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Dr. Praveen Kammar

MS, MRCS, MCH

Surgical Oncologist

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Liver Blogs | 22 Feb 2022, Tuesday

How Serious Is a Tumor in the Liver?

how-serious-is-a-tumor-in-the-liver

Overview

When a tumor develops in the liver, it either destroys the liver cells or interferes with its function. A tumor is an abnormal mass of cells that form when cells reproduce at an increased rate uncontrollably.

There are two varieties of tumors – cancerous (malignant) and noncancerous (benign) tumors that can develop inside the liver. Both forms of tumors are harmful and can cause significant damage to the liver. This blog discusses the types of tumors that occur in the liver and how they affect your body.

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What causes tumor in the liver?

The liver’s function is to filter out the blood circulating through the body continuously. It also helps absorb the nutrients and process any drugs or medications from the digestive tract. Besides, the liver performs other important functions, such as removing chemical waste and toxins from the blood and processing them for excretion.

Since the whole blood in the body passes through it, the liver is easily accessible to cancer cells that could travel in the bloodstream.
Tumors can also arise inside the liver due to the changes(gentic mutations) in the DNA of liver cells. There are several factors that can put you at the risk of such tumor development. These include:

  • Chronic infection with hepatitis B or C
  • Liver cirrhosis (scarring of liver tissues)
  • Inherited liver disease (Wilson’s disease and hemochromatosis)
  • Non-alcoholic fatty liver disease
  • Excessive alcohol intake

Symptoms of liver cancer

Early stage primary liver cancer and limited spread of cancer from other regions to the liver may not produce any symptoms at all. Similarly majority of benign tumours do not give rise to any complaints. They may be identified incidentally and/or when the primary tumour situated elsewhere produces symptoms. However when the liver cancer or benign tumour is large enough, you may observe the following symptoms:

  • Abdominal pain
  • Weight loss
  • Nausea
  • Vomiting
  • Feeling of enormous mass in the upper right side of the abdomen
  • Fever
  • Yellow discoloration of the eyes and skin
  • Persistent itching

Based on these symptoms, your doctor may advise some tests to confirm the tumor diagnosis and types and stage of the tumor. These diagnostic tests include:

Liver function tests (LFTs):

A type of blood test to determine liver functioning.

Sonography is also known as abdominal ultrasound to visualize the liver and other internal body organs. It is one of the commonest tests available. However it cannot give precise and in depth information of the disease.

Computed tomography scan (CT scan)/ MRI:

Contrast enhanced CT scan and MRI scans are now routinely used to map the disease in the liver to plan treatments accurately. A 3D reconstruction of the images creates a 3 dimensional picture of the liver to help the surgeon plan a meticulous surgery.

Liver biopsy:

In this diagnostic test, samples of tissues from the liver are removed (with a needle or during surgery) and examined under a microscope in the lab.

Not all liver tumours need a biopsy.

The modern CT and MRI scans are very sensitive to identify the presence and type of liver cancer accurately. Hence we can avoid a biopsy most of the times.

However a biopsy is indicated when

  1. The scans are not giving a clear diagnosis
  2. When there is a single tumour nodule in liver that has spread from another organ
  3. Non surgical treatments are planned.

Benign and malignant liver tumours:

Liver tumours can be divided into benign and malignant tumours. Benign tumours are those which do not spread to the other organs. Malignant tumors are the ones that can progress and spread to nodes, blood streams and other organs. In common language, liver cancer generally refers to malignant liver tumor.

Here are some common benign tumors of the liver:

  • Hemangioma
  • Hepatic adenoma
  • Focal nodular hyperplasia
  • Cysts
  • Lipoma
  • Fibroma
  • Leiomyoma

Since these tumors are benign, they don’t causes any major effect or require any treatment. However, they are surgically removed only if they cause any pain or bleeding.

Liver cancer is of two types:

  1. Primary cancer: The origin of the cancer/ tumor site is inside the liver.
  2. Secondary cancer is a form of cancer that has started elsewhere in the body and has reached the liver. This is also termed “Metastatic Cancer.”

What is the primary cancer of the liver?

Primary cancer, also known as hepatocellular carcinoma, is the most common type of primary liver cancer. Chronic infections such as hepatitis B and C significantly increase the risk of developing this form of cancer.

Other causes of liver cancer can include certain chemicals, high consumption of alcohol, and chronic liver cirrhosis (liver damage).

Cholangiocarcinoma is another common variety of primary liver cancer.

What is secondary cancer of the liver?

Secondary cancers of livers are those that have spread from other organs to liver.
These malignant cancers include:

  • Hepatocellular carcinoma
  • Intrahepatic and extrahepatic cholangiocarcinoma (originates from bile duct)

Treatment of liver tumours :

Treatment depends on the type of tumour.

1. Benign tumours:

The treatment depends on the nature of benign tumors. The type or nature of benign tumour is identified by CT/ MRI scans most commonly. Sometimes a biopsy is also needed.

A hemangioma need not be treated if it is smaller than 5cm. Treatment is considered only when there are symptoms or when the hemangioma is growing rapidly.

Similarly , a hepatic adenoma is not treated when it is smaller than 5cm. Surgical treatment is considered only when the size crosses 5cm or becomes symptomatic. In select cases RFA and TACE are used as non surgical measures.

Whenever the treatment of benign tumours is considered it usually involves surgical removal. However these surgeries are not as extensive as those performed for lover cancers.

Focal nodular hyperplasia is usually kept under observation and uncommonly requires any interventions. Most of them remain stable or regress without any treatment. If there are symptoms attributed to its presence , then non surgical interventions like TACE, RFA or surgical removal can be considered.

Simple cysts of liver do not produce any symptoms and do not require any treatment. When they get bigger than 4 cm they have a tendency to produce symptoms. In such scenarios intervention is needed. Percutaneous aspiration and sclerotherapy is a noninvasive method to remove the cyst fluid and burn the lining of the cyst to prevent recurrence. Surgical deroofing of the cyst is a surgical option to treat symptomatic cysts.

2. Primary liver cancer :

Depending on the stage of the cancer, several treatment options are available.

These include :

  • Surgical removal
  • liver transplant
  • ablative therapies like radiofrequency ablation, microwave ablation, stereotactic body radiation therapy, proton beam therapy
  • TACE, TARE
  • Targeted therapy
  • Chemotherapy

3. Secondary liver cancer:

Any cancer that spreads to the liver is considered a stage 4 cancer. However in some varieties of cancers, with aggressive treatment, we can achieve good results even in stage 4 disease that has liver metastasis.

The disease biology and patient selection play a key role in the outcomes.

Cancer that has spread from colon or rectum to the liver is an example where aggressive treatments are considered to achieve cure in some cases.

Conclusion

The development of a tumor inside the liver can have harmful effects on the body and raise some serious long-term issues. Hence, it is important to watch the symptoms and report them to your doctors as soon as you notice any. The benign tumors are easily treatable. However, the malignant ones may require aggressive treatment.

If you have any further queries about tumors of liver, reach out to our team of experts now!

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