THE LIVER

The liver is a solid organ that lies in the upper right side of the abdomen. It has many functions in our body including the formation of protein which we need to heal tissues and clot blood, the elimination of toxins and the formation of bile which helps our bodies to absorb nutrients.

TYPES OF LIVER CANCER

It is important to know that not all masses in the liver are cancer. Some masses such as haemangiomas and focal nodular hyperplasia are usually benign (non-cancerous).

Unfortunately, some liver masses are cancer. These are called malignant liver tumours and they may arise in the liver itself (Primary liver cancer) or they may have arisen in other parts of the body and travelled to the liver in the bloodstream (Secondary or metastatic liver cancer).

  • The most common primary liver cancer is Hepatocellular carcinoma (HCC). This is a type of liver cancer that usually occurs in the context of underlying chronic liver disease. Certain conditions that are associated with HCC include infection such as hepatitis B and C, cirrhosis, environmental toxins such as aflatoxin, the chewing of betel nut, tobacco and alcohol, non-alcoholic fatty liver disease (NAFLD), iron overload and alpha-1 antitrypsin deficiency amongst others.

    The other common type of primary liver tumour is Cholangiocarcinoma. These tumours arise from the lining of the bile ducts that lie inside the liver. Certain conditions that increase the risk of cholangiocarcinoma include primary sclerosing cholangitis and chronic parasitic infections.

    There are other rarer primary liver cancers such as fibrolamellar carcinoma, angiosarcoma and hepatoblastoma. Fibrolamellar carcinoma is a rare subtype of HCC that occurs in younger people and is not usually linked with cirrhosis or infection with hepatitis B or C. People with fibrolamellar carcinoma may not have high levels of AFP in their blood. Angiosarcoma, also known as haemangiosarcoma is a very rare type of liver cancer that develops in the blood vessels of the liver. It is usually found in people over 70. Hepatoblastoma is another very rare primary liver cancer that usually affects young children. It is treated with surgery, chemotherapy and sometimes liver transplantation.

  • The location of a primary cancer is where it begins in the body. Sometimes, cancer cells break away from the primary cancer and spread through the bloodstream or lymphatic system to another part of the body where they form a new cancer. The cells are the same as the primary cancer but they are located in a different spot. This is called a secondary cancer or a metastasis.

    The liver is a common site for metastases to occur because it receives blood from the gastrointestinal system (mesenteric) as well as the rest of the body. The most common cancers to spread to the liver include bowel, breast, lung, melanoma and neuroendocrine cancers although any cancer can metastasise to the liver.

SYMPTOMS

Often patients with liver cancer will have no symptoms. Sometimes, patients feel some abdominal pain or discomfort, fullness or bloating while others notice yellowness in the skin or eyes (jaundice). Liver cancer can also be associated with loss of weight.

DIAGNOSIS & INVESTIGATIONS

There are a variety of tests available to investigate liver cancer. These include blood tests, imaging studies such as an ultrasound, CT scan or MRI scan. Sometimes a biopsy is necessary although this is rare.

TREATMENT OPTIONS

The treatment of liver cancer depends on the type of cancer (primary or secondary), where the metastasis has spread from (if a metastasis), the fitness of the patient and the amount of disease elsewhere in the body. Surgery plays a significant part in the management of both primary and secondary liver cancers, especially in the circumstance of colorectal liver metastases. Other liver cancer treatment options may include medical therapy, ablation therapy (radiofrequency or microwave), transarterial treatments (TACE-Transarterial chemoembolisation or SIRT-Selective internal radiation therapy) or even liver transplantation.

LIVER SURGERY

The liver is the largest organ in the body, located in the upper right part of the abdomen. It has multiple functions including:

  • Converting sugar into energy

  • Assist with the digestion of fats

  • Assist with the excretion of waste products

  • Protection against infections

  • Production of blood clotting factors

  • Regulation of sex hormones and cholesterol level

  • Metabolism and elimination of various drugs

Different liver disorders affect the normal functioning of the liver. Liver resection means that part of the liver is removed with surgery, usually as a way of removing a tumour in the liver.

Liver tumours are categorized into:

  • Primary Tumours: These tumours develop within the liver. Common malignant liver tumours include hepatocellular carcinomas and cholangiocarcinomas.

  • Metastatic Tumours: They develop in some other organ and migrate to the liver through the bloodstream.

Colorectal cancer is the most common cause of liver metastases. Single or even multiple tumours involving both lobes of the liver can be resected safely and with a high rate of cure.

Liver resection may also be employed for benign tumours of the liver such as a cyst, adenoma, or haemangioma in certain circumstances. Resection may be performed with laparoscopic, open or robotic surgery.

Liver resection does not usually require blood transfusion and takes 2-5 hours. Up to 80% of the liver can be removed in fit individuals. Following surgery, the liver can regenerate. Complete regeneration of the resected liver may take 6-8 weeks. Good nutrition with a high protein diet is crucial for liver regeneration.

Patients may be required to stay in the hospital for up to 5-7 days after the procedure

RISKS & COMPLICATIONS

The common complications associated with liver surgery include:

  • Liver failure

  • Liver abscess

  • Infection around the surgical site

  • Bleeding

  • Blood clots

  • Bile leakage

  • Pneumonia

POST-OPERATIVE GUIDE

Dressings can be removed one week following liver surgery. It is important to stay active although it is best to avoid heavy (>10kgs) lifting for 6 weeks following the surgery.