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• Types of liver cancer
• Symptoms
• Causes
• Risk Factors
• Diagnosis
• Treatment
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Liver Cancer

There are two types of liver cancer: primary liver cancer and secondary liver cancer.

• Primary liver cancer occurs in the liver. It can divide into two types regarding on the cell type: hepatocellular carcinoma and intrahepatic cholangiocarcinoma.
• Secondary liver cancer is the spread of cancerous cell that originates from other body organs to the liver. This is called metastatic liver cancer. This article will focus only on hepatocellular carcinoma (HCC).

Symptoms of liver cancer

Patients with early stages of liver cancer rarely show any symptoms. However, if the large liver mass causing the liver to become enlarged, these are some of the symptoms the patient may encounter: 

• A noticeable lump below the rib 
• Pain in the right side of the abdomen that may radiate to the right shoulder 
• Unexplained weight loss, feeling nauseous, or loss of appetite 
• Fatigue
• Darkened urine or yellowish skin or conjunctiva
• Bloated stomach

Causes of liver cancer

Liver cancer is caused by genetic mutation and abnormal growth of liver cells. Most patients tend to have underlying of liver diseases that cause liver dysfunction, especially cirrhosis from various etiologies such as alcohol consumption, viral hepatitis B or C, and autoimmune hepatitis. However, some patients with chronic hepatitis B infection or fatty liver disease can also have liver cancer without cirrhosis.

Risk factors

Factors that could increase the risk of developing liver cancer include patients with different types of chronic liver disease as mentioned above. Additional factors are including hereditary factors. Obesity could lead to hyperglycemia, which is a factor that causes fatty liver disease. Long-term exposure to toxins and male gender are also the risk factors for developing of liver cancer.

Diagnosis

Generally, high-risk patients including cirrhotic patients and patients with chronic viral hepatitis B infection, need to undergo the surveillance program for HCC which is an ultrasound of the upper abdomen and blood test for tumor marker (AFP) every six months. These tests aim for early detection of liver cancer. If abnormal mass is detected from ultrasound, further computed tomography (CT scan) or magnetic resonance imaging (MRI scan) will be performed to determine the nature of the mass. The typical pattern of enhancement from either a CT scan or MRI together with a history of underlying chronic liver disease is usually sufficient to make the diagnosis of HCC without a liver biopsy needed.

However, in some patients with chronic liver disease which radiological image showed an atypical pattern for HCC diagnosis, and vice versa, the typical radiological pattern for HCC shows in patients who have no underlying chronic liver disease. In this case, a biopsy may be needed to confirm the diagnosis.

Treatment

The treatment of liver cancer must consider two factors: the size (or stage) of the tumor and the patient's liver function. Liver cancer often occurs in patients with cirrhotic condition that liver function has deteriorated. The treatment of cancer without considering the liver's primary function, may increase the risk of liver failure. Therefore, before deciding on the treatment for liver cancer, the doctor will need to treat other underlying liver diseases, such as antiviral medication, abstinent of alcohol, or anti-inflammatory drugs.

In patients with suitable liver function, the cancer treatment will be determined primarily from the cancer size, as follows:

• Small size tumors may be treated with surgical resection or radiofrequency ablation (RFA). 
• Larger tumor that cannot be treated with surgery, but has not yet vascular ivasion will be treated with chemoembolization. The drug will be injected directly into the hepatic artery together with the blockage of the artery that supplies cancer. 
• Large tumors with vascular invasion or have distance metastasis will need to be treated with systemic therapy such as targeted therapy or chemotherapy, radioembolization, or radiation therapy. 
• In case that the tumors are smaller in size, but the patient is unable to undergo cancer treatment due to poor liver function. The doctor may consider the patient to be listed for liver transplantation. Those will be considered based on the tumor size, cancer extent of the disease, the overall physical condition, and the patient's underlying diseases.

Prepare for the doctor's appointment

Patients should prepare information before the doctor's appointment, such as current symptoms, different drugs that the patient is currently taking, and questions to ask the doctor.

What to expect at the doctor's appointment? 

During the history-taking session, the doctor will ask the patient a series of questions to assess the disease's severity. Some of the questions are when it starts, the severity, and any family member who suffers from the disease.