Hepatocellular Carcinoma: Understand The Basics Of Liver Cancer

“It’s usually caused by chronic inflammation in the liver – it could be because of genetics or it could be because of environmental factors – can lead over a lifetime to develop HCC.” – adds Dr Kinkhabwala.

The most common risk factor for HCC is viral hepatitis, which affects many patients throughout the world, especially in Africa and Southeast Asia, but also many patients in the United States.

In the US hepatitis C is more important than hepatitis B in the development of liver cancer.

“There are other risk factors too, such as chronic alcohol use and now, an emerging public health crisis, is the development of obesity and diabetes in the population. Which causes inflammation in the liver and over time can actually cause liver cancer. So fatty liver is now becoming much more important in the United States as one of the causes of liver cancer.” – says Dr Kinkhabwala.

Risk factors

• Gender (Hepatocellular carcinoma is much more common in men than in women)
• Race/ethnicity (In the United States, Asian Americans and Pacific Islanders have the highest rates of liver cancer, followed by Hispanics/Latinos, American Indians/Alaska Natives, African Americans, and whites)
• Chronic viral hepatitis
• Cirrhosis (a disease in which liver cells become damaged and are replaced by scar tissue)
• Heavy alcohol use
• Tobacco use
• Obesity
• Type 2 diabetes

Signs and symptoms

“Early symptoms are very difficult to appreciate because they’re very subtle. Many times patients may not realize that they have a small cancer in the liver until it could be too late.” – adds Dr Kinkhabwala.

When it comes to symptoms of liver cancer, many times they can be very vague and many other diseases can also cause the same symptoms. Patients with liver cancer can develop abdominal pain mostly in the right side close to the rib cage where the liver sits in the body.

Patients can also develop jaundice, which is yellowing of the eyes or dark urine, which is also caused by an elevated bilirubin in the blood. And some patients can also develop swelling in the abdomen, which is related to liver failure. But many times these times these symptoms are pretty advanced.

Liver cancer symptoms are:

• Jaundice: yellowing of your skin and the whites of your eyes
• Intensely itchy skin
• White or clay-like stool (acholia)
• Dark urine (choluria)
• Fatigue
• Abdominal pain on the right side, just below the ribs
• Losing weight without trying
• Fever
• Night sweats

Is Bile duct Cancer the same as Liver Cancer?

“Primary liver cancer and bile duct cancer are two separate entities but they both affect the same organ. The liver bile duct cancers can also affect the bile duct system that runs from within the liver to outside the liver. We have what are called intra hepatic cholangiocarcinomas, that’s bile duct cancer within the liver and extrahepatic bile duct cancers which are cholangiocarcinomas that are outside of the liver.” – Dr. Elliot Newman, Chief of Surgical Oncology at the Northwell Health Cancer Institute at Lenox Hill Hospital in Manhattan, explained to SurvivorNet.

“Primary liver cancer, often called hepatocellular carcinoma or hepatoma affects the liver itself. They are somewhat related in that they both have a relationship to the liver but they are often treated differently and the risk factors and etiologies can be different.”

Liver Cancer Treatment

“We kind of individualized treatment based on a few factors. Stage is definitely an important consideration in deciding the best treatment. So an earlier stage cancer may be appropriate for something like surgical resection. However, there’s other factors also such as the patient’s condition, their medical comorbidities and what their goals are in care.” – explains Dr Kinkhabwala.

“Someone who may not want to undergo aggressive surgery or transplant can certainly be offered non-surgical techniques that may be less likely to affect their function and allow them to continue to work and perform their daily activities without much interruption. Other patients who may want a much more aggressive approach to trying to cure their cancer could be candidates for a big operation such as hepatectomy for example.”

It’s also important to know that many times doctors combine treatments. This could include surgery, systemic therapy (like chemotherapy), embolization (which is another treatment that radiologists perform where an angiogram is performed with a little catheter inserted into the liver and particles can be squirted into the tumor to try and kill the cancer cells).

Many times physicians combine these treatments with surgery or transplantation, which gives patientes a much better chance of getting success.

Immunotherapy For Liver Cancer

“One of the amazing new treatments that have developed over the last few years in cancer in general is immunotherapy, which is a way that we use the body’s immune system to boost its responsiveness to attack the cancers.” – adds Dr Kinkhabwala.

He also explains that the the standard of care for liver cancer from a systemic therapy standpoint is a combination of immunotherapy with another drug (Atezolizumab Plus Bevacizumab):

• Atezolizumab (brand name Tecentriq)
• Bevacizumab (brand name Avastin)

How Does Tecentriq Works?

• Atezolizumab is a PD-L1 blocking antibody. PD1 or programmed cell death 1 is a protein on the surface of cells in your immune system.
• PD-L1 is on the surface of some normal blood cells, as well as some cancer cells. When PD-1 binds to PD-L1, the cell stops itself from dying.
• Normally, this acts as a braking mechanism to prevent our immune systems from becoming overactive and going haywire. Cancer cells can take over this mechanism, preventing cancer cells from dying.
• Immune checkpoint inhibitors are drugs that are designed to target either PD-1 or PD-L1, and have an important role in treating HCC

How Does Avastin Works?

• Bevacizumab is a tumor-starving (anti-angiogenic) therapy. It is designed to block a protein called vascular endothelial growth factor (VEGF).
• Normal cells make VEGF, but some cancer cells make too much VEGF. Blocking VEGF may prevent the growth of new blood vessels, including normal blood vessels and blood vessels that feed tumors.
• Unlike chemotherapy that attacks the cancer cells, the purpose of Avastin is to block the blood supply that feeds the tumor. This can stop the tumor from growing.

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