Cancer begins when healthy cells change and grow out of control, forming a mass called a tumor.
A cancerous tumor is malignant, meaning it can grow and spread to other parts of the body. Cancer that begins in the liver is known as primary liver cancer.
There are a number of types of primary liver cancer that occur in adults.
Patients with HCC may experience no symptoms, particularly when the tumor is detected early as part of a screening program. When symptoms or signs do occur, they include:
Some symptoms experienced by people with HCC may be caused by cirrhosis rather than the tumor.
AFP levels in the blood are elevated in about 50% to 70% of people who have HCC.
Computed tomography (CT) scans
HCC can be diagnosed based on features specific to liver cancer that are seen on a CT scan.
Magnetic resonance imaging (MRI)
An MRI scan uses magnetic fields to produce detailed images of the body.
A biopsy is the removal of a small amount of tissue for examination under a microscope.
When the AFP blood test, CT scan, or MRI strongly indicates HCC, and other test results that are typical of HCC, a biopsy may not be needed.
Molecular testing of the tumor
These laboratory tests will identify specific genes, proteins, and other factors unique to liver cancer.
Results of these tests will help determine your treatment options.
The Barcelona Clinic Liver Cancer (BCLC) system categorizes HCC based on characteristics of the tumor, liver function, performance status, and cancer-related symptoms.
BCLC stage groupings include:
The tumor is smaller than 5 cm. Liver function varies, and portal vein pressure may or may not be increased.
Patients with early-stage disease may be candidates for a liver transplant, surgery, or radiofrequency ablation (RFA).
The tumor may be large or there may be multiple tumors. Regional therapies, such as trans-arterial chemoembolization maybe recommended for these patients with intermediate stage HCC.
The tumor has invaded the portal vein or spread to other parts of the body, such as the lymph nodes, lungs, and bones.
Targeted therapy or immunotherapy maybe recommended for these patients.
These treatments are recommended for early stage cancer. These treatments include surgery, radiofrequency ablation, percutaneous ethanol injection, and radiation therapy.
While these treatments will most likely not eliminate the cancer, they have been shown to improve symptoms, quality of life and survival.
During chemoembolization, chemotherapy drugs are injected into the hepatic artery, and the flow of blood through the artery is blocked for a short time so the chemotherapy stays in the tumor longer.
Blocking the blood supply to the tumor also destroys cancer cells. During radio embolization, the specialist places radioactive beads into the artery that supplies the tumor with blood. The beads deliver radiation therapy directly into the tumor when they become trapped in the small blood vessels of the tumor.
Targeted therapy is drug treatment that targets the cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. This type of treatment blocks the growth and spread of cancer cells while limiting damage to healthy cells.
Recent studies show that not all tumors have the same targets. To find the most effective treatment, our Oncologist may run tests to identify the genes, proteins, and other factors in your tumor.
This will help out oncologist better match you with the most effective treatment whenever possible.
For HCC, anti-angiogenesis drugs are the most common type of targeted therapy. Anti-angiogenesis therapies focused on stopping angiogenesis, which is the process of making new blood vessels.
Because a tumor needs the nutrients delivered by blood vessels to grow and spread, the goal of anti-angiogenesis therapies is to “starve” the tumor.
The first anti-angiogenesis therapy is believed to work through this process and used to treat advanced HCC that cannot be completely removed with surgery. In 2017, the U.S. Food and Drug Administration (FDA) approved the use of a second oral targeted therapy for previously treated HCC.
In 2018, a 3rd anti-angiogenesis oral targeted therapy was approved by the FDA as first-line treatment for inoperable HCC.
Immunotherapy, also called biologic therapy, is designed to boost the body's natural defenses to fight the cancer.
The PD-1 pathway is critical in the immune system’s ability to control cancer growth. PD-1 and PD-L1 antibodies block this pathway and can stop the growth of HCC.
In 2017, the FDA approved an immune checkpoint inhibitor for the treatment of HCC, following the use of a targeted therapy.
In 2020, the FDA subsequently approved the use of a combination of immune checkpoint inhibitors that work to block the PDL-1 pathway that would otherwise allow the cancer to hide from the immune system.
Other immunotherapy drugs are still being studied in clinical trials.
Patients and their families have opportunities to talk about the way they are feeling with our oncologists, nurses, counselors, or join our psychosocial program and support group at Onco Life Centre.