Malignant liver tumors are cancerous growths that develop in the liver, an organ that performs numerous functions, including filtering toxins from the blood, producing bile for digestion, and storing energy. When cancerous cells form within or spread to this organ, they can significantly impair its ability to perform these functions.
Understanding Malignant Liver Tumors
Malignant liver tumors are broadly categorized based on their origin. Primary liver cancers begin directly in the liver tissue itself. The most common type of primary liver cancer is hepatocellular carcinoma (HCC), originating from hepatocytes (main liver cells) and accounting for 85% to 90% of all primary liver cancers.
Another primary liver cancer is cholangiocarcinoma, also known as bile duct cancer. This type of cancer develops in the bile ducts, which are tubes that transport bile from the liver to the small intestine. In contrast to primary cancers, metastatic or secondary liver cancers occur when cancer cells from another part of the body spread to the liver. These metastatic tumors are more common than primary liver cancers, frequently originating from cancers of the colon, rectum, breast, or lung.
Factors Increasing Risk
Several factors increase the risk of developing malignant liver tumors, particularly hepatocellular carcinoma. Chronic infections with hepatitis B virus (HBV) or hepatitis C virus (HCV) are leading causes worldwide. These viruses cause ongoing inflammation and damage to liver cells, which can lead to genetic mutations and tumor formation over time.
Cirrhosis, a progressive condition where healthy liver tissue is replaced by scar tissue, is another risk factor. This scarring impairs blood flow and liver function, creating an environment conducive to cancer development. Chronic alcohol abuse and non-alcoholic fatty liver disease (NAFLD/MASLD) are common causes of cirrhosis and thus contribute to liver cancer risk. Additionally, exposure to aflatoxins, toxic compounds produced by certain molds found in contaminated foods like corn and peanuts, can damage liver cell DNA and mutate the p53 tumor suppressor gene, increasing cancer risk. Certain inherited liver diseases, such as hemochromatosis and Wilson’s disease, along with metabolic conditions like type 2 diabetes and obesity, also contribute to an elevated risk.
Recognizing Symptoms and Diagnosis
Malignant liver tumors often do not cause symptoms in their early stages. As the tumor grows, individuals may experience unexplained weight loss, loss of appetite, and a feeling of fullness even after consuming small meals. Abdominal discomfort or pain in the upper right side, sometimes extending to the right shoulder blade, can also develop. Other signs include nausea, vomiting, weakness, and fatigue.
Jaundice, characterized by yellowing of the skin and eyes, occurs when the liver’s ability to process bilirubin is impaired, leading to its accumulation in the body. Dark urine, pale or chalky stools, and itching may also accompany jaundice.
Diagnosis begins with a physical examination, where a doctor may feel for a lump or tenderness in the abdomen. Blood tests assess liver function and check for tumor markers, such as alpha-fetoprotein (AFP), which can be elevated in HCC. Imaging scans, including ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI), are used to visualize the liver and identify tumors, determining their size, number, and location. While imaging can suggest a diagnosis, a liver biopsy, involving the removal of a small tissue sample, provides a definitive diagnosis.
Treatment Approaches
Treatment for malignant liver tumors is individualized, depending on the cancer’s type and stage, the patient’s overall health, and the extent of underlying liver disease. Surgical options offer the best chance for a cure, particularly in early-stage disease. Liver resection involves removing the tumor with a small margin of healthy tissue, viable if the tumor is small, confined, and the remaining liver is healthy enough to function. For patients with small tumors and significant underlying liver damage like cirrhosis, a liver transplantation may be considered.
Locoregional therapies deliver treatment directly to the tumor within the liver, minimizing impact on healthy tissues. Transarterial chemoembolization (TACE) involves injecting chemotherapy drugs mixed with embolic agents into the artery feeding the tumor, blocking its blood supply and concentrating the drug at the site. Radiofrequency ablation (RFA) and microwave ablation (MWA) use heat to destroy tumor cells, effective for smaller lesions. Stereotactic body radiation therapy (SBRT) is a precise form of external radiation that delivers high doses to the tumor while sparing surrounding healthy liver tissue.
Systemic therapies, which treat cancer throughout the body, are often used for advanced or widespread disease. Chemotherapy uses medications to kill rapidly dividing cancer cells, though liver cancers can be less sensitive. Targeted therapies focus on specific molecular pathways involved in cancer growth, with fewer side effects than traditional chemotherapy. Immunotherapy, a newer approach, works by boosting the body’s immune system to recognize and attack cancer cells, becoming a first-line option for advanced HCC. Supportive care is integrated throughout treatment to manage symptoms like pain, nausea, and fatigue, and to improve the patient’s quality of life.