PhytoScience - Article

Liver Cancer

Liver cancer is cancer that begins in the cells of your liver. Your liver is a football-sized organ that sits in the upper right portion of your abdomen, beneath your diaphragm and above your stomach.

Liver cancer is one of the most common forms of cancer in the world, but liver cancer is uncommon in North America. Rates of liver cancer diagnosis are increasing in both the United States and Canada.

Typically, most cancer that occurs in the liver begins in another area of the body, such as the colon, lung or breast. Doctors call this metastatic cancer, rather than liver cancer. And this type of cancer is named after the organ in which it began - such as metastatic colon cancer to describe cancer that begins in the colon and spreads to the liver.

Signs and symptoms

Most people don't have signs and symptoms in the early stages of primary liver cancer. When symptoms do appear, they may include:

Losing weight without trying
Loss of appetite
Upper abdominal pain
Nausea and vomiting
General weakness and fatigue
An enlarged liver
Abdominal swelling
Yellow discoloration of your skin and the whites of your eyes (jaundice)

When to see a doctor
Make an appointment with your doctor if you experience any signs or symptoms that worry you.

Causes

It's not clear what causes most cases of liver cancer. But in some cases, the cause is known. For instance, chronic infection with certain hepatitis viruses can cause liver cancer.

Liver cancer occurs when liver cells develop changes (mutations) in their DNA {the material that provides instructions for every chemical process in your body. DNA mutations cause changes in these instructions. One result is that cells may begin to grow out of control and eventually form a tumor } a mass of malignant cells.

Types of liver cancer
Primary liver cancer, which begins in the cells of the liver, is divided into different types based on the kind of cells that become cancerous. Types include: Bile duct Diagram

Hepatocellular carcinoma (HCC). This is the most common form of primary liver cancer in both children and adults. It starts in the hepatocytes, the main type of liver cell.
Cholangiocarcinoma. This type of cancer begins in the small tube-like bile ducts within the liver. This type of cancer is sometimes called bile duct cancer.
Hepatoblastoma. This rare type of liver cancer affects children younger than 4 years of age. Most children with hepatoblastoma can be successfully treated.
Angiosarcoma or hemangiosarcoma. These rare cancers begin in the blood vessels of the liver and grow very quickly.

Risk Factors

Factors that increase the risk of primary liver cancer include:

Your sex. Men are more likely to develop liver cancer than are women.
Your age. In North America, Europe and Australia, liver cancer most commonly affects older adults. In developing countries of Asia and Africa, liver cancer diagnosis tends to occur at a younger age - between 20 and 50.
Chronic infection with HBV or HCV. Chronic infection with hepatitis B virus (HBV) or hepatitis C virus (HCV) increases your risk of liver cancer.
Cirrhosis. This progressive and irreversible condition causes scar tissue to form in your liver and increases your chances of developing liver cancer.
Certain inherited liver diseases. Liver diseases that can increase the risk of liver cancer include hemochromatosis, autoimmune hepatitis and Wilson's disease.
Diabetes. People with this blood sugar disorder have a greater risk of liver cancer than do people who don't have diabetes.
Nonalcoholic fatty liver disease. An accumulation of fat in the liver increases the risk of liver cancer.
Exposure to aflatoxins. Consuming foods contaminated with fungi that produce aflatoxins greatly increases the risk of liver cancer. Crops such as corn and peanuts can become contaminated with aflatoxins.
Excessive alcohol consumption. Consuming more than a moderate amount of alcohol can lead to irreversible liver damage and increase your risk of liver cancer.
Obesity. Having an unhealthy body mass index increases the risk of liver cancer.

When to seek medical advice

If you think you may have liver cancer, you're likely to start by first seeing your family doctor or a general practitioner. If your doctor suspects you may have liver cancer, you may be referred to a doctor who specializes in diseases of the liver (hepatologist) or to a doctor who specializes in treating cancer (oncologist).

Because appointments can be brief, and because there's often a lot of ground to cover, it's a good idea to be well prepared for your appointment. Here's some information to help you get ready for your appointment, and what to expect from your doctor.

What you can do Abdominal pain

Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as restrict your diet.
Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
Write down key personal information, including any major stresses or recent life changes.
Make a list of all medications, as well as any vitamins or supplements, that you're taking.
Take a family member or friend along, if possible. Sometimes it can be difficult to absorb all the information provided during an appointment. Someone who accompanies you may remember something that you missed or forgot.
Write down questions to ask your doctor.

Your time with your doctor is limited, so preparing a list of questions will help you make the most of your time together. List your questions from most important to least important in case time runs out. For liver cancer, some basic questions to ask your doctor include:

What type of liver cancer do I have?
What is the stage of my liver cancer?
What does my pathology report say? Can I have a copy of the pathology report?
Will I need more tests?
What are my treatment options?
What are the potential side effects of each treatment option?
Is there one treatment you recommend over the others?
What advice would you give a loved one in my same situation?
How will my treatment affect my daily life?
How much time can I take to make my decision about liver cancer treatment?
Should I seek a second opinion?
Should I see a liver cancer specialist? What will that cost, and will my insurance cover it?
Are there any brochures or other printed material that I can take with me? What Web sites do you recommend?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time that you don't understand something.

Screening and diagnosis

Diagnosing liver cancer
Tests and procedures used to diagnose liver cancer include:

Blood tests. Blood tests may reveal liver function abnormalities.
Imaging tests. Your doctor may recommend imaging tests, such as an ultrasound, computerized tomography (CT) scan and magnetic resonance imaging (MRI).
Removing a sample of liver tissue for testing. During a liver biopsy, a sample of tissue is removed from your liver and examined under a microscope. Your doctor may insert a thin needle through your skin and into your liver to obtain a tissue sample. Liver biopsy carries a risk of bleeding, bruising and infection.

Determining the extent of the liver cancer
Once cancer is diagnosed, your doctor will work to determine the extent (stage) of the liver cancer. Staging tests help determine the size and location of cancer and whether it has spread. Imaging tests used to stage liver cancer include CT, MRI, chest X-ray and bone scan.

The stages of liver cancer are:

Stage I. At this stage, liver cancer is a single tumor confined to the liver that hasn't grown to invade any blood vessels.
Stage II. Liver cancer at this stage can be a single tumor that has grown to invade nearby blood vessels, or it can be multiple small tumors in the liver.
Stage III. This stage may indicate that the cancer is composed of several larger tumors. Or cancer may be one large tumor that has grown to invade the liver's main veins or to invade nearby structures, such as the gallbladder.
Stage IV. At this stage, liver cancer has spread beyond the liver to other areas of the body.

Treatment

Treatments for primary liver cancer depend on the extent (stage) of the disease as well as your age, overall health and personal preferences.

The goal of any treatment is to eliminate the cancer completely. When that isn't possible, the focus may be on preventing the tumor from growing or spreading. In some cases only comfort care is appropriate. In this situation, the goal of treatment is not to remove or slow the disease but to help relieve symptoms, making you as comfortable as possible.

Liver cancer treatment options may include:

Surgery to remove a portion of the liver. Your doctor may recommend partial hepatectomy to remove the liver cancer and a small portion of healthy tissue that surrounds it if your tumor is small and your liver function is good.
Liver transplant surgery. During liver transplant surgery, your diseased liver is removed and replaced with a healthy liver from a donor. Liver transplant surgery may be an option for people with early-stage liver cancer who also have cirrhosis.
Freezing cancer cells. Cryoablation uses extreme cold to destroy cancer cells. During the procedure, your doctor places an instrument (cryoprobe) containing liquid nitrogen directly onto liver tumors. Ultrasound images are used to guide the cryoprobe and monitor the freezing of the cells. Cryoablation can be the only liver cancer treatment, or it can be used along with surgery, chemotherapy or other standard treatments.
Heating cancer cells. In a procedure called radiofrequency ablation, electric current is used to heat and destroy cancer cells. Using an ultrasound or CT scan as a guide, your surgeon inserts several thin needles into small incisions in your abdomen. When the needles reach the tumor, they're heated with an electric current, destroying the cancer cells.
Injecting alcohol into the tumor. During alcohol injection, pure alcohol is injected directly into tumors, either through the skin or during an operation. Alcohol dries out the cells of the tumor and eventually the cells die.
Injecting chemotherapy drugs into the liver. Chemoembolization is a type of chemotherapy treatment that supplies strong anti-cancer drugs directly to the liver. During the procedure, the hepatic artery {the artery from which liver cancers derive their blood supply} is blocked, and chemotherapy drugs are injected between the blockage and the liver.
Radiation therapy. This treatment uses high-powered energy beams to destroy cancer cells and shrink tumors. During radiation therapy treatment, you lie on a table and a machine directs the energy beams at a precise point on your body. Radiation side effects may include fatigue, nausea and vomiting.
Targeted drug therapy. Sorafenib (Nexavar) is a targeted drug designed to interfere with a tumor's ability to generate new blood vessels. Sorafenib has been shown to slow or stop advanced liver cancer from progressing for a few months longer than with no treatment. More studies are needed to understand how this and other targeted therapies may be used to control advanced liver cancer.

Coping skills

Learning you have any life-threatening illness can be devastating. Each person finds his or her own ways of coping with a diagnosis of liver cancer. Although there are no easy answers for people dealing with liver cancer, some of the following suggestions may be of help:

Learn about your liver cancer. Ask your doctor about your liver cancer, including the stage of your cancer, your treatment options and, if you like, your prognosis. Ask your health care team for trusted sources of information so that you can learn more about liver cancer and your treatment options. One good source of information is the National Cancer Institute. As you learn more about liver cancer, you may become more confident in making treatment decisions.
Keep friends and family close. Keeping your close relationships strong will help you deal with your liver cancer. Friends and family can provide the practical support you'll need, such as helping take care of your house if you're in the hospital. And they can serve as emotional support when you feel overwhelmed by cancer.
Find someone to talk with. Find a good listener who is willing to listen to you talk about your hopes and fears. This may be a friend or family member. The concern and understanding of a counselor, medical social worker, clergy member or cancer support group also may be helpful. Ask your doctor about support groups in your area. Or check your phone book, library or a cancer organization, such as the National Cancer Institute or the American Cancer Society.
Make plans for the unknown. Having a life-threatening illness, such as cancer, requires you to prepare for the possibility that you may die. For some people, having a strong faith or a sense of something greater than themselves makes it easier to come to terms with a life-threatening illness. Ask your doctor about advance directives and living wills to help you plan for end-of-life care, should you need it.

Prevention

Get vaccinated against hepatitis B
You can reduce your risk of hepatitis B by receiving the hepatitis B vaccine, which provides more than 90 percent protection for both adults and children. Protection lasts years and may even be lifelong. The vaccine can be given to almost anyone, including infants, older adults and those with compromised immune systems.

Take measures to prevent hepatitis C
No vaccine for hepatitis C exists, but you can reduce your risk of infection.

Know the health status of any sexual partner. Don't engage in unprotected sex unless you're absolutely certain your partner isn't infected with HBV, HCV or any other sexually transmitted disease. If you don't know the health status of your partner, use a condom every time you have sexual intercourse.
Don't use IV drugs, but if you do, use a clean needle. The best way to protect yourself from HCV is to not inject drugs. But if that isn't an option for you, make sure any needle you use is sterile, and don't share it. Contaminated drug paraphernalia is a common cause of hepatitis C infection. Take advantage of needle-exchange programs in your community and consider seeking help for your drug use.
Seek safe, clean shops when getting a piercing or tattoo. Needles that may not be properly sterilized can spread the hepatitis C virus. Before getting a piercing or tattoo, check out the shops in your area and ask staff about their safety practices. If employees at a shop refuse to answer your questions or don't take your questions seriously, take that as a sign that the facility isn't right for you.

Ask your doctor about liver cancer screening
Screening for liver cancer hasn't been definitively proved to reduce the risk of dying of liver cancer. For this reason, many medical groups don't recommend liver cancer screening. However, the American Association for the Study of Liver Diseases recommends liver cancer screening for those thought to have a high risk, including people who have:

Hepatitis B and one or more of the following apply: are an Asian male older than 40, Asian female older than 50, or African and older than 20; have liver cirrhosis; or have a family history of liver cancer
Liver cirrhosis from alcohol use
Hepatitis C infection
An inherited form of hemochromatosis
Primary biliary cirrhosis
Nonalcoholic fatty liver disease

Discuss the pros and cons of screening with your doctor. Together you can decide whether screening is right for you based on your risk. Screening typically involves an ultrasound exam or blood tests once or twice each year.

Complementary and alternative medicine

Alternative treatments may help control pain in people with advanced liver cancer. Your doctor will work to control pain with treatments and medications. But sometimes your pain may persist or you may want to avoid the side effects of pain medications.

Ask your doctor about alternative treatments that may help you cope with pain, such as:

Acupressure
Acupuncture
Deep breathing
Listening to music (music therapy)
Massage

Supplementation
A range of dietary supplements and herbal medicines claim to offer new ways to prevent or treat diseases in general. Some supplements show promise and are slowly gaining acceptance in mainstream medicine. But the benefits and risks of many products and practices remain unproved in human clinical trials.

Although some complementary treatments can be a good addition to your regular treatment, take some precautions first:

Don't stop taking your prescribed medications or skip therapy sessions. Complementary medicine is not a substitute for regular medical care.
Be honest with your doctors and health providers. Tell them exactly which complementary treatments you practice or would like to explore. There have been many cases {based on patients test results} where doctors have reduced or stopped medications due to the benificial effects from natural health products.
Be aware that some complementary treatments can interfere with your regular treatment. Even over-the-counter or so-called natural supplements may interfere with your prescribed medications. When purchasing a health product; look for information that may be found in small print that would indicate drug interactions or product warnings.
Natural remedies that lower inflammation can also be very beneficial; when indicated they may be preferred over some medications that have adverse effects with prolonged usage. Although long-term use of NSAIDs in high doses can provide great benefit in terms of anti-inflammatory effects, pain relief and cardioprotective effects, there is an increased risk of gastrointestinal complications ranging from stomach pain to ulcers, hemorrhage, and severe and potentially deadly gastrointestinal problems. Each year in the US, the side effects of long-term NSAID use cause nearly 103,000 hospitalizations and 16,500 deaths.
Tumeric is a spice that comes from the root Curcuma longa, a member of the ginger family, Zingaberaceae. Curcumin has historically been safely used in Ayurveda for its medicinal properties for various indications. Curcumin has demonstrated some anti-inflammatory activity. Several studies were identified on the antioxidant, anti-inflammatory, antiviral, and antifungal properties of curcuminoids.
Mangosteen. Mangosteen has been demonstrated to exhibit potent anti-oxidant, anti-inflammatory and anti-tumor properties. Natural remedies that lower inflammation can be very beneficial in the prevention or treatment of disease. It has been suggested by the American Cancer Society that mangosteen juice can be used as an effective adjunct with standard cancer therapies to reduce many of the side effects and helps to speed up recovery.

Xanthones, which are unique to the mangosteen, as a class of phytonutrients are polyphenolic bioflavonoids. Over 60 research papers show anti-tumor, antiproliferative, antimicrobial, antihistamine, anti-inflammatory, anti-oxidant and gastrointestinal protective effects. Mangosteen has been used successfully for microbial (Viral, Bacterial and Fungal) conditions for centuries throughout Southeast Asia.

When indicated; mangosteen juice, consumed daily, may be preferred over some medications that have adverse effects with prolonged usage. Mangosteen juice from the whole fruit puree has successfully been used as an adjuctive therapy to treat Liver Cancer.

Recent Invivo studies have demonstrated cytotoxic properties against three human cancer cell lines. The flow cytometric analysis indicated that this compound induced apoptosis in time-and concentration-dependent manners. Alpha-mangostin (One of the many xanthones found in the pericarp of the mangosteen fruit} showed the features of the mitochondrial apoptotic pathway such as mitochondrial membrane depolarization and cytochrome c release. Furthermore, alpha-mangostin inhibited the sarco(endo)plasmic reticulum Ca(2+)-ATPase markedly.

In some cases, people using mangosteen for the first time may experience a healing crisis or detoxifying effect {an increase or outbreak of some symtoms that may last from 4 to 10 days} in the earliest stages of use. Once the body is cleared of the toxins that exasperate the condition, the healing process can get underway. This is normal and should be expected when using a quality natural product. Results will vary with individuals but the long term benefits are well worth the short term discomfort as mangosteen juice has been effective with many types of cancer.

Mangosteen juice from the whole fruit puree consumed daily, has successfully been used to treat inflammatory conditions and has demonstrated numerous additional benefits over other natural products. More mangosteen research is needed, but current scientific studies have demonstrated promising results in regards to benefiting patients with Liver and Colon Cancer. Mangosteen Science

Lacking scientific evidence
A few herbal and dietary products claim to help cure or prevent cancer. There's no scientific evidence that these products work, and some may be dangerous. Three popular "cancer-fighting" supplements include:

Chaparral. Also known as creosote bush or greasewood, chaparral (Larrea tridentata) comes from a desert shrub found in the southwestern United States and Mexico. Research hasn't shown that the herb effectively treats cancer, and it can lead to irreversible liver failure.
PC-SPES. This mixture contains eight herbs that have been used for hundreds of years in traditional Chinese medicine to treat prostate issues and other health problems. Some studies show it may reduce cancer growth, but it can also cause side effects. It was sold as a dietary supplement, but is no longer being manufactured because some batches were found to contain prescription drug ingredients. While the individual herbs are still available, the PC-SPES mixture has not been reintroduced because further studies are needed to determine whether it's safe.
Shark cartilage. Shark cartilage contains a protein that has some ability to inhibit the formation of new blood vessels within tumors in sharks. Shark cartilage therapy is based on the theory that capsules containing shark cartilage will do the same in humans; stop and shrink cancerous tumors. However, these benefits haven't been shown in humans.

Talk with your doctor first
Because it's not always easy to tell which products may be unsafe, interact negatively with other medications or affect your overall cancer treatment, it's best to talk with your doctor before you take any dietary or herbal product.

Source - Phytoscience Research Group, Mayo Clinic, American Cancer Society, National Library of Medicine.

Updated 03 Jul 2009

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