What Is Liver Cancer?

Liver cancer or heart cancer is a cancer that originates from the liver or liver organ. There are two classifications of liver cancer based on the location of growth or spread ( metastasis ), namely primary and secondary liver cancer. Primary liver cancer is a cancer that begins in the liver and includes a potentially fatal type of cancer. Secondary liver cancer starts from other body parts then spreads and grows in the liver.

One of the most common types of liver cancer is hepatocellular carcinoma (HCC) / hepatoma which is a primary liver cancer that develops from a major liver cell called hepatocytes. HCC occurs about 75% of all primary liver cancers. This cancer can be a complication of hepatitis (inflammation of the liver) and cirrhosis (normal liver tissue is replaced by scar tissue).

Secondary liver cancer is commonly named by the organ from which early cancer cell sites develop, such as metastatic colon cancer, which begins in the large intestine and then spreads to the liver. Secondary liver cancer is more common than primary liver cancer. In addition to the spread of cancer in the colon, secondary liver cancer also comes from the spread of breast, lung, pancreatic, stomach, ovarian, and skin cancers (melanoma).

Much Happens in Developing Countries
In the world, liver cancer is the fifth most common cancer among men and ninth among women. This cancer is the second most common cause of cancer deaths worldwide, after lung cancer.

About 83 percent of cases of liver cancer in the world occur in developing countries. The cause of high cases of liver cancer in developing countries is the high cases of hepatitis B and C in these countries, including in Indonesia. Whereas in developed countries such as countries in Europe, the main causes of liver cancer are high alcohol consumption and increased obesity .

In Indonesia, there are an estimated 18,000 new cases of liver cancer each year, based on data in 2012. This figure is expected to increase with increasing numbers of hepatitis B and C patients who currently reach 30 million inhabitants.

Important Functions of Liver Organs

With hundreds of functions performed, the liver becomes one of the most complex organs in the human body. Liver cancer is categorized as a serious disease due to inhibition of liver functions, even actually stop it. The following are some of the most important functions of the heart:
  • Eliminating toxins from the body
  • Digest protein and fat
  • Producing a fat-busting liquid (gall) that helps digestion
  • Helps control blood clots
Recognizing Liver Cancer Symptoms
Symptoms of this disease are usually in the form of general or less specific such as fatigue and nausea . Many people who just feel the symptoms clearly after the cancer reaches an advanced stage. Symptoms of liver cancer include:
  • Fatigue
  • Weight loss without cause
  • Nausea
  • Gag
  • Jaundice (skin and whites of yellowing eyes due to increased levels of bilirubin in the human body)
Causes Of Liver Cancer
The exact cause of liver cancer is still unknown, but the disease is thought to be related to tissue damage of liver cells, such as cirrhosis liver disease. Cirrhosis can be caused by hepatitis B or hepatitis C virus infection.

Hepatitis B or C sufferers of liver inflammation are at risk of triggering damage and the occurrence of scar tissue in the liver. This condition can then develop into liver cancer.

Some unhealthy habits or lifestyle can be a risk factor for liver cancer. One of them is alcohol abuse. Consuming more than the recommended amount of alcohol can cause permanent liver damage and increase the risk of liver cancer. In addition, obesity is believed to also increase the risk of liver cancer because it is closely related to non-alcoholic fatty liver disease ( Non Alcoholic Fatty Liver Disease (NAFLD).

Early Cancer Diagnosis May Be Possible

If a general practitioner suspects or diagnoses you have had liver cancer, you will be referred to a specialist hospital for further examination. The sooner the disease is diagnosed, the more effective the treatment is given.

In fact only 1 in 5 people can survive, at least a year after being diagnosed with liver cancer. And only 1 in 20 people survive at least five years. This is because as many as 9 out of 10 new patients are diagnosed when the cancer already exists at an advanced stage. In most people, the cancer has grown too severe to be cured.

So that liver cancer can be diagnosed early, people who are at high risk of the disease is advised to check themselves regularly and regularly. These high-risk groups are those who are positively infected with hepatitis B and C and who have had cirrhosis. The benefit of routine examination is to diagnose liver cancer at an early stage, ie when treatment for total recovery is more likely.

Liver Cancer Treatment
The cancer stadium determines what type of treatment will be administered to the patient. If the cancer is diagnosed already in an advanced stage, treatment is only intended to reduce pain and discomfort for the patient for the rest of his life. But it is different if the cancer can be diagnosed before it develops more severe, then the condition is more likely to be handled.

There are at least three ways to treat liver cancer. The first is a radio frequency ablation, namely the use of an electrical device specifically used to destroy cancer cells in the liver. The second is a resection surgery, which is the process of removal of certain parts of the liver that is infected. The third is a liver transplant, which replaces the liver of the patient with the liver organ of the donor.

Preventing Liver Cancer by Healthy Living
The risk of liver cancer can be reduced by avoiding the risk of getting infected with hepatitis B and C by getting vaccinated and having sex safely. No less important, apply a healthy lifestyle such as regular diet and exercise so that the body avoid obesity.

In addition, avoid excessive alcohol consumption and cigarettes. If you want a body piercing or tattooing, be sure to do so in a place that has a guaranteed level of sterility.

Symptoms of Liver Cancer

Generally, liver cancer patients in the early stages do not feel the symptoms are meaningful. New symptoms will be seen clearly at an advanced stage. However, some of the following symptoms can be cautioned as symptoms of liver cancer:
  • Feeling very tired and limp
  • Stomach ache
  • Itchy
  • Liver organs swell
  • Feeling nauseous and vomiting
  • Ascites or fluid buildup in the stomach. The abdomen looks swollen.
  • The limbs swell due to fluid accumulation.
  • Weight loss without cause
  • The skin and whites of the eyes are yellowing
  • Urine is dark
  • The stool is white like chalk
The symptoms above are common and not always a marker of liver cancer, but still better to do the examination. Try consulting your doctor if you have one or more of the above symptoms including people who have had cirrhosis or are infected with hepatitis.

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Causes Of Liver Cancer

The cause and how changes in cells in liver cancer are still unclear. However, the risk of liver cancer seems to increase with liver damage, such as cirrhosis . However, not all cases of cirrhosis will lead to liver cancer.

The link between cirrhosis and liver cancer

Liver cancer is closely related to cirrhosis, which occurs in the formation of scar tissue in the liver. In the state of cirrhosis, the normal liver tissue is replaced by scar tissue so the liver becomes hardened. As a result of cirrhosis, liver function begins to decline. Keep in mind that not all patients with cirrhosis will develop liver cancer.

In a developing country such as Indonesia, cirrhosis is commonly caused by hepatitis B and C. viral infections. In addition, cirrhosis can also be caused by non-alcoholic fatty liver disease, excessive alcohol consumption, and autoimmune disease .

Hepatitis B virus infection

Hepatitis B is a virus that spreads through contaminated blood. In addition the virus is also spread through other body fluids such as saliva, semen, and vaginal fluids. Some people with hepatitis B suffer the same symptoms as those with liver cancer and are at increased risk of extensive scarring of the liver. Scarring is the liver tissue that forms when normal and soft tissues undergo the process of injury.

Ethnic factors are thought to affect the potential risk of hepatitis B infections developing into liver cancer. Asians who are infected with hepatitis B have a higher risk of above average liver cancer, regardless of whether they also have liver cirrhosis or not. As with other ethnic hepatitis B patients, their risk for developing liver cancer only increases if they also have cirrhosis or other liver diseases such as hepatitis C. The combination of smoking and hepatitis B make the risk of liver cancer become higher.

Hepatitis C infection

In the long run, people with hepatitis C can experience inflammation and damage to the liver. If you are a person with hepatitis C, keep yourself away from cigarettes. People with hepatitis C who smoke more at risk of liver cancer later in life.

Indonesia is one of the countries with the highest rates of hepatitis C in Southeast Asia. One of the methods of spread of hepatitis C in Indonesia is the use of contaminated needles.

Non alcoholic fatty liver disease

The exact cause of non-alcoholic fatty liver disease ( non-alcoholic fatty liver disease ) remains unclear. However, this disease is often associated with obesity and type 2 diabetes.

Non-alcoholic fatty liver is a common condition and does not cause obvious symptoms in most sufferers. The fats that accumulate in the liver tissue cause this disease.

But in some people, the buildup of fat in high levels can cause inflammation of the liver. Over time this inflammation will cause scarring of the liver.

Due to bad liquor

Other than other organs, the liver is an organ with strong resistance. This is because the liver cells are able to regenerate after an injury.

Every time you consume liquor, this powerful and soft organ will filter out harmful substances in alcohol from your blood. This filtering causes some liver cells to die.

The liver cells are indeed able to regenerate making new cells. But how strong is this organ, excessive consumption of alcohol and in the long run can damage the liver permanently. If you continue to consume excessive liquor for years, your heart will lose the ability to regenerate.

Factors from Other Risks
Liver cancer is also triggered by several other factors as follows:
  • Autoimmune hepatitisThis rare genetic condition arises when the immune system or the body's natural resistance that normally attacks infections actually attacks healthy liver cells. The risk of autoimmune hepatitis against liver cancer is smaller than patients with cirrhosis or other liver disorders.
  • Primary biliary cirrhosisThe underlying cause of primary biliary cirrhosis remains unknown. This disease attacks the bile ducts, the pipelines that function to drain the bile into the digestive system. Damage to the bile duct then causes bile buildup in the liver. This buildup damages the organ and causes cirrhosis. About 5% of patients with advanced biliary tract cirrhosis are expected to develop liver cancer in the future.
  • HemochromatosisAbout ten percent of people with cirrhosis due to hemokromatosis have liver cancer. Hemochromatosis is a genetic condition when the body stores too much iron absorbed from food. The accumulating iron eventually reaches levels that poison and damage the liver.

Diagnosis Of Liver Cancer

People who are more at risk of developing liver cancer need to undergo periodic checkups. Convey the symptoms you feel and when you begin to feel it to the doctor. If it is necessary to require further examination, your doctor will refer you to a specialist.

A number of investigations may be necessary, one of which is to ascertain whether there are cancer cells in the liver and whether they come from other organs (primary liver cancer) or primary liver cancer. In addition, the examination was done to find out how big the lump of cancer in the liver and how large the area of ​​spread. It is necessary to know at what stage the patient is located. Thus the doctor will get an idea of ​​the condition and function of the liver, its effect on the health of the patient, and to decide the right handling.

Generally, you will undergo the following checks:

Monitoring for Intensive Liver Cancer Detection
If you belong to a group of people who are at high risk of developing liver cancer such as cirrhosis patients, it is advisable to perform periodic checks every six months.

The examination is usually through two stages, namely blood tests and ultrasonography (USG). Blood tests serve to detect the presence or absence of a protein in the blood called alpha fitoprotein (AFP). More than half of people with primary liver cancer produce this protein in their blood. In addition, ultrasound or ultrasound is performed to determine abnormalities in the liver.

Further Investigation
In addition to ultrasound and AFP detection via blood tests, doctors may use various other investigations for the diagnosis of liver cancer, namely:
  • MRI ( Magnetic Resonance Imaging ). Taking a look at your liver organ using magnetic fields and radio waves.
  • CT scan. Your heart organ will be photographed with special X-rays.
  • Biopsy. Your liver tissue sample will be taken with a needle. This example will then be tested in the laboratory to detect cancerous cells.
  • Laparoscopy. It is run by making a small stroke on the abdomen so that a flexible camera called endoscopy can be inserted to check your heart. The test is run with total anesthesia.
However, you may not need to use any type of test to confirm the diagnosis.

Stages of Development of Liver Cancer
The rating system Barcelona Clinic Liver Cancer (BCLC) divides the five stages of development of liver cancer as follows:
  • Stage o: the patient is still in good health and his heart is functioning well, but there are tumors less than 2 cm in diameter.
  • Stage A: the patient is in good health and his heart is functioning normally. But it has grown a tumor less than 5 cm in diameter, or there are three or more tumors with a diameter of less than 3 cm.
  • Stage B: There are several tumors in the liver, but it has no effect on the liver function.
  • Stage C: the cancer has begun to spread into the blood vessels, into the surrounding lymph nodes or other body parts. The person's body is not very healthy and the function of his heart does not work so well.
  • Stage D: People begin to show symptoms of late stage of liver disease, such as fluid accumulation in the stomach. The heart has lost most of its functional abilities.

Liver Cancer Treatment

Liver cancer patients will be treated with the type of treatment in accordance with the stage of each cancer. There are three main ways that can be done to treat liver cancer:
  • Resection (operation): take part of the liver that is affected by cancer.
  • Liver transplant: surgery to replace the organ with a new liver.
  • Radiofrequency ablation (RFA): uses heat to kill cancerous cells.
Patients can be completely cured if at the time of diagnosis of cancer, the cancer he suffered was in stage A. But total healing can not be done if cancer is detected at stage B or C. While in stage D, treatment will only focus on relieving pain and discomfort.

Removal of liver cancer by surgery (surgery)

Resection surgery is performed by removing cancerous cells through surgery. Generally it takes 3-4 months to restore your organs after surgery. However you have been allowed to leave the hospital within 6-12 days of surgery.

But like all medical procedures, resection surgery also has risks. In some patients, liver resection surgery leads to complications such as infection, bleeding, and deep vein thrombosis . It is estimated that of 30 people who undergo liver resection surgery, there are 1 person who died after or during surgery. This is because liver resection can sometimes lead to lethal complications such as heart attacks .

Transplant with a liver donor

Transplants may be performed using organs from deceased persons and living donors. Each way has advantages and disadvantages.

The transplant of the deceased will face the following conditions:
  • It can take a while to wait for a suitable donor.
  • The result is better than that of living donors.
While transplants from living donors will be encountered under the following conditions:
  • No need to wait too long.
  • Higher complication rate of procedure.
  • The results tend not to be as good as if using the heart of someone who has died.
In addition, liver transplantation is only appropriate for certain cases. This procedure is usually suitable if the tumor is less than 5 cm in diameter. But it will not be beneficial if you have multiple tumors or a tumor that is more than 5 cm in diameter. Liver transplantation may be recommended for people with three or more tumors with a diameter of less than 3 cm. This procedure is also recommended for people with tumors who are highly unresponsive to treatment until they show no signs of tumor progression until six months later.

Killing Cancer Cells with Radio Frequency
RFA or Radiofrequency Ablation kills the cancer cells and shrinks the size of the tumor by heating processes that use electricity.

Ablation / removal by radio frequency can be recommended as an alternative step other than surgery to handle cases with one or more tumors less than 5 cm in diameter.

After undergoing the procedure, you may feel uncomfortable and experience flu- like symptoms , such as chills or muscle aches for several days. Although rare, complications that may occur are bleeding, infection, minor burns , or damage around the organs.

Treatment of Chemotherapy
The type of chemotherapy recommended for treating liver cancer stage B and C is called transcatheter arterial chemoembolization (TACE ). This treatment does not heal, but only relieves pain and prolongs life expectancy. However, this procedure is not recommended for treating Stage III liver cancer as it may aggravate the condition.

Chemoembolization can be run when people are waiting for an organ for liver transplantation. This procedure helps prevent the spread of cancer to the liver when the patient awaits the liver grafts. Coembirization is lived with a combination of two techniques:

Helps slow the growth of tumors by injecting small plastic gels or granules into the blood vessels that flow through the tumor

Chemotherapy drugs are injected directly into your liver. This process prevents patients from side effects that are often associated with 'traditional chemotherapy' such as hair loss and fatigue.

About a month after undergoing chemoembolization, the body's response to it will be evaluated by CT scan .

Approximately 30% of patients undergoing chemoembolization experience a side effect known as post-chemoembolization syndrome with symptoms of nausea , vomiting, abdominal pain, fever , and loss of appetite. These side effects can disappear 1-2 weeks later.

In addition, there are also some more rare chemoembolization complications:
  • Inflammation of the liver.
  • Deterioration of liver function. Usually temporary.
  • Abdominal swelling due to fluid accumulation.
  • Damage to the channel or gallbladder.
Choice of alcohol injections

Alcohol injections aim to make cancer cells dehydrated and stop blood flow to the tumor. This treatment can only be done if you have only a few small tumors.


Sorafenib is a tablet used to treat liver cancer in certain cases. Not all cases of liver cancer can be treated with sorafenib. In the case of advanced liver cancer, the use of sorafenib may not be recommended because of its limited benefits. The medical team will check whether this drug tends to bring benefits or losses, and it is appropriate or not if it is used to you.

Freezing Cancer ( Cryoablation )

The process of cell destruction can also be done by using a tube containing liquid nitrogen which will freeze the cancer tissue first before it is destroyed. This procedure is performed with the help of images produced by ultrasound as a guide when monitoring and destroying cancer cells. The tool used for this treatment procedure is cryoprobe .

Prevention Of Liver Cancer

Growth of liver cancer can be prevented. The main key is with a healthy lifestyle and discipline in maintaining health. Liver cancer prevention measures include:
  • Avoidance of hepatitis C risk factors such as hepatitis C Â and hepatitis B.
  • Healthy diet.
  • Avoid yourself from obesity with regular exercise.
  • Limit alcohol consumption.
  • Perform regular medical checkups, especially early detection or liver cancer screening. Especially in patients with hepatitis B or C, liver cirrhosis, primary biliary cirrhosis , and people who have a history of liver cancer or other liver diseases in the family.
Hepatitis B vaccine

You can avoid the risk of hepatitis B with the vaccine. In Indonesia, this hepatitis B vaccine has become part of the immunization that must be taken at birth and at the age of two, four, and six months. However, adults of all ages may receive this vaccine.

Hepatitis B vaccine is also recommended for high-risk groups of people as follows:
  • Persons with chronic renal failure and chronic liver disease.
  • People who frequently switch sexual partners.
  • Medical personnel and users of injecting drug users.
  • Close family of people with chronic hepatitis B.
  • People who receive blood donors regularly.
  • Prisoners and prison officers.
Reduce the risk of hepatitis C transmission

Hepatitis C virus is often transmitted through the blood of an infected person to another. This causes common hepatitis C to occur among the narcotics users, especially those who share the use of drugs such as needles in vain. Here are some things you can do to minimize the risk:
  • Avoid the use of personal items together. Avoid exchanging objects contaminated with other people's blood such as earrings, shavers or toothbrushes.
  • It is recommended to use condom contraceptives during sex, because hepatitis C can also be transmitted through other body fluids such as semen.

It would be better if you were more alert by assuming that anyone might have been infected with hepatitis C. Many people with hepatitis C themselves do not realize that they contract the disease, so they do not take care of themselves. This can be caused because hepatitis C can appear without symptoms accompanied in years.

Limit or avoid alcohol consumption

If you consume liquor, you should not exceed the limit of consumption per day. Consumption of alcohol is 3-4 units a day for men and 2-3 units a day for women. One unit of alcohol is roughly equivalent to 284 ml of light, normal-strong beer, half a glass of wine (87.5 ml), or 25 ml of high ethanol-containing beverages produced from fermentation (spirit). Even so, the decision to stop taking liquor is the most effective recommended step in reducing the risk of developing liver cancer.

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