LIVER CANCER

What is the liver?
The liver is the largest and one of the most complex organs of the human body.  Located in the upper right part of the abdomen, the liver is divided in two lobes and receives major blood supplies from two large vessels: the portal vein and the hepatic artery.  The liver performs multiple vital functions, including securing the metabolism of nutrients and medications, storing glycogen, synthesis of plasma proteins, and removing toxic substances from the blood.

What is liver cancer?
Liver cancer is caused by an uncontrolled growth of tumor cells. This is an extremely serious condition because it prevents the liver from performing its vital functions.  As for all forms of cancer, liver cancer can be:

  • Primary, when it originates from the hepatocytes (liver cells). The most common type of cancer is the hepatocellular carcinoma in adults and the hepatoblastoma in children. Primary tumors can start with a single nodule or with multiple localizations inside the organ (multifocal tumor).
  • Secondary, which is the most common type of tumor of the liver, specifically due to its filtering function, and derives from tumor cells from other parts of the body (colon, breast, lung, etc.). The liver metastases can remain asymptomatic for long periods of time.

Liver cancer is the sixth most common cancer and the second leading cause of death globally.  The 5-year survival rate is very low (5%) because very often the disease is diagnosed when already in an advanced stage.  The incidence varies according to the geographical area (it is more widespread in Asia than in Europe).  In Italy it is rarer and represents 3% of all new diagnoses of cancer with a 2:1 men to women ratio (13,000 cases reported in 2017). In Italy too figures vary according to the different regions (it is more common in southern Italy).

Risk factors of liver cancer
Why liver cancer develops remains uncertain but there are some well-established risk factors:

  • Age and sex: the risk of onset increases beyond the age of 50, and is higher in men.
  • Familiarity
  • Chronic infections: Hepatitis B and C are the main risk factors (more than 70% of primary tumors).
  • Cirrhosis: over 5% of people who suffer from this disease develop a liver cancer.
  • Aflatoxins: poisonous carcinogens produced by certain molds and fungi that contaminate some foods.
  • Obesity and metabolism alterations (diabetes, hypertension, and hypercholesterolemia) cause diseases such as steatohepatitis, fibrosis, and cirrhosis, and increase the risk of liver cancer.
  • Smoking

Treatment of liver cancer
The progress in medicine has made metastatic liver cancer more curable, although its treatment is complex and, as for all other tumors, the selected treatment depends on several factors (type of cancer, extension, liver functionality, patient’s general conditions). Of course early diagnosis increases the chances of a successful treatment.

  • Surgery: when the cancer is still at an early stage and has not extended outside the liver, patients can undergo surgery (resection of one or more portions of the organ, or transplant).
  • Radiation therapy: patients not eligible for surgery or other local ablation treatment can undergo stereotactic body radiation therapy (SBRT) that involves targeting radiations to the tumor site to destroy tumor cells without damaging the healthy cells. Radiation therapy can be delivered also in combination with chemotherapy and surgery.  At UPMC Hillman Cancer Center at Villa Maria we perform stereotactic radiotherapy and radiosurgery.
  • Chemotherapy: use of antiblastic or cytotoxic drugs that stop tumor cells proliferation.