrhosis).
What are the complications of liver cancer?
• "Hepatic encephalopathy" occurs when the liver is no longer functioning properly and waste accumulates in the blood and various signs related to "brain poisoning" appear: mental confusion, drowsiness, change of Personality or mood, nervousness and anxiety, speech impairment (difficulty articulating), breath with a sweet or moldy odor, tremors or difficulty in controlling the movement of hands and arms, and finally, coma.
• "Portal hypertension" refers to an increase in blood pressure in the main vein that transmits blood to the liver (the "portal vein"). This can occur when a liver tumor blocks blood circulation in this vein, or in the presence of significant cirrhosis. The increase in blood pressure leads to the formation of large veins, or "varicose veins", in the stomach and esophagus in order to allow the blood to bypass the blockage. Varicose veins are very fragile and can easily bleed and the signs of portal hypertension include: a lump on the left side of the belly (caused by swelling of the spleen or "splenomegaly"), an accumulation of fluid in the abdomen (called " Ascites "), shortness of breath (caused by accumulation of fluid around the lungs, called" pleural effusion ") and digestive hemorrhages, either minimal with blood in the stool (black color and tar), or massive with vomiting of Blood.
• When diagnosed late, liver cancer can be treated in a curative manner (complete elimination) in about one-third of patients. In other cases, treatment is possible but the recidivism rate is high (in 80 to 85% of cases five years after the first diagnosis).
• Survival rate five years after a diagnosis of liver cancer varies strongly according to the stage of cancer evolution at the time of diagnosis: 25% in the forms where the tumour is located at less than 10% in the forms where the tumor is more extensive.
When a liver transplant has been performed to treat cancer, the five-year survival rate is about 70%.
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