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A patient with liver cancer usually complains of pain in the right abdomen, lower back or shoulder.
A patient with liver cancer usually complains of pain in the right abdomen, lower back or shoulder. They complain of throbbing or stabbing pain that does not subside. Usually, the patient also has pain in the right side of the abdomen. Pain may be severe at 7/10 in intensity. Pain and other symptoms only develop in the later stages. Other common signs and symptoms may include
- A lump on the right side just below the rib cage or a heavy feeling in the upper abdomen
- An enlarged spleen felt as fullness under the ribs on the left side
- Bloating (swollen abdomen) or ascites (fluid in the abdomen)
- Loss of appetite and feelings of fullness after eating a small meal
- Unexplained weight loss
- Unusual weakness or fatigue
- Nausea and vomiting
- Jaundice (yellow skin and eyes), pale stools and dark urine
- Easy bruising or bleeding
- Unexplained fever
- Loss of sexual drive
- Generalized skin irritation and itching
The patient may develop hepatic encephalopathy—when the liver does not work properly and waste products build up in the blood. Symptoms may include confusion, slurred speech and personality/mood changes. They may also develop portal hypertension, which is an increase in blood pressure in the hepatic portal vein (the main vein that brings blood to the liver). It can develop when a liver tumor blocks the flow of blood in the vein. It can also develop with liver scarring (cirrhosis). The increase in pressure causes the large veins (varices) to develop in the stomach and esophagus to get around the blockage. Varices are very fragile and can bleed easily.
What are the possible treatment options for liver cancer?
The choice of treatment will depend on the extent and location of cancer, health of the liver and overall health of the patient. Treatment options may include
Resection
- Resection refers to surgical removal of cancer and some surrounding normal tissue. This is often the treatment of choice in a patient without cirrhosis.
- Although resection is potentially curative, an estimated 70 percent of patients will develop cancer recurrence during the first five years after treatment.
- Furthermore, resection is only possible when the remaining part of the liver is healthy enough to function on its own after the surgery.
For many patients with cirrhosis or other liver diseases, this will not be the case and other treatment options will need to be considered.
- Chemotherapy: Chemotherapy is a medication that is administered intravenously or orally to kill cancer cells.
- Radiation therapy: Radiation therapy uses targeted radioactive waves to kill cancer cells and shrink tumors.
- Radioembolization: A specialized interventional radiologist may use intra-arterial yttrium-90 radioembolization (commonly called Y-90) to radiate a liver tumor.
- Chemoembolization: Doctors administer anticancer drugs directly into a tumor through its feeding blood supply, which allows for a higher concentration of the drug to be in contact with the tumor for a longer period.
- Ablation therapies: Ablation is a type of treatment that destroys tumors without removing them. These techniques may be used for a patient when surgery is not a good option because of their poor health or reduced liver function. Often, ablation can be done without surgery by inserting a needle or probe into the tumor through the skin.
- Liver transplantation: Because the liver is the only organ in the body that can regenerate or grow back, a transplanted segment of a liver can grow to normal size within a few months. Liver transplantation is a surgical procedure performed to remove a diseased or injured liver from one person and replace it with a whole or a portion of a healthy liver from another person called the donor.
Who may qualify for a liver transplant?
Never will ethnicity, religion, national origin, gender or sexual orientation have any part in deciding if a patient is a transplant candidate. Liver transplant is a major surgery; hence, a patient should meet certain criteria that include
- A liver transplant is an option if the patient’s quality of life may improve with it.
- The patient should not have other diseases that cannot be treated or too sick to likely survive the transplant surgery.
- All other medical or surgical treatment options either have not worked or are not a good choice for the patient.
- The patient and support systems (family and friends) understand and accept the risks of having a liver transplant.
- The patient should not have a history of psychiatric disorder (bulimia, anorexia, etc.).
- Patient support systems are fully committed to and compliant with what is needed before and after the transplant to make the transplant a success. This would include access to funding for the transplant procedure, post-transplant medicines and other healthcare costs. The social worker and patient financial liaison may be able to help find other ways to pay for the patient’s care.
Indications for liver transplantation
- The patient has an acute (sudden) onset of liver failure.
- They have had cirrhosis (liver disease) for a long time.
- They have liver disease that will lead to death or affect their quality of life.
- They have had treatments that did not work (and others are not expected to work).