Liver cancer

What is it?

Liver cancer is known and feared throughout the population. In the Western world, in the vast majority of the cases, metastases of malignant diseases from other organs are detected in the liver (metastases).

Cancer that originates in the liver itself (primary hepatocellular carcinoma) is far less frequent and usually occurs in long-term conditions resulting in fibrosis and cirrhosis. The main causes of primary liver cancer are hepatitis B, C and D, alcoholic cirrhosis, storage diseases (such as hemochromatosis) and non-alcoholic steatohepatitis.

All patients with liver cirrhosis (liver shrinkage) or chronic inflammation of the liver have a higher risk of developing a tumour in the liver: the hepatocellular carcinoma (HCC, liver cell cancer). More than 80% of patients with HCC have liver cirrhosis. The hepatocellular carcinoma is the seventh most common cancer worldwide. There has been a sharp increase in incidence in our regions, and epidemiological studies indicate that the tumour has tripled in frequency over the last 20 years.

In case of a large tumour, the symptoms are severe fatigue, abdominal pain, poor appetite and shortness of breath. It is a malignant tumour for which the treatment options depend on the stage in which the tumour is detected. Patients in high-risk groups should be checked for the possible development of such a tumour. This can be done with an ultrasound or a CT scan or MRI scan and by determining the level of alpha-foetoprotein in the blood. The alpha-fetoprotein (AFP) is a tumour marker: a substance created by the tumour which is used to detect or monitor a tumour.

Research

Suspicion of primary liver cancer may arise based on an ultrasound, a CT scan or an MRI scan of the liver.

Treatment

Treatment consists of surgery (operation) or a liver transplant, if possible. If surgery is not possible, there are other options for treating the tumour, such as transarterial chemo embolisation (TACE). TACE is a form of chemotherapy for liver cancer that is brought locally to the tumour to destroy the tumour in the liver. We use plastic balls (particles) loaded with special anti-cancer drugs (chemotherapeutics). In advanced forms of HCC, treatment consists of administering medication that inhibits or even stops the growth of cancer cells and/or the formation of blood vessels in the tumour. The first medication to do this was sorafenib, but in recent years several new medications have been approved in patients who do not tolerate sorafenib or in whom the tumour worsens despite sorafenib. Regorafenib, cabozantinib, lenvatinib and ramucirumab have been approved as first or second line therapy at HCC since 2017. Over the last few years, immunotherapy has also become an option in the treatment of HCC. Several clinical trials with immunotherapy for HCC are ongoing in the Digestive Centre. The exact treatments possible for each patient depend on various factors and are discussed with the patient together with a multidisciplinary team. Clinical trials sometimes offer a solution and provide access to the very latest treatments.

Latest publication date: 11/12/2023
Supervising author: Dr Monsaert Els