Liver cancer (hepatocellular carcinoma, HCC) is an insidious disease. It is a malignant neoplasm with a difficult course and an unfavorable prognosis. Small liver tumors usually don’t show any symptoms. Tumors very often arise in the cirrhotic liver, and then the picture of the underlying disease dominates. Cancer may appear as a result of previous infection with a type B or C virus, which the patient often talks about during the interview conducted by the doctor. Alcohol abuse or diagnosed haemochromatosis or primary biliary cirrhosis may also contribute to the development of cancer.

• Liver cancer is not easy to diagnose
• Actual symptoms appear only when it is already advanced
• The later liver cancer is found, the worse the prognosis is

What are the warning signs of liver cancer? Liver cancer symptoms

Advanced liver cancer presents itself as follows:

• – there is general and progressive deterioration of the organism,
• – have eating disorders – mainly loss of appetite
• – ascites develops (fluid accumulates in the peritoneal cavity, which is visible as swelling),
• – digestive system disorders appear – constant feeling of fullness, abdominal pain and nausea,
• – you have jaundice (a yellowish discoloration of the skin, mucous membranes and whites of the eyes)
• – body temperature rises.

If the tumor mass is very large, the symptoms of liver failure superimpose on the cirrhosis of the liver: blood coagulation disorders, hypoglycaemia (low blood glucose levels), hypoalbuminemia (reduction in the amount of albumin protein in the blood plasma), hormonal disorders, symptoms of portal vein hypertension and many other.

The methods used to diagnose the Liver cancer include:

• – ultrasound examination of the liver,
• – fine-needle aspiration biopsy of the lesion with cytological examination (for small tumors 1–2 cm, with an ambiguous picture or in patients not eligible for surgery),
• – AFP (α-fetoprotein) concentration test,
• – spiral computed tomography,
• – abdominal magnetic resonance imaging,
• – angiography, Doppler ultrasound, positron emission tomography (PET) or intraoperative ultrasound may also be necessary.

Treatment of liver cancer

• The basic method of therapy and the only one that gives a chance for a permanent cure is surgery or liver transplantation. After the excision of part of the liver, the chances of survival for 5 years are 25%, and after liver transplantation as much as 70-80%. Patients with early liver cancer, i.e. those whose tumor diameter does not exceed 2 cm, have much greater chances (survival 5 years after the procedure in about 90% of patients). That is why it is so important to constantly monitor patients with cirrhosis of the liver to capture the moment when an ordinary regenerative nodule becomes cancer! For this purpose, ultrasound should be performed every six months and the concentration of AFP should be determined. Radical surgical treatment is complete excision of the lesion with a 0.5–1 cm margin of healthy tissues, with the requirement of intraoperative ultrasound and removal of lymph nodes of the hepatoduodenal ligament. Up to 80% of the liver parenchyma can be removed. Among the surgical methods, we distinguish the removal of the right or left lobe of the liver (both procedures can be extended) and the removal of individual liver segments. The methods that facilitate the operation are the use of an ultrasonic or argon knife. A patient who cannot be operated on, has no internal contraindications, and has a single tumor (up to 5 cm) or 2-3 tumors up to 3 cm in diameter, each with no evidence of vascular infiltration or metastasis, may be eligible for liver transplantation. distant. The methods that facilitate the operation are the use of an ultrasonic or argon knife. A patient who cannot be operated on, has no internal contraindications, and has a single tumor (up to 5 cm) or 2-3 tumors up to 3 cm in diameter, each with no evidence of vascular infiltration or metastasis, may be eligible for liver transplantation. distant. The methods that facilitate the operation are the use of an ultrasonic or argon knife. A patient who cannot be operated on, has no internal contraindications, and has a single tumor (up to 5 cm) or 2-3 tumors up to 3 cm in diameter, each with no evidence of vascular infiltration or metastasis, may be eligible for liver transplantation. distant.

• Other treatments used are palliative therapies (slowing disease progression), e.g., thermoablative treatments using cryotherapy (freezing) or high-frequency hyperthermia (overheating) (RFA).Cryotherapy requires the opening of the abdominal cavity, but it enables the destruction of large tumors, even up to 12 cm in diameter. RFA hyperthermia can be used percutaneously under ultrasound guidance, laparoscopically or with the opening of the abdominal cavity, and is used to destroy smaller tumors (6-7 cm).

• Alcoholization involves injecting alcohol directly into the tumor. Lesions up to 5 cm in diameter can be treated in this way. Such treatments should be repeated several times.

• Embolization methods close the artery that supplies blood to the tumor tissue, thereby blocking the supply of nutrients and oxygen to the tumor cells. Embolization techniques are different: from simple artery ligation, through the administration of substances closing the vessel (tissue adhesives), to the so-called radioembolization, i.e. the administration of radioactive yttrium particles to the branch of the hepatic artery, which destroys the tumor tissue. We also distinguish chemoembolization, which consists in intra-arterial administration of a chemotherapeutic agent (doxorubicin, which disrupts cell division and leads to cell death) in combination with a tissue glue.Cyber ​​Knifetechnology raises great hopes. It is a non-invasive method of treating patients suffering not only from liver cancer, but also tumors in other organs (brain, pancreas, lungs, kidneys).Cyber ​​Knifeis a computer-integrated medical system, which includes a linear accelerator, X-ray cameras and a robot that precisely doses radiation doses exactly into the tumor tissue, saving healthy tissues. The accuracy of theCyber ​​Knifesystem is estimated at 0.7 ± 0.3 mm. The system tracks the patient’s natural movements (e.g. related to breathing) and corrects the position of the radiation beam on an ongoing basis. A certain group of patients may be qualified for surgery using theda Vincirobot .Da Vinciis an operating system that enables precise operations in hard-to-reach regions of the human body (e.g. the small pelvis or the base of the skull). Interventions carried out with the use of this system minimally damage the healthy tissues surrounding the tumor, cause little perioperative bleeding and allow for quick recovery.The da Vincirobot supports the surgery, it is an extension of the surgeon’s hands, it is still operated by a human, not a robot.

• Systemic chemotherapy is the administration of systemic cytotoxic drugs (usually intravenously, sometimes oral administration is possible). A chemotherapeutic agent, acting on various phases of cell growth and development – destroys it and prevents it from dividing into daughter cells. In this type of therapy, several drugs with different mechanisms of action are most often used simultaneously to destroy all cancer cells remaining in different stages of development. In the case of hepatocellular carcinoma, regimens based on doxorubicin, cisplatin and fluorouracil are used. Such therapy is more effective when combined with topical treatment of the disease (thermoablation, embolization, and other techniques). Locoregional chemotherapy is the administration of chemotherapeutic agents (anthracyclines, mitomycin, fluorouracil) directly to the arterial system of the liver. The advantage of this method is the prolongation of action and obtaining a higher concentration and activity of the drug in the tumor with less systemic toxicity to the rest of the body. Targeted therapy is an attempt to directly interfere with the molecular basis of cancer formation. Sorafenib was registered for palliative treatment in patients with advanced hepatocellular carcinoma. It is an inhibitor of various kinases (enzymes) of the Raf pathway and receptors for growth factors (the so-called vascular endothelial growth factor – VEGF and platelet growth factor – PDGF). It works by preventing the cancer cells from multiplying and the formation of blood vessels in the tumor. It prolongs the life of patients with hepatocellular carcinoma, however, like all drugs, it can have side effects. These include: exhaustion syndrome, hypertension, cardiotoxicity,

Intensive research is underway on other biological substances. These are: bevacizumab, sunitinib, erlotinib and temsirolimus. All of them offer hope for patients with various types of cancer, not just liver cancer.