2. Types of primary liver cancer in adults.

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Two types of primary  liver cancer  in adults are:

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• Hepatocellular carcinoma  ...

• Cholangiocarcinoma  (bile duct cancer). (To receive  additional  information see Summary  PDQ  on  treating bile duct cancer (cholangiocarcinoma)  ...

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The most common type of primary liver cancer in adults is hepatocellular carcinoma. This type of liver cancer is the third leading cause of cancer death worldwide.

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This is a summary of the treatment  primary  liver cancer (  cancer,  which starts in the liver). This summary does not cover the treatment of cancer that starts elsewhere in the body and spreads to the liver.

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Primary liver cancer can occur in both adults and children. However, treatment for children is different from that for adults. (For more information, see the PDQ summary on  treatment of liver cancer in children).

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3. Risk factors for liver cancer

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Having hepatitis or cirrhosis can affect the risk of primary liver cancer in adults.

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Anything that increases the likelihood of a disease is called  risk factor  ... Having a risk factor does not mean you will get sick  cancer  ; the absence of risk factors does not mean that you will not get cancer. Talk to your doctor if you think you are at risk  liver cancer  ...

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Liver cancer risk factors include the following:

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• Having  hepatitis B  or  hepatitis C  infections  ... Having both hepatitis B and hepatitis C further increases the risk.

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• Having  cirrhosis  ...

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• Drinking strong  alcohol  ... Alcohol abuse and hepatitis B infection further increase the risk.

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• Eating foods containing  aflatoxin  (I  fungus,  which can grow on foods such as grains and nuts that have not been stored properly).

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• Non-alcoholic steatohepatitis (NASH)  condition,  in which fat accumulates in  liver  and can progress to  inflammation  liver and damage  cells  liver.

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• Use  tobacco  e.g. smoking  cigarettes  ...

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• The presence of certain  hereditary  or rare  diseases  that damage the liver, including the following: ​​

  1. Glycogen storage disease  , a hereditary disorder in which problems arise with how the form  glucose  (sugar) called glycogen is stored and used in the body.

  2. Late  cutaneous  porphyria  is a rare condition that affects the skin and causes painful blisters on parts of the body exposed to the sun, such as hands, arms and face. Liver problems can also occur.

  3. Wilson's disease  - a rare hereditary disease in which the body accumulates more copper than it needs. Additional copper is stored in the liver,  brain  , eyes and others  bodies  ...

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• Alpha-1 antitrypsin deficiency  - hereditary disease that can cause liver disease and  lungs  ...

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• Hereditary hemochromatosis  - hereditary disease in which the body accumulates more  gland,  than he needs. The extra iron is mainly stored in the liver, heart,  pancreas  , skin and  joints  ...

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Old age is a major risk factor for most cancers. The likelihood of developing cancer increases with age.

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4. Signs and symptoms of primary liver cancer in adults  

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Signs and symptoms of primary liver cancer in adults include swelling or pain on the right side.

These and others  signs  and  symptoms  can be caused by primary liver cancer in adults or other conditions. Check with your doctor if you have any of the following:

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• A hard lump on the right side just below the ribcage.

• Discomfort in the upper abdomen on the right side.

• Bloating.

• Pain near the right  shoulder blades  or in the back.

• Jaundice  (yellowing of the skin and whites of the eyes).

• Easy bruising or bleeding.

• Unusual tiredness or weakness.

• Nausea  and  vomit  ...

• Loss  appetite  or feeling full after eating a small meal.

• Losing weight for an unknown reason.

• Pale, chalky  chair  and dark urine.

• Fever  ...

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5. Tests for the diagnosis of primary liver cancer in adults.

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Tests that examine the liver and blood are used to detect and diagnose primary liver cancer in adults.

The following tests and procedures can be used:

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• Medical checkup  and  anamnesis  : A body exam to check for general signs of health, including checking for signs of illness such as lumps or anything else that seems unusual. There will also be a history of the patient's health habits, as well as past illnesses and treatments.

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• Serum tumor markers test  : a procedure in which a blood sample is examined to measure the amount of certain substances that enter the bloodstream of the organs,  fabrics  or  tumor  cells  in the body. Certain substances are associated with certain types of cancer when they are found in high amounts in the blood.  These are the so -called  tumor markers  ... Elevated level  alpha-fetoprotein  (AFP) in the blood may be a sign of liver cancer. Other cancers and some benign diseases, including cirrhosis and hepatitis, can also increase AFP levels. Sometimes AFP levels remain normal even in liver cancer.

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• Liver function tests  : A procedure in which a blood sample is tested to measure the amount of certain substances that enter the bloodstream by the liver. A higher than usual amount of the substance may be a sign of liver cancer.

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• CT scan  (computed tomography): A procedure in which a series of detailed pictures of areas inside the body, such as the abdomen, are taken from different angles. Pictures were taken by a computer connected to  x-ray  apparatus.  Dye  may be  introduced  in  vein  or swallow so that organs and tissues are seen more clearly. This procedure is also called computed tomography, computed tomography, or computed axial tomography. Images can be taken up to three times after dye is injected to get the best possible image of abnormal areas in the liver. This is called a three-phase CT.  Spiral  or  spiral CT  scanning  takes a series of highly detailed images of areas inside the body using an X-ray machine that scans the body in a spiral.

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• MRI  (magnetic resonance imaging): a procedure that uses a magnet,  radio waves  and a computer to create a series of detailed images of areas inside the body, such as the liver. This procedure is also called nuclear magnetic resonance imaging (MRI). To create detailed images  blood vessels  in the liver and next to it, a dye is injected into a vein. This procedure is called MRA (magnetic resonance imaging  angiography  ). After dye injection, images can be taken at three different time periods to obtain the best possible image of abnormal liver areas. This is called a three-phase MRI.

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• Ultrasonic  research: a procedure in which high energy sound waves (ultrasound) are reflected from internal tissues or organs and create an echo. The echo forms a pattern of body tissue called  sonogram  ... The picture can be printed to view later.

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• Biopsy  : removal of cells or tissues to  pathologist  could see them under  microscope  to check for signs of cancer. The procedures used to collect a sample of cells or tissues include the following:

  • Fine needle aspiration biopsy  : removal of cells, tissue or  liquids  using a fine needle.

  • Core needle biopsy  : Removal of cells or tissue with a slightly wider needle.

  • Laparoscopy  :  surgical  a procedure to examine the internal organs of the abdominal cavity for signs of illness. The lining of the abdominal cavity is made small  incisions  (cuts), and one of the cuts is inserted  laparoscope  (thin tube with illumination). Another instrument is inserted through the same or a different incision to remove tissue samples.

​ A biopsy is not always necessary for  diagnostics  primary liver cancer in adults.

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6. Several factors affect prognosis (chance of recovery) and treatment options.

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Forecast  (chance  convalescence  ) and treatment options depend on the following conditions:

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1. The stage of the cancer (the size of the tumor, whether it affects part or all of the liver, or has spread to other places in the body).

2. How well the liver works.

3. The patient's general health, including the presence of cirrhosis of the liver.

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7. Stages of primary liver cancer in adults

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KEY POINTS

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• After adults are diagnosed with primary liver cancer, tests are done to see if the cancer cells have spread to the liver or to other parts of the body.

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• Cancer spreads through the body in three ways.

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• Cancer can spread from where it originated to other parts of the body.

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• The Barcelona Clinic Liver Cancer Staging System can be used to stage primary liver cancer in adults.

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• The following groups are used for treatment planning.

  • BCLC stages 0, A and B

  • BCLC stages C and D

After adults are diagnosed with primary liver cancer, tests are done to see if the cancer cells have spread to the liver or to other parts of the body.

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The process used to determine if it has spread  crayfish  in  liver  or to other parts of the body is called  staging  ... Information Collected in the Identification Process  stages,  defines  stage  diseases. It is important to know the stage in order to plan treatment. During the preparation process, the following tests and procedures can be used:

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• CT scan  (computed tomography): a procedure in which a series of detailed pictures of areas inside the body, such as the chest, are taken,  stomach  and  pelvis  shot from different angles. Pictures were taken by a computer connected to  x-ray  apparatus.  Dye  may be  introduced  in  vein  or swallowed to help  organs  or  fabrics  show more clearly. This procedure is also called computed tomography, computed tomography, or computed axial tomography.

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• MRI  (magnetic resonance imaging): a procedure that uses a magnet,  radio waves  and a computer to create a series of detailed images of areas within the body. This procedure is also called nuclear magnetic resonance imaging (MRI).

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• PET scan  (positron emission tomography): search procedure  malignant  tumor  cells  in the body. A small amount is injected into the vein  radioactive  glucose  (Sahara).  Scanner  The PET spins around the body and takes a snapshot of where glucose is being used in the body. Malignant tumor cells appear brighter in the image because they are more active and consume more glucose than normal cells.

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8. Ways of spreading liver cancer  body by three  

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Cancer can spread through  fabrics  ,  lymphatic system  and  blood  :

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• Textile. Cancer spreads from where it originated to surrounding areas.

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• The lymphatic system. Cancer spreads from where it originated to the lymphatic system. Cancer is spreading through  lymphatic vessels  to other parts of the body.

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• Blood. Cancer spreads from where it originated into the bloodstream. Cancer is spreading through  blood vessels  to other parts of the body.

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Cancer can spread from where it originated to other parts of the body.

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When cancer spreads to another part of the body, it is called  metastasis  ... Cancer  cells  break away from the place where they arose (  primary tumor  ), and move through the lymphatic system or blood.

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• The lymphatic system. Cancer enters the lymphatic system, travels through the lymphatic vessels and forms  tumor  (  metastatic  swelling) in another part of the body.

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• Blood. Cancer enters the bloodstream, travels through the blood vessels, and forms a tumor (metastatic tumor) in another part of the body.

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A metastatic tumor is the same type of cancer as the primary tumor. For example, if the primary  liver cancer  spreads on  lungs  , the cancer cells in the lungs are actually liver cancer cells. The disease is metastatic liver cancer, not lung cancer.

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9. Treatment options for primary liver cancer in adults

Stage 0, A, and B primary liver cancer in adults

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Treatment  primary  liver cancer in  adults  stages  0, A, and B may include the following:

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• Observation  per  defeats  less than 1  centimeters  ...

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• Partial  hepatectomy  ...

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• Total  hepatectomy  and  transplantation  liver  ...

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• Ablation  from  tumors  using one of the following methods:

  • Radiofrequency ablation  ...

  • Microwave therapy  ...

  • Percutaneous ethanol injection  ...

  • Cryoablation  ...

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• Clinical research  on  electroporation therapy  ...

Stages C and D Primary liver cancer in adults

Treatment  primary  liver cancer in  adults  stages  C and D may include the following:

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• Embolizing  therapy  by one of the following methods:

  • Transarterial embolization  (TAE).

  • Transarterial chemoembolization  (TACHE).

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• Targeted therapy  with  tyrosine kinase inhibitor  ...

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• Immunotherapy  ...

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• Radiation therapy  ...

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• Clinical research  on targeted therapy after  chemoembolization  or in combination with  chemotherapy  ...

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• Clinical trials of new  drugs  targeted therapy.

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• Clinical trials of immunotherapy.

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• Clinical trials of immunotherapy in combination with targeted therapy.

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• Clinical trials  stereotactic body radiation therapy  or  radiation therapy  protons  ...

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10. Treatment of recurrent primary liver cancer in adults

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Treatment options  recurrent  primary  liver cancer in  adults may include the following:

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• Total  hepatectomy  and  transplantation  liver  ...

• Partial  hepatectomy  ...

• Ablation

• Transarterial chemoembolization  and  targeted therapy  with  sorafenib  , in  palliative care  for relax  symptoms  and improvements  quality of life  ...

• Clinical research  a new method of treatment.

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