Liver Cancer

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WHAT IS LIVER CANCER?

According to the Malaysian National Cancer Registry Report 2007-2011, liver cancer is amongst the top ten most common cancer in Malaysia. However, not all cancers that affect the liver are considered primary liver cancer. Cancers that begins in another area of the body or organ and spreads to the liver is called metastatic cancer rather than liver cancer.

Different types of cells in the liver can form different types of liver cancer:

Hepatocellular carcinoma (HCC) – Most cases of HCC are the result of infection with hepatitis B or C, or cirrhosis of the liver caused by alcoholism.
Cholangiocarcinoma (bile duct cancer) – occurs in the small, tube-like bile ducts within the liver that carry bile to the gallbladder.
Angiosarcoma, also known as hemangiosarcoma – begin in the blood vessels of the liver and grow quickly. Typically diagnosed at an advanced stage.
Fibrolamellar HCC – typically more responsive to treatment than other types of liver cancer.

In most cases, symptoms of primary liver cancer are often left unnoticed until the cancer is at an advanced stage. When signs and symptoms do appear, they may include:

Unintended weight loss
Loss of appetite
Abdominal swelling
Upper abdominal pain
Nausea and vomiting
Fatigue (often tired and feeling weak)
Jaundice (yellowing of the skin the whites of your eyes)
Itchy skin

The exact cause of liver cancer is unknown, but in most cases, they are associated with damage and scarring of the liver known as cirrhosis. This could be due to many reasons which inclusive of:

Drinking excessive amounts of alcohol over many years
Having long-term hepatitis B or hepatitis C infection
An inherited disorder in which iron levels in the body builds up over the years
Long-term liver disease in which the bile ducts in the liver become damaged
Obesity as it could produce non-alcoholic fatty liver disease
Exposure to certain chemicals – Exposure to vinyl chloride (a chemical used in the making of some plastics)
Diabetes
Smoking

Diagnosis

Procedures for diagnosing liver cancer inclusive of:

Biopsy

The doctor will obtain a tissue sample to determine the type and stage of the disease.

PET/CT scan

To determine whether the liver cancer has spread to areas such as the bones or lungs.

Computerized Tomography (CT) scan

A CT scan can provide precise information about the size, shape and position of tumors in the liver or elsewhere in the abdomen, as well as nearby blood vessels.

Ultrasound

This test may be recommended every six to 12 months to assess the progress of treatment.

Magnetic Resonance Imaging (MRI) scan

The scans may help distinguish between benign and malignant tumors as well as to examine blood vessels in and around the liver.

Treatment

Before deciding on a treatment plan, the patient’s general health will be taken into consideration as well.

Surgery

The primary goal of treatment is to remove cancer entirely through surgery. However, this option is limited to the growth and location of the tumour.

Liver transplant surgery

To remove the diseased liver and replace it with a healthy liver from a donor. This option is only possible for patients with early-stage liver cancer.

Localized Treatments

For liver cancer is an option where the treatment is administered directly to the cancer cells or the area surrounding the cancer cells. There are various types of localized treatments inclusive of:

Radiofrequency ablation – Using ultrasound or CT scan as a guide, one or more thin needles are used to make small incisions in the abdomen to reach the tumour. It is then heated with an electric current to destroy the tumour.
Placing beads filled with radiation in the liver – Tiny beads that contain radiation are placed directly in the liver where they can deliver radiation directly to the affected area.
Radiotherapy – Radiation (in this case, high-energy x-rays) for targeting cancer in the liver.
Targeted Therapy– ‘Kinase Inhibitor Drug’ is a targeted drug that works in 2 ways. It helps block tumours from forming new blood vessels, which they need to grow. It also targets some of the proteins on cancer cells that normally help them grow.

Halcyon™ 4.0 Radiotherapy System

Halcyon™ 4.0 Radiotherapy System at Beacon Hospital enables:

Fast and precise X-ray dose delivered to each tumour with high accuracy over a minimum number of treatment sessions
Reduces unwanted radiation dose, thus, minimising side effects

Unlike any other radiation delivery system, the Halcyon technology’s beam-on time could be as fast as 1-minute plus. Its gantry rotates 4 times faster than a standard linear accelerator and its multi-leaf collimator (MLC) can move twice faster than traditional MLCs. All of these features help in improving the time it takes to treat the patients.

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