Liver Tumors - Types and Treatment

Introduction

The liver is the largest organ in the abdomen, performing many bodily functions. Most of the chemical levels in the body fluids are regulated by the liver. The liver consists of hepatocytes, the cells of the liver, and secretes a substance called bile, which is transported to the intestines. The digestive juice secreted by the liver is called bile juice. Abnormal growth of cancer cells leads to the formation of tumors that can be benign or malignant. This article describes various treatments with regard to liver tumors.

What Are Liver Tumors?

Tumors in the body arise due to the uncontrolled growth of cells. Such tumors present in or on the liver are called liver tumors or hepatic tumors.

What Are the Types of Liver Tumors?

Following are the types of liver tumors-

• Benign liver tumors.

• Malignant liver tumors.

What Are Non-Cancerous Liver Tumors?

Benign tumors are large tumors occurring in the liver but do not spread to distant locations or surrounding organs in the body.

Following are the noncancerous liver tumors

• Hemangioma.

• Hepatic adenoma.

• Focal nodular hyperplasia.

• Simple liver cysts.

• Liver cell adenomatosis.

Hemangioma: It is the most common type of benign liver tumor that starts in blood vessels. Most of the hemangiomas of the liver show no symptoms, and they do not need treatment. However, some may bleed and have to be treated and removed with surgery.

Hepatic Adenoma - Hepatic adenoma is a benign liver tumor that starts from the main type of liver cells, the hepatocytes. Most of them are asymptomatic and need no treatment. Eventually, symptoms are noticed, such as a lump in the abdomen (stomach area), pain, or blood loss. The risk of the tumor getting ruptured is high, which can lead to severe blood loss, which can pave the way to the development of liver cancer. Most surgeons advise surgery to remove any possible tumor.

Focal Nodular Hyperplasia - Focal nodular hyperplasia (FNH) comprises several types of cells (bile duct cells, hepatocytes, and connective tissue cells) forming a tumor-like growth. Not all benign tumors are asymptomatic. FNH tumors, being benign, can cause symptoms. As it can become difficult to diagnose liver cancers, as true liver tumors or overgrowths cannot be differentiated, surgical removal of the tumors is done when there is an unclear diagnosis.

Simple liver cysts and liver cell adenomatosis are other benign tumors.

What Are Cancerous Liver Tumors?

Following are the cancerous liver tumors.

• Hepatocellular Carcinoma - Hepatocellular carcinoma starts in the liver. There are two types of hepatocellular carcinomas, each with several subtypes.

• The single tumor grows larger.

• Multiple Small Tumor Nodules - It is the most common type of liver cancer seen in patients suffering from chronic liver diseases like liver cirrhosis.

• A common subtype of hepatocellular carcinoma includes -

• Fibrolamellar Hepatocellular Carcinoma - It is a rare tumor mostly occurring in teenagers and adults.

• Cholangiocarcinoma - Intrahepatic cholangiocarcinomas account for nearly 10 to 20 percent of all liver tumors. These cancers start in the liver cells lining the bile ducts (tubes carrying bile to the gallbladder). However, cholangiocarcinomas start outside the liver.

• Hepatoblastoma -This is a very rare cancer developing in children, usually those four years old or younger. Cells of hepatoblastoma are similar to fetal liver cells. Treatment of these tumors usually gives a positive, successful outcome.

What Are the Symptoms of Liver Tumors?

Liver tumor and liver cancer symptoms may include:

• Upper abdominal pain.

• Nausea or vomiting.

• Swelling in the abdomen.

• Yellow skin (jaundice).

• Chalky stools.

• Unexplained weight loss.

• Lack of appetite.

• General fatigue or weakness.

What Are the Diagnostic Methods for Liver Tumors?

The following are the diagnostic methods for liver tumors:

• Ultrasound imaging.

• Computed tomography scan.

• Magnetic resonance imaging.

Diagnosis usually involves two stages of diagnosis. They are detection and characterization.

Detection of the tumor is based on the method of diagnosis and information like the number and location of the tumor. These characteristics of the tumor are helpful in staging the liver.

Characterization of the tumor is based on the nature of the tumor, like consistency, appearance, and so on.

Both detection and characterization help in obtaining a diagnosis and setting up the prognosis of the condition.

• Ultrasound: Characterization of the tumor using ultrasound is based on consistency (liquid, solid, mixed), elasticity, structural appearance (homogeneous or heterogeneous), and relation with adjacent organs or structures (displacement, invasion).

• Computed Tomography: Evaluating the liver tumors with a CT (computed tomography) scan can be done by performing arterial and venous phase images. An additional arterial phase is indicated to be sure of the tumors. To be more specific about the diagnosis, magnetic resonance imaging (MRI) is performed.

• Magnetic resonance Imaging: It is more specific and sensitive in detecting tumors. It is helpful in visualizing the tumor in a more accurate way and even planning the surgical therapeutic procedure.

What Are the Treatment Options for Liver Tumors?

The following are the treatment options for liver tumors:

Surgery -

• Partial Hepatectomy (a procedure where the partial liver is removed) is carried out in people who have a healthy liver and have only a single tumor.

• Liver Transplantation - Transplanting the liver with a liver from a compatible host is the best option in many cases of liver cancer.

Embolization For Liver Tumors - Blocking or obstructing the blood vessels supplying the tumors is done by injecting certain substances. This process is called embolization.

Ablation is a process of destroying the tumor cells without removing them. It is implemented in patients who are not susceptible to surgery. Following are the types of ablation.

• Cryoablation.

• Microwave ablation.

• Radiofrequency ablation.

• Alcohol ablation.

It is a useful procedure with certain side effects like infection in the liver, abdominal pains, or fever. They can even become worse, but it does not occur all the time.

Targeted Drug Therapy - Certain drugs are administered that are targeted toward the abnormally growing tumors that resemble chemotherapy-like kinase inhibitors. Kinases are those which can directly or indirectly help in the growth of tumor cells. Inhibiting the growth of kinases can help in destroying tumors.

Immunotherapy is a treatment given to improve the immunity of an individual to destroy cancer cells.

Chemotherapy - Administration of drugs that destroy the cancer cells are administered, such as

• Cisplatin.

• Oxaliplatin.

• Gemcitabine.

• Mitoxantrone.

Conclusion

Hepatologists, along with oncologists, radiologists, interventional radiologists, radiation oncologists, and surgeons, develop a proper treatment plan for each patient. Every patient's symptoms should be noted to arrive at the right diagnosis. Care should be taken to follow all the precautions suggested by the physician to obtain the best treatment outcome.