Liver Cancer

Liver cancer is a deadly disease that develops in hepatocytes, the liver cells initially and may move to other parts of the body as it progresses. It is often a result of other underlying liver diseases like hepatitis B viral infection etc. There can be several types of liver cancers and a variety of treatment plan follow to tackle each one of them. Let’s talk about all that you need to know about liver cancer and insurance options available against it.

Liver Cancer in the UAE

Unlike breast and prostate cancer, liver cancer cases are not as common in the UAE. It constitutes 1.7% of the total new cancer cases in the UAE that are diagnosed every year. The total deaths caused by liver cancer amount to 4%. 

Types and Stages of Liver Cancer 

• Primary Liver Cancer: In simple terms, cancer that begins from the liver itself is known as primary liver cancer. Primary liver cancer can be further divided into different types as listed below:
  • Hepatocellular Carcinoma (HCC): HCC or hepatocellular carcinoma is the most prominent form of liver cancer found in adults. It begins in the liver, being a primary liver cancer and then may spread further depending on its growth pattern. One type of HCC starts as a single tumour that grows further into the rest of the liver. The other type begins in several small nodules in the liver and not just one place. The latter type is more commonly seen in people with liver cirrhosis. 
  • Intrahepatic Cholangiocarcinoma: Only 10-20% of primary liver cancers are intrahepatic cholangiocarcinoma. This cancer begins in the cells from the lining of the bile ducts of the liver. It may also begin in the bile ducts located outside of the liver though. 
  • Angiosarcoma and Hemangiosarcoma: This is one of the rarest kinds of liver cancers. Angiosarcoma and hemangiosarcoma begin in the cells of the blood vessels of the liver. This cancer is often caused when the patient has been exposed to elements like thorium dioxide, arsenic or radium. Hereditary hemochromatosis, an inherited disease, may also cause this cancer. These cancers spread very quickly and cannot be treated using surgery in most cases. Chemo is often used as a treatment option. 
  • Hepatoblastoma: This type of liver cancer occurs mostly in children younger than 4 years of age. Hepatoblastoma cancer cells are similar to that of fetal liver cells. It is most treatable when identified and diagnosed early. But if cancer spreads to other parts of the body, it is rather tricky to treat with surgery or chemotherapy. However, the treatment rate is pretty good for hepatoblastoma. 2 out of 3 children successfully get treated and recover. 

• Secondary Liver Cancer: The thing about tumours and cancers is that they spread or metastasize to other parts of the body. Secondary tumours are the ones that travel to the liver from some other body part. A secondary liver cancer could have been originated in the stomach, pancreas, breast or even colon. However, secondary liver cancers are treated as per the site of origination and not the site of relocation. This means breast cancer that spreads to the liver will be treated as breast cancer and not liver cancer. Treatment plans used to treat breast cancer will be used for the second site, i.e., the liver as well. 
• Benign Liver Tumors: The least problematic type of liver tumour, benign liver tumours seldom spread to other parts of the body. They can be treated very easily, generally by surgery. Benign cancers or tumours can be categorised further as per their site of origination. 
  • Hemangioma: This is a benign tumour that originates in the blood vessels of the liver. Hemangioma is generally not something that requires treatments. However, if the blood vessels start to bleed, they may need to get removed by surgery. 
  • Hepatic Adenoma: Another type of benign liver cancer that causes almost no symptoms, hepatic adenoma begins in the main liver cells, hepatocytes. However, the hepatic adenoma may lead to further complications if it develops into cancer or rupture and causes severe blood loss. This is why doctors almost always remove these tumours as soon as possible. 
  • Focal Nodular Hyperplasia: Not exactly a tumour but a tumour-like growth, focal nodular hyperplasia begins not from one but many different kinds of cells found in the liver. It can be treated by doing a small surgery. This type of cancer is more common among women. 

Liver Cancer Stages 

• The First or the Very Early Stage: At this stage, the liver tumour is no more than 2 cm big. The situation is not even bad enough to raise bilirubin levels. There is no relative pressure on the portal vein of the liver, the main vessel that supplies blood to the liver. Surgery is the best way to get the tumours at this stage treated. 
• Early Stage: On the second stage of liver cancer, the tumour here is no more than 5 cm big and no less than 2 cm big. Bilirubin levels may increase at this stage and liver function may be affected. But it is more of a case-by-case basis thing. RFA, surgery and liver transplant may be potential liver cancer treatment plans for early-stage liver cancer. 
• Intermediate Stage: Not only the tumour can be bigger at this stage but there can be multiple tumours too. Chemoembolization and other region-targeting therapies are prescribed to patients with intermediate-stage liver cancer. 
• Advanced Stage: The portal vein is invaded by the time stage 4 liver cancer develops. It may even spread to other parts of the body. Targeted therapy is the general course of treatment for stage 4 liver cancer. 

Liver Cancer Risk Factors 

• Liver Cirrhosis: When the healthy liver tissues are replaced with scar tissues, liver cirrhosis comes into the picture. It is generally caused by excessive alcohol consumption over the years or non-alcoholic fatty liver diseases. Liver cirrhosis can also be caused by other diseases such as hepatitis A, B or C. Livers with damaged, scarred tissues are more prone to get cancer mutation as well. 
• Viral Hepatitis: Hepatitis B or C are known as viral hepatitis and they directly affect the liver. Hepatitis C is more commonly found since there is no vaccine to prevent its spread like Hepatitis B. Both these types can be transmitted by sharing bodily fluids or blood, for example, sharing needles or having intercourse. Hepatitis B can also be passed down to unborn children if the mother has it already. But it can be prevented by the Hepatitis B vaccine which is given to infants. Both hepatitis B and C are completely curable. But, if left to reach severe stages, they lead to the growth of cancerous cells and hence tumours. Hepatitis is the biggest risk factor for liver cancer so far. 
• Obesity: Alcohol or viruses are not the only things that can put your liver in danger of getting cancer. The storage of excessive fat in the body can also lead the liver to the same fate. Hepatocellular carcinoma is the type of liver cancer that is caused when excess fat is stored in the liver. Obesity counts as one of the biggest risk factors for hepatocellular carcinoma. 
• Age: While age is not a risk factor per se for liver cancer, it has been observed in several studies that liver cancer mostly occurs when people cross the 60th birthday milestone. 
• Gender: While the studies are still in the works for this particular risk factor, men are more likely to get liver cancer than women, almost twice more likely. This could be because of a protein released by the body in response to liver injury – interleukin-6. Men have higher levels of this protein since the production in the female body is hampered by estrogen. This protein increases the risk of primary liver cancer aka hepatocellular carcinoma in men. 
• Environment: Exposure to certain toxins can increase your risk of getting liver cancer. These toxins could be present in the water as well as the food you eat. 
• Fatty Liver Diseases: As mentioned above, fatty liver diseases are also a leading risk factor of liver cancer apart from diseases caused by alcohol. While non-alcoholic fatty liver diseases are common among obese people, a few sub-types of this condition can lead to liver cirrhosis and hence cancer. One such sub-type is non-alcoholic steatohepatitis. 
• Metabolic Diseases: Inherited diseases may also increase your risk of getting liver cancer several folds. A disease known as hereditary hemochromatosis is one such existence. This hereditary disease makes people absorb too much iron from the food they consume. The excessive iron build-up in the liver leads to cirrhosis and then cancer. 
• Type 2 Diabetes: Type 2 diabetes increases your risk of liver cancer when combined with other alarming risk factors like excessive alcohol consumption or hepatitis B/C. If obesity is also a concern here, the risk is that much higher. 
• Anabolic Steroids: Hormonal steroids like anabolic steroids are known to have increased the risk of liver cancer for the users when consumed for a very long time regularly. Other steroids which are cortisone-like do not carry the same risk. 
• Aflatoxins: A highly toxic substance, aflatoxins are found on certain fungi. This is a cancer-causing substance that can grow on daily food items like peanuts, soybeans, corns, etc. When consumed for long enough, aflatoxins significantly increase the risk of liver cancer. Combined with risk factors like viral hepatitis and cirrhosis, the risk increases further several folds. 

Symptoms of Liver Cancer 

• Pain in the top right part of the abdomen
• Excessive unannounced weight loss
• Fatigue and weakness
• Enlarged liver or lumps under the right-side ribs 
• Appearance of jaundice 
• Nausea and vomiting 
• Enlargement of the spleen
• Swelling on the abdomen of built-up fluid
• Excessive sudden itching
• Lost appetite
• Enlarged veins on the belly
• Bruising on the abdomen or bleeding 
• Persistent fever

Diagnosis Procedure of Liver Cancer 

There are several diagnostic tests doctors can use to identify the type and nature of a tumour. Doctors may use one or more of these tests to ensure that the diagnosis is correct and to the point. Following are all different kinds of diagnostic tests used for liver cancer:

• Blood Tests: Up to 70% of people with hepatocellular carcinoma are found to have an element known as AFP in their blood. Blood tests done for potential liver cancer patients aims to find this element. Blood tests are also done to find out hepatitis B or C infection as well. Blood tests are one of the first stages of screening for liver cancer. 
• Physical Examination: Another one of the preliminary exams done to diagnose liver cancer, physical exams are conducted by your treating doctor or the primary care physician. The doctor can check for lumps, swelling and other physical symptoms on the stomach, spleen and around the liver. Yellowness in the eyes and other symptoms of jaundice may also be something that the doctor checks. 
• Ultrasound: Ultrasound tests use radiation waves to create a picture of the organs they hit. These images are used to see if there are any unusual growth patterns on, in and around the liver and identify if any of them are cancerous. 
• CAT Scan: A very handy diagnosis test, CT scans can not only be used to figure out the presence of the tumour but also its size, and any features that are specific to the tumour present. In a CAT scan, a 3D picture of the liver is created using x-rays. The patient may be given a dye, injected or taken orally, to ensure a better quality of the images created. A properly done CAT scan often eliminate the need for a biopsy. 
• MRI Scans: In Magnetic Resonance Imaging or MRI, magnetic fields are used to get images of organs like the liver. Like CT scans. MRIs are also used to determine the size and type of the tumour. Again, like CAT scans, a liquid dye is given to the patients to make sure the developed images are better. 
• Angiogram: Used to cover the diagnosis for angiosarcoma, angiogram covers the blood vessels of the liver and examine the presence of tumours in them. X-ray is used to create a picture of the blood vessels. Yet, a dye is injected into the blood to make sure that the pictures created are of good quality. 
• Laparoscopy: Laparoscopy is used to examine the ongoings inside the body. It is used to diagnose many other kinds of cancer apart from liver cancer. A small incision is made in the stomach and a thin, flexible tube is inserted in the liver and a small camera attached to the tip of the tube is used to see the insides of the liver. Local anaesthetic is used to either numb the area of the incision or to make the patient sedated.  
• Biopsy: A biopsy is one of the most trusted ways to diagnose liver or any other kind of cancer. A small tissue from the liver is taken and then sent to a pathologist for an examination. The cells are examined for cancer growth. The biopsy can differ as per the type of cancer as well as tests that are being done with it. 
• Biomarker Testing: This test is done to determine the proteins and other elements that are unique to your liver tumour. Biomarker testing results are useful to determine the kind of drugs you will need for immunotherapy and targeted therapy if they are included in your treatment plan. 

Liver Cancer Treatment Plans and Procedure

• Surgery: Just like for most types of cancers, surgery is a very common liver cancer treatment procedure as well. However, the surgeries that are done to remove and treat cancers and tumours will differ as per the type of cancer concerned. In the case of liver cancer, the top options include hepatectomy and liver transplant. Hepatectomy is the first contender when it comes to liver cancer treatment. Generally, hepatectomy is considered when the cancer is located only in one part of the liver. If the rest of the liver is working fine, hepatectomy is used to remove the cancer-ridden part of the liver. Since the liver is capable of growing on its own, it grows back to its original size in a few weeks. There may be a few side effects of hepatectomy such as pain, weakness, temporary liver failure, etc. A liver transplant is also something doctors can consider if certain conditions are met. First, the tumour can be no more than 5 cm big or there can be 3 tumours that are no more than 3 cm big. Another condition is the availability of the doner. Liver transplants are highly dependent on the second fact. Transplants are supervised very carefully since the body can reject the new liver or the tumour returns. 
• Radiofrequency Ablation: RFA is a therapy that uses heat waves to eliminate cancer in the liver. Microwave therapy is another similar therapy that uses heat waves to destroy tumours. RFA could be given through the skin itself or via laparoscopy after making an incision. 
• Percutaneous Ethanol Injection: In this liver cancer treatment procedure, alcohol is injected into the tumour to eliminate it. It is generally preferred to treat tumours that are no more than 3 cm big. Pain is a potential side effect if the alcohol happens to escape from the tumour and enter the liver. 
• Radiation Therapy: Out of all different kinds of radiation therapies, stereotactic body radiation therapy is one that is used to treat liver cancer. In this radiation therapy, a high dosage of radiation is transferred to the tumour while making sure that healthy tissues are not damaged in the process. Tumours less than 5 cm big can be treated by this procedure. 
• Chemoembolization And Radioembolization: Another common liver cancer treatment procedure, chemotherapy uses anticancer drugs to cure the tumour in the liver. The drugs are transferred into the bloodstream to help slow down the growth of the tumour. A similar kind of procedure is followed in radioembolization. Except for anti-cancer drugs, radioactive beads are put inside the tumour to treat it. 
• Targetted Therapy: Another drug liver cancer treatment, targeted therapies use anti-cancer drugs that are specifically made to target the unique element of your tumours. Biomarker testing is done to identify the specifies of a tumour and then the drugs are prescribed. 
• Immunotherapy: The final item of the list, immunotherapy targets the checkpoints cancer cells use to stop the immune system from destroying it. The checkpoints are destroyed by the drugs to restore the original functions of the immune system. Then, the immune system destroys the tumour itself. 

Live Cancer and Health Insurance

Like many other kinds of cancers, liver cancer is also covered by critical illness plans. The policyholder receives a lump sum amount as compensation for the critical illness cover. This sum can be used to cover the treatment costs of the surgery or other treatment procedures. Basic health insurance coverage may not cover the liver cancer treatment costs and other services taken during the treatment process. Critical illness insurance plans are generally more than enough to cover most of the treatment costs. 

In a Nutshell

Liver cancer is as lethal as any other kind of cancer. Just like other types of cancers, there are a few risk factors that can contribute to its growth and a few preventive things you can do to keep liver cancer at bay. Make sure you have a critical illness plan ready if you are at an increased risk of getting liver cancer. With early detection and regular treatment, one can easily get liver cancer treated with a good survival rate.