Liver Cancer
Overview
Several types of cancer can form in the liver. The most common are primary liver cancer, also known as hepatocellular carcinoma or cholangiocarcinoma, which originate from the liver, and secondary liver cancer, where the cancer has spread to the liver from somewhere else, known as a liver metastasis. Liver metastases are more common than primary liver cancer. Liver cancer cases in general are increasing globally. Primary liver cancer is the sixth most frequent cancer and the fourth leading cause of cancer related death globally, and 13th and nineth respectively in Cyprus. Higher rates of liver cancer are found in places where hepatitis B and C are common, including Asia and sub-Saharan Africa. Men are more often affected with hepatocellular carcinoma (HCC) than women. Diagnosis occurs most frequently among patients who are 55 to 65 years old. Cirrhosis, a progressive and irreversible condition that causes scar tissue to form in your liver, is the leading cause of liver cancer. Cirrhosis is frequently caused by hepatitis B, hepatitis C or excessive alcohol consumption. Other risk factors for developing primary liver cancer include exposure to aflatoxin, which are a poison produced by mold that grows on poorly stored crops, non-alcoholic fatty liver disease, and liver flukes, which is a chronic parasitic disease.
Diagnosis
Most people don’t have any signs or symptoms of liver cancer, but you may experience unexplained weight loss, loss of appetite, nausea and vomiting, general weakness, or jaundice, which is yellow discoloration in your skin and the whites of your eyes. If your medical team suspects a liver tumor based on your symptoms and risk factors, they may recommend imaging studies. For a suspected case of hepatocellular carcinoma (HCC) a medical ultrasound, computed tomography (CT) and magnetic resonance imaging (MRI) are often recommended. Most cholangiocarcinoma cases often present as bile duct obstruction. If your medical team suspects the bile duct obstruction may be caused by a malignant tumor, they may recommend endoscopic retrograde cholangiopancreatography (ERCP), ultrasound, CT, MRI and magnetic resonance cholangiopancreatography (MRCP) to guide their diagnosis.
In some cases, your medical team may also recommend a liver biopsy if they detect a mass during the imaging studies. Additionally, tumor markers, which are small molecules sometimes found in the blood of people with cancer, can be helpful in diagnosing and monitoring liver cancer. In many cases of HCC and intrahepatic cholangiocarcinoma, high levels of alpha-fetoprotein (AFP) are found in blood tests. AFP tests are most useful for monitoring if liver cancer recurs after treatment rather than for initial diagnosis. Cholangiocarcinoma can be detected with these commonly used tumor markers: carbohydrate antigen 19-9 (CA 19–9), carcinoembryonic antigen (CEA) and cancer antigen 125 (CA125). These tumor markers are found in primary liver cancers, as well as in other cancers and certain other disorders.
The specific case of liver cancer is then staged, often following the TMN staging systems. There are also other liver cancer specific staging systems. For example, for HCC, the Barcelona Clinic Liver Cancer Staging System it is commonly used.
To assess the potential spread of the cancer, your medical team may recommend you undergo further imaging studies, including magnetic resonance imaging (MRI), and positron emission tomography / computed tomography (PET / CT).
Treatment
Like other types of cancer, treatment varies greatly depending on the specific type of liver cancer, as well as how the cancer has progressed. Every step in the diagnostic procedure helps the GMI team tailor each treatment plan to each patient, taking into consideration your individual case and personal preferences. To determine the best course of action each patient’s case is discussed in a multidisciplinary tumor board where several experts from our team come together to create your comprehensive treatment plan. For cases where the cancer remains localized, a dedicated team of surgeons or radiation oncologists will eradicate the tumor using the most modern treatment options. Treatments may include surgery, medications, ablation methods such as high-dose rate brachytherapy. The GMI Radiation Oncology team has received world-wide recognition for implementing high-precision radiotherapy techniques, such as brachytherapy or stereotactic body radiotherapy.
For cases where the cancer is at a more advanced stage, our Medical Oncology team will propose the best treatment plan for each patient, which will include the newest regimen of systemic therapies like targeted therapy, chemotherapy and / or immunotherapy.
Why GMI
At the GMI German Oncology Center, a dedicated team of internationally acclaimed physicians guides each liver cancer patient through their entire journey, from their diagnostic work-up to their treatment and post-treatment care.
The GMI team will never offer a simple “one size fits all” approach to any patient. We believe each patient’s case is as individual as they are and strive to find the best solution for each of our patients, taking their specific case and diagnosis, their lifestyle, and choices into account.
We believe each of our patients is more than their diagnosis. That’s why our dedicated paramedics team supports liver cancer patients on their journey by offering more than just expert medical care. We offer psychological help, integrative oncology services (including yoga classes, and acupuncture) and have a GMI Patient Advocacy Program.
Adhering to our passion for innovation, and desire to progress the medical field, the GMI German Oncology Center both initiates and participates in several clinical trials in which the most modern and advanced treatment concepts are tested.
