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Liver cancer means that there are one or more cancerous tumors in the liver. It can be released from cancer if it is detected early, but it is more common than it is detected late. Then there are treatments that can slow down and relieve the disease. Some can live a good life with such treatment.

What is liver cancer?

There are different types of liver cancer. This text is about liver cancer, HCC. It is most common in the cancers that start in the liver.

It is more common than cancer of the liver is due to the fact that a cancer disease elsewhere in the body has spread to the liver and formed daughter tumors there. Daughter tumors are the same as metastases.

Children can also get liver cancer, but the disease is usually different from that of adults. Most children who get liver cancer get rid of the disease. Here you can read more about liver cancer in children.

What are the symptoms of liver cancer?

The liver has a great ability to function despite having inflammation or another disease. Therefore, it usually takes a long time before liver cancer causes symptoms. The symptoms of liver cancer can be diffuse and are usually due to something other than liver cancer. You may have one or more complaints:

Fatigue and fatigue

You may feel inexplicably tired and powerless. This may be because the liver does not fulfill its task of purifying the blood.

Discomfort and nausea

You may feel discomfort in the upper abdomen and feel unwell.

Stomach and back pain

You may get high up in the right part of the stomach. Some get hurt in the right shoulder. This is because the cancer tumor presses so that organs and tissue around it are affected. You have no feeling in the liver.

Weight loss and decreased appetite

You can lose weight without knowing why. This may be because the cancer tumor prevents the body from absorbing nutrition properly. You may also lose the desire to eat. It is not known what this is due to.

Jaundice

Jaundice in liver cancer is usually due to the fact that the liver cells are unable to purify the blood. Jaundice is a collective name for some typical symptoms:

  • The urine becomes darker.
  • The whites of the eyes and the skin turn yellow.
  • It can start to scratch the skin a lot.

For the most part, jaundice has completely different causes than liver cancer, such as gallstones or hepatitis. Hepatitis is an inflammation of the liver caused by viruses.

When and where should I seek care?

If you have any or all of the symptoms of liver cancer, contact a health care provider. You can contact many receptions by logging in.

If it’s in a hurry

If you get yellow eye whites or yellow skin at the same time as you get a fever and chills, contact a health center or on-call reception immediately. If this is not possible, seek medical attention at an emergency room.

Investigations

Blood tests and ultrasound examinations are usually enough for the doctor to know if you have liver cancer. If you have liver cancer you need to be examined more so that you can get the treatment for liver cancer that is best for you.

Substances in the blood are examined

Blood tests can measure levels of substances that form in the liver. Changed levels may be signs of liver cancer but may also be due to something else.

Ultrasound can show if there is cancer

An examination with ultrasound means the doctor for an instrument over the abdomen. The study can show if there is cancer in the liver.

The cancer is examined with a magnetic camera or computer tomography

If you have cancer, your doctor needs to find out more about it and see if it has spread. First, you get a syringe with a contrast agent that makes the changes to be examined more visible. Then you will be examined with a magnetic camera or with computer tomography.

Tissue tests are sometimes needed

Sometimes a tissue sample from the liver is needed. The doctor takes the test with a needle. You get local anesthesia before the sampling, which takes a few seconds and feels like a light pressure. The tissue sample is also called a liver biopsy.

Survey with peephole technique

Sometimes the doctor needs to examine the liver with a puncture surgery to see where there is cancer and to be able to take samples. Titanic surgery is also called laparoscopy. You will have local anesthesia or be anesthetized before the examination.

The investigation is conducted according to a standardized course of care

You are offered an examination according to a standardized course of care if the doctor suspects you may have liver cancer.

Standardized care is a way of organizing the investigation so that it goes as quickly as possible. Among other things, there are times set for the surveys you may need to do.

The doctor who writes the referral tells you why you should be investigated according to a standardized course of care and what it means and when you can be told if you have cancer or not.

It is often quick to get calls for examinations in a standardized course of care. It is good if you are clear about how the staff most safely reach you so that you do not miss any time.

Treatment that can remove the disease

In some, cancer is detected at an early stage when it can still be removed. There are three types of treatments for liver cancer

  • Operation
  • transplantation
  • treatment with heat so that the cancerous tumors are destroyed in the liver.

What treatment you can receive depends on how many cancerous tumors are present in the liver, where they are located and how large they are. It is important how the liver works otherwise. The possibility of getting treatment can be affected, for example, if you also have liver cirrhosis. The treatment for liver cancer also depends on how you feel and what you want.

Liver surgery works well enough

Cancer can be removed if it is in a limited area of ​​the liver and the liver works well enough. The cancer is removed and also some of the liver around it. The most common is that the operation is done by a cut in the stomach. Sometimes, one can be operated with a peephole technique, also called laparoscopy. You are anesthetized during the operation.

Bleeding sometimes occurs after surgery. They can often be stopped without the need for surgery again. It can also leak bile. The bile can be led away and out through the skin through a small tube called drainage. If that does not help, a small tube may need to be inserted into the bile ducts. It can be done in various ways, for example by means of a narrow, flexible instrument that is carried down the stomach through the mouth to the biliary tract. The method is called ERCP.

How long you need to stay in the hospital depends on how you feel and if any complications have occurred. It is common to have to stay three to seven days.

Transplantation on liver function is impaired

Transplantation can sometimes be an option if the cancer is only present in the liver, you are feeling well enough but the function of the liver is impaired. Transplantation means replacing your liver with a liver from a person who has died.

The first 24 hours after the transplant you may need to be treated with a respirator. Sometimes complications arise. For example, the body may want to repel the new liver. Therefore, the length of care at the hospital varies from person to person. Some may leave the hospital after ten days. Others need to stay up to three weeks.

Heat treatment – local ablation

The cancerous tumors can sometimes be treated in the liver to disappear. This is done with the help of the heat that destroys the cancerous tumors. It is called local ablation. Local ablation can be used if the cancerous tumors are small. The treatment can be done while you are undergoing surgery if some of the cancerous tumors are located so that they cannot be removed with surgery. You can also get local ablation if you are unable to perform an operation.

The doctor inserts a needle through the skin and into the cancer tumor using ultrasound or computed tomography. Through the needle is sent a heat that destroys the cancerous tumor. Multiple cancer tumors can be treated simultaneously. You are anesthetized when you receive the treatment.

You may return home the day after treatment for liver cancer. You are given prescriptions for painkillers that you can take if you need to.

What can I do for myself?

The treatments can be stressful. You can cope better and recover faster if you take care of yourself so you feel as good as you can. Here are some things you can do that are of great importance:

Avoid alcohol and smoking

If you smoke or drink alcohol, try to refrain. There is help available if you need it. Talk to your doctor or contact nurse.

Eat as well as you can

Try to get enough nutrition. You may need to eat frequently and even before you fall asleep. It can be difficult if you feel bad or get saturation feelings quickly. You can get dietary advice from a dietician. There are also medicines that can increase appetite and reduce nausea. Here you can read more about food in cancer.

Physical activity

Touch yourself as much as you can. It can help if you feel very tired, which is common in cancer. You can get help from a physiotherapist or physiotherapist who can suggest exercises that are tailored to you.

Fertility and breastfeeding

Disease and treatment can affect fertility. Talk to your doctor before treatment if you want to freeze sperm or meet a gynecologist to discuss what other options may be available to get pregnant after treatment for cancer. Read more in the article Fertility after cancer treatment.

Although fertility is impaired, it is good if you protect yourself from pregnancy while receiving treatment against cancer. It is also good if it takes some time after treatment before you try to get pregnant or to use your sperm in a pregnancy. Talk to your doctor. Also, talk to your doctor if you have liver cancer and want to breastfeed.

Post-checks and risk of relapse

You need to go for post-checks about every six months. It is different how long you need to go for post-checks. It can vary between three and five years. Some need to go further. The post-checks are done to see how you are feeling and whether cancer has returned. It is called relapse if cancer returns.

Relapse is quite common if you have had surgery or have been treated with local ablation. This is because the injury that caused cancer remains in the liver. Often you can get treatment again.

Life after liver cancer

Most can go on with life much like it was before cancer about a month after the treatment. But life can feel different. You always have the experience of what you have been with. It can be painful periodically, but usually, it gets better – although it can take time. Some feel vulnerable and worried long after treatment is over.

Sometimes contact with others in the same situation can feel empowering. The ideal association Palma is for you who have or have had liver cancer or who are related. Here you can read more about different types of help and support in cancer.

Treatment that can slow down liver cancer

It is possible to receive treatment that slows down the course of the disease, even if the disease cannot be removed. Radiation or cytostatics can be given directly in one or more cancerous tumors if present in the liver. If cancer has spread outside the liver, there is a drug that you take as tablets.

Blocking with cytostatics – chemoembolization

Chemo-embolization means you are treated through a narrow, flexible tube called a catheter. The catheter is inserted into the groin and through the blood vessels to the liver. The doctor injects a drug through the catheter. The agent contains small beads with cytostatic drugs that prevent the cancer tumor from continuing to grow. The agent simultaneously isolates the cancer tumor so that the healthy tissue around it is spared. Therefore, it is possible to give fairly high doses of cytostatic drugs.

You may have local anesthesia or be anesthetized during treatment. Most people can leave the hospital the day after treatment.

Drugs for spreading cancer

Drugs containing active substance sorafenib can slow cancer if it has spread. It is a drug that makes it harder for cancer cells to grow and spread. You take the medicine as tablets.

Treatment that can relieve pain

Liver cancer can cause various problems that need to be treated. On the Advice and Support page, you can read more about what help you can get if you need psychological, existential or social support.

In this chapter, you can read about the physical problems you can get and what treatment is available. You may have one or more of the problems if the disease cannot be removed. Even if you have received treatment that has removed the disease, you may experience one or more of the problems at a time.

If you are in pain

There are many types of effective help if you are in pain. There are pain-relieving drugs in the form of tablets or patches where the medicine is taken up through the skin. Pain relief is also available as a drop directly into the blood. 
Radiation therapy can also help.

Whether it’s itching

Jaundice can, among other things, cause it to start itching a lot on the body. It can alleviate if you shower cool. Alcoholic liquor you bathe on the skin can also help. Lubricate with moisturizing cream if you have dry skin. There are various drugs that can make it itchy less if neither cream or other remedies help. For example, medicines with antihistamines may help.

Fluid in the stomach

A liquid can accumulate in the stomach so that it becomes swollen. Sometimes liquid drugs help. The fluid can also be drained through a needle inserted into the stomach. Then you get local anesthesia first.

Changed personality

Harmful substances can be formed in the body if the liver’s ability to purify the blood is impaired. It can affect the brain. For example, you may find it difficult to concentrate, get confused, lose memory or otherwise behave differently. The condition is called liver encephalopathy. It can both be prevented and treated with certain antibiotics and other drugs.

Where can I get soothing care?

You can get soothing care at home or at a hospital, for example, if your inconvenience is because the disease cannot be removed. It depends on what care you need and what you want yourself. You can read more in the text about palliative care. 

What does liver cancer depend on?

Liver cancer that begins in the liver is often caused by the liver being damaged, for example by prolonged inflammation. Here are some causes of inflammation of the liver:

  • viruses, such as  hepatitis B  or  hepatitis C
  • long-term and high alcohol consumption
  • obesity and diabetes.

Liver cancer can also be caused by a mold poison called aflatoxin.

How does cancer occur?

The body consists of many billions of cells. The cells divide to form new cells so that the body can function. Sometimes it gets wrong when a cell divides. Usually, it does nothing or the cell can stop the error from spreading to more cells at the next cell division. But sometimes it doesn’t work. Then more and more altered cells can be formed for each cell division. Eventually, cancer cells can form and become a cancerous tumor. The cancer cells divide uncontrollably and do not die when they should. You can read more in the article What is Cancer?

Metastases in the liver

The most common is that liver cancer is metastasis, daughter tumors. This means that cancer has started somewhere else in the body and then spread to the liver. A tissue sample can show where the metastases come from.

The treatment and prognosis are different depending on where a metastasis comes from. Metastases due to colon cancer can sometimes be completely removed with, for example, surgery or local ablation. Liver metastases due to breast cancer cannot be operated on. Instead, cytostatic or hormonal therapy can be used to curb the disease.

It is most common that metastases in the liver are due to colon cancer or breast cancer. Here you can read about other cancers that can also cause metastases in the liver:

  • lung cancer
  • prostate
  • pancreatic cancer
  • ovarian cancer
  • renal cancer
  • skin cancer.

Be involved and influence your care

You have the right to be involved in your care as far as possible. The healthcare staff should tell you what treatment options are available. They should make sure you understand what the different options mean, what side effects are available and where you can get treatment. This way you can help decide on your treatment.

Ask questions if you don’t understand. You can also ask for information printed so that you can read it peacefully.

You have the right to receive interpreting assistance if you have a hearing impairment.

You can make a care plan together with the contact nurse, the doctor and other staff. The care plan should contain information that is important to you, such as contact information and how to get the rehabilitation you need. Here you can read more about the contact nurse and the care plan.

You can get a new medical assessment

You may get a  new medical assessment from another doctor if you have a life-threatening or particularly serious illness. Obtaining another doctor’s assessment can help you, for example, if you are unsure of which treatment or treatment is best for you. 

Getting a cancer message

You can respond in many ways to a cancer message. It is common to need a lot of time to talk to your doctor and other healthcare professionals about what the message means. If possible, please let a relative accompany you. The related person can act as a support and help to remember what has been said.

In many hospitals, there are special nurses called contact nurses who should be especially accessible to the sick person and to their relatives. The contact nurse can provide support and also help with various practical things. Here you can read more about contact nurses.

You can get help in several places

Talk to the contact nurse or the hospital’s curator if you feel anxious or have questions. You can also contact for example Cancer Counseling or Cancer Foundation. Paloma is a patient association for people with cancer of the pancreas, liver or esophagus. There you can get in touch with one or more people who have their own experience with liver cancer. Here you will find contact information for Palma, Cancer Counseling, Cancer Foundation and others who can also give advice and support in cancer.

It is common for it to feel easier once treatment has begun and you know what is going to happen.

Children need to know

A child under the age of 18 is entitled to receive information and support based on his or her own needs if a close adult becomes ill. It is the responsibility of care. If you want to tell the child yourself about the disease, you can get help with what to say. Often it is good to make children as involved as possible, no matter how big or small they are. That doesn’t mean you have to tell everything.

Being related

It can feel difficult to be close to someone who is sick. It is common to want to support while you have a strong concern and feel bad.

If you have people close to you, they can be a support. Often it will be easier for them to help you if you tell them how it feels. You can also talk to the contact nurse if you are close and need supportive calls.

You can get relief if you help take care of or support the sick person. You can also get support, for example in the form of calls or help with practical things.

Muhammad Nadeem

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