Liver and Gall Bladder Cancer

Liver and Gall Bladder Cancer

It is the growth of abnormal cells in the tissues of the liver and gall bladder. Liver cancer can be divided into 2 groups, namely primary liver cancer (those which arise from the liver tissue) and secondary liver cancer (which arises due to spread of cancer cells to the liver from elsewhere in the body). Primary liver cancer has mainly three different types:

  • Hepatocellular carcinoma – is the most common type of cancer to affect the liver. It arises in the hepatocytes of the liver.
  • Cholangiocarcinoma – which arises in the cells of the bile ducts that connect the liver with the gall bladder.
  • Angiosarcoma – is a type of cancer which arises in the blood vessels within the liver. It is a rare form of liver cancer which affects the elderly population.

Gall bladder cancers on the other hand arise within the gall bladder and may sometimes involve the common bile duct as well. They are many times associated with gall stones.

What Are the Symptoms of liver and gall bladder Cancer?

These cancers are very unlikely to cause symptoms during the early stage of the disease. The two conditions give rise to more or less similar symptoms and as the disease advances you may develop symptoms such as:

  • Abdominal pain especially in the right upper quadrant
  • Abdominal distention
  • Yellowish discoloration of the eyes and skin
  • Passage of pale colored stools
  • Easy fatigability
  • Weight loss
  • Loss of appetite
  • Unexplained episodes of fever

If you have developed any of these symptoms and you are worried, then you should definitely see your doctor at the earliest.

What causes liver and gall bladder cancer?

Although an exact cause for the development of these conditions cannot be pointed out, certain factors have been associated with an increased risk of developing liver and gall bladder cancer.

Risk factors for liver cancer include:

  • Increased consumption of alcohol
  • Hepatitis B and C infection
  • Previous conditions which affect the liver such as fatty liver or liver scarring
  • The presence of genetic conditions such as hemochromatosis and alpha 1 antitrypsin deficiency
  • Tobacco smoking
  • Obesity
  • Type 2 diabetes

Risk factors for gall bladder cancer:

  • Increased age
  • Female sex
  • History of other conditions which affect the gall bladder such as gall bladder stones or chronic infection of the gall bladder

What tests are used to diagnose liver and gall bladder cancer?

Diagnosis of liver and gall bladder cancers are done through evaluation of the patient’s medical history, a complete physical examination and diagnostic investigations. During the physical examination, the doctor will want to examine your abdomen and feel for the presence of an enlarged liver or palpable gall bladder. The investigations which will help confirm the diagnosis include:

  • Blood tests esp Liver Function test-  which help the assess the liver function by checkingthe blood levels of enzymes which are released by the liver
  • Tumor Markers – Alpha fetoprotein (aFP) is used for liver cancer and Ca 19.9 may be helpful in gall bladder cancers.
  • Ultra sound scan – which helps to image both the liver and the gall bladder, and assess the presence of any abnormality in the size and nature of the organs
  • CT scan & MRI –cross-sectional views of the liver and gall bladder. It tells about any changes in the structure of the organs and can help in staging the disease.
  • PET scan – makes use of radioisotopes to image any cancer cells that may be present elsewhere in the body.
  • Biopsy – It is always required in advanced cases where chemotherapy has to be given. It can be done either by either Ultrasound or CT guidance where a fine needle aspiration is done by inserting a needle into your liver under local anesthesia& the tissue sample which is taken is then viewed under the microscope for the presence of cancer cells.

What is the treatment for liver and gall bladder cancer?

The type of treatment you will receive depends on the staging of the disease. For this your doctor will use the TNM system, which will be determined using the size of the tumor and the extent of spread of the tumor.

Treatment of liver and gall bladder cancer has to be individualized according to each patient depending on the stage of the disease. Therefore you need a specialized team of professionals to care for a patient diagnosed with these conditions which includes a GP, Gastroenterologist, Hepatobiliary Surgeon, Hepatologist, Medical Oncologist, Radiation Oncologist, Cancer Nurses, as well as other healthcare workers such as dietician and social worker.

The treatment options available for liver and gall bladder cancer are:

  • Surgery – is the treatment of choice for gall bladder cancer whenever surgery is feasible.It entails removal of not just the gall bladder but also a part of liver and related lymphnodes. In the case of liver cancer, if the tumor is small, a part of the liver can be removed which is called a partial hepatectomy. When a small area of the liver is removed, it has the capability to regrow back to its original size after some time. If the tumor is too large and the patient is fit, then your doctor might consider removing the entire liver and replacing it with a donor liver, which is called a liver transplant.
  • Tumor ablation – is an option for small primary liver cancers when patient is not fit for surgery, where the tumor is destroyed using heat from radio waves or microwaves.
  • Chemotherapy – is the use of anti-cancer medication to slow down the growth and shrink the tumor.
  • Selective Internal Radiation Therapy (SIRT) – where high doses of internal radiation in beads is given to target liver tumors.

What is the Prognosis of liver and gall bladder cancer?

The outcome of these conditions is dependent on many factors such as the stage of the cancer, as well as patient factors, such as age, level of fitness and medical history.

Screening for and prevention of liver and gall bladder cancer

There are currently no specific screening methods available for the early detection of liver and gall bladder cancer.

Vaccination against hepatitis B and C for the ‘’at risk’’ individuals have shown to reduce the risk of developing liver cancer.