Oncological liver diseases are a fairly common problem that occurs mainly in adults of all age groups, men are more often affected than women. Malignant lesions of liver are especially dangerous. The most common form of primary liver cancer is hepatocellular carcinoma (a tumor that grows directly from liver cells – hepatocytes). Every year, 500,000 to 1 million new cases of this pathology are diagnosed in the world. It ranks 6th among all malignant neoplasms. Metastatic liver damage occurs 20 times more often than primary malignant tumors.
In oncological mortality causes, hepatocellular carcinoma ranks 3rd among adult population, second only to lung and stomach cancer. This is because of disease aggressive course, certain limitations in treatment and late tumor diagnosis due to lack of specific symptoms in early stages.
Early pathology diagnosis is extremely important in terms of malignant liver lesions prognosis. Liver cancer is a serious disease, but it is completely curable with the right comprehensive treatment approach. If you have such a diagnosis – do not give up in any case! There is always a way out and it is nearby. Highly qualified doctors of Oncology Department Maimonides Multidisciplinary Medical Center will help you successfully go through this difficult path and defeat the disease.
Maimonides Medical Center works under the patronage of “Keren Or for our Child” the Charitable Foundation, so all our patients who cannot afford the necessary treatment financially can count on help.
Maimonides Medical Center works according to Israeli medicine model, as one of the best in the world. We use not only Israeli model of providing medical services, but also work closely with the best Israeli cancer centers. Each individual clinical case is jointly managed by attending oncologist, the head of the department – Dr. Iryna Stefanska and responsible oncologist directly from Israel. Thanks to such a professional team work, each patient receives the best treatment program, which significantly increases chances of a full recovery.
One of the advantages that we implemented on Israeli medicine model is an individual approach to each patient’s treatment, because there are no two identical people or two identical diseases. Making up an examination plan and treatment scheme, specialists do not use one template or protocol for everyone, and the necessary medical and diagnostic manipulations are modified, depending on each patient’s needs and the characteristics of his illness . Of course, all treatment measures comply with global clinical recommendations and standards of medical care in oncology, so patient may not worry about medical services quality.
A whole multidisciplinary team works in Oncology Department of Maimonides Medical Center . Oncologists, surgeons, gastrenterologists, hepatologists, radiation therapists, chemotherapists, rehabilitators, physical therapists, psychologists and other narrow specialists provide assistance to one patient as needed. All our specialists are highly qualified, have repeatedly completed internships at the best oncology centers in the world.Our department is equipped only with modern medical and diagnostic equipment of an expert class. If a certain narrow specialist or rare medical and diagnostic equipment is not available, the patient is referred to subsidiary institutions of Maimonides Medical Center or our Israeli partner clinics, where he is guaranteed to receive the full range of necessary medical services.
Liver tumors causes and types
One proven cause of liver tumors has not been established to date, but there are known risk factors for these lesions that significantly increase the chances of liver cancer developing.
Such factors include:
- infection with hepatitis B and C viruses.
- cirrhosis.
- alcoholic liver disease.
- aflatoxins exposure is a group of chemicals produced by fungi Aspergillus flavus and Aspergillus parasiticus. Food contamination with these mushrooms leads to aflatoxins ingestion, which are very toxic to liver. Common foods that are contaminated with toxins include grains, peanuts, and vegetables.
- autoimmune hepatitis.
- genetic disease with liver damage – hemochromatosis.
- non-alcoholic steatohepatitis (fatty liver disease).
- alpha-1-antitrypsin enzyme deficiency.
- obesity and diabetes.
- smoking.
- primary sclerosing cholangitis.
All liver tumors can be divided into benign and malignant primary (grow primarily in liver) and secondary (metastatic lesions of liver from malignant tumors of other organs).
Benign liver tumors are relatively common. Most of them are asymptomatic, but some can cause hepatomegaly development (liver enlargement), a feeling of discomfort in right hypochondrium area, or even hemorrhage into abdominal cavity. Most of these tumors are discovered accidentally during ultrasound or other research types. The diagnosis is usually established using visual methods, sometimes a liver biopsy is required. Treatment is indicated only in individual cases.
Hepatocellular adenoma is a benign liver tumor that most often develops in women of reproductive age, especially those taking oral contraceptives. Most adenomas do not cause clinical symptoms, but large adenomas can cause discomfort in the right hypochondrium. They almost never turn into malignant neoplasms.
Focal nodular hyperplasia is a benign liver neoplasm. According to its structure, it is a focal hamartroma, which histologically can be similar to large nodular cirrhosis. Diagnosis is usually based on MRI or CT with contrast enhancement. However, confirmation may require a biopsy. Treatment is usually not indicated.
Hemangioma is a benign tumor from blood vessels. It is asymptomatic, occurs in 1-5% of population. Hemangiomas are often an incidental finding during ultrasound, computed tomography, or magnetic resonance imaging. Treatment is usually not indicated. If disease symptoms appear and they cause significant discomfort or hemangioma rapid growth is noted, a question of tumor resection can be raised.
Lipomas and fibroids can be found among other benign liver tumors. They are almost always asymptomatic and do not require treatment.
Hepatocellular carcinoma is the most common primary liver cancer. It most often develops in patients with liver cirrhosis and chronic viral hepatitis B and C . First clinical signs of liver cancer are nonspecific, which significantly delays the correct diagnosis and appointment of specific treatment. When diagnosis is made in the late stages, prognosis is unfavorable.
Other primary malignant liver tumors are rare. Diagnosis usually requires a liver biopsy. These include the following tumors.
Fibrolamellar carcinoma is a specific histological type of liver carcinoma that grows from hepatocytes. This tumor usually occurs at a young age and is not associated with previous cirrhosis, hepatitis B virus (HBV) or hepatitis C virus (HCV) infection, or other known risk factors. Prognosis is better than with hepatocellular carcinoma.
Cholangiocarcinoma is a malignant tumor originating from bile ducts epithelium. It is common in China, where a previous parasitic infestation, as suppose to, have contributed to its development. In other regions, it is less common than hepatocellular carcinoma. Primary sclerosing cholangitis significantly increases cholangiocarcinoma risk developing.
Hepatoblastoma is a rare malignant liver tumor in adults, but it is one of the most common primary malignant liver tumors in children.
Angiosarcoma is a rare type of malignant liver tumor associated with specific chemical carcinogens, including industrial vinyl chloride.
Cystadenocarcinoma is a rare malignant liver disease that develops, most likely, as a result of benign cystadenoma malignant transformation and often affects several liver lobes.
Secondary malignant liver lesions (metastatic) occur 20 times more often than primary liver cancer. Liver metastases are observed in many types of cancer, especially in malignant tumors of gastrointestinal tract, mammary glands, lungs, and pancreas. The first symptoms of metastatic liver damage are usually non-specific (weight loss, discomfort in right hypochondrium). Diagnosis is confirmed using visual methods, most often ultrasound, MSCT or MRI with contrast. Treatment usually includes palliative chemotherapy.
Symptoms of liver tumors
In early stages of tumor development, there are usually no symptoms. As the disease progresses, patient may develop non-specific general symptoms: unmotivated weight loss, lack of appetite, general weakness, constant nausea, prolonged fever.
When tumor reaches a significant size or complications arise, the following symptoms may appear: pain, discomfort, heaviness in right hypochondrium , a tumor-like formation can be detected on abdomen palpation, characteristic symptoms and signs of liver cirrhosis (jaundice, ascites, increased bleeding, etc.), various dyspeptic manifestations, abdomen increased in extent, jaundice development , bleeding, skin itching,, spleen increase,hepatic encephalopathy signs appearance.
Diagnosis methods of liver tumors
The earlier the diagnosis of a malignant liver tumor is made, the better prognosis and treatment outcome. Therefore, high-quality and quick diagnosis is an extremely important stage. Maimonides Clinic uses only modern, expert-class equipment, all our doctors are perfectly mastered all examining methods of oncological patient, are able to interpret received data correctly, which helps them to create a modern, individual and effective treatment plan.
Diagnosis is based on AFP (alpha-fetoprotein – liver cancer tumor marker) level determining and results of visual examination methods. In adults, an increase in AFP means hepatocytes differentiation process, which most often occurs in hepatocellular carcinoma. In 40–65% of patients with liver cancer, AFP level is high. Increased concentration of this tumor marker in blood is rarely observed in other diseases, except testicular teratocarcinoma – a tumor that occurs much less often.
A choice of the first diagnosis visual method (CT with contrast enhancement, ultrasound or MRI)depends on doctor’s preferences and medical institution capabilities. All modern medical imaging techniques are available in our clinic. Selective angiography can be useful in doubtful cases and can be applied to clarify vascular course in ablation or resection preparation.
Diagnosis becomes obvious when characteristic changes are detected according to imaging methods examination results and AFP increased level in blood. However, in certain cases, a liver biopsy under ultrasound control or CT is used to clarify diagnosis.
After biopsy we send biopsy data to the world's best pathohistological laboratories (Israel, Germany, USA).). Thanks to such double molecular checks, we are absolutely sure of diagnosis correctness and effectiveness of chosen treatment regimen.
Our patients also have access to innovative molecular diagnostics of biopsy specimens (molecular genetic studies). This is a mandatory part of oncological diseases modern diagnosis. Thanks to molecular genetic diagnostics, we can choose the most effective treatment regimens, because response to certain drugs effect depends on the type of changes. An example of such modern diagnostics are test systems for molecular genetic testing. Such as the Foundation One and Caris Molecular Testing.
Innovative methods such as PET-CT, PET-MRI , and bone scintigraphy are used for a complete body scan and possible distant metastases detection. These examinations help to establish the stage of malignant process correctly and to choose an effective treatment for each stage and each patient. All necessary diagnostic procedures can be performed directly in clinic, without leaving Ukraine.
Liver tumors modern treatment
One of the main liver oncology treatment advantages in our clinic is a comprehensive therapy approach application. In the struggle against a malignant tumor, an oncologist uses the entire available arsenal of treatment methods. Therapy is always combined with 2, 3 or more methods. Typically,treatment regimen includes tumor surgical removal in combination with chemotherapy and/or radiation therapy. In some cases, certain innovative treatment methods are added to treatment program (target drugs, immunobiological drugs, experimental agents, etc.).
Liver cancer treatment depends on the stage of disease and concomitant liver pathology severity, for example, cirrhosis.
For isolated focal liver lesions, iver transplantation is the method of choice . Surgery provides the same good prognosis as liver transplantation for non-cancerous diseases of organ. In selected patients with solitary tumors and portal hypertension absence, surgical resection is a potentially radical curative procedure with a 5-year survival rate of 60 to 80% of patients.
Palliative techniques and methods that slow tumor growth include ablation (for example, hepatic artery chemoembolization, embolization with Y90-labeled microspheres, selective internal radiofrequency therapy, transarterial embolization with certain drugs). These methods are used for patients who are waiting for a liver transplant. For small tumors, radiofrequency ablation (RFA) is a potentially effective treatment procedure.
These are technically very complicated surgical interventions, but all our surgeons master all the necessary surgical techniques, so every patient can receive quality medical care in full.
Chemotherapy is not the main treatment method of liver cancer, but it can be used in patient’s complex treatment. Conventional systemic therapy is sorafenib, which only marginally improves overall outcomes. In our clinic, several new chemotherapy drugs are used for chemotherapy, which have a better prognosis and have fewer side effects than sorafenib. These include levatinib, regorafenib, and immunotherapy drugs such as nivolumab.
Systemic immunotherapy, including targeted therapy, is rapidly advancing and showing promise in improving liver cancer outcomes. Combined therapy with atezolizumab and bevacizumab is available in our clinic for patients with advanced hepatocellular carcinoma. Atezolizumab is a humanized monoclonal antibody (PD-L1) immune checkpoint inhibitor, while bevacizumab is a vascular endothelial growth factor (VEGF) monoclonal antibody. Immunotherapy is not recommended for patients with recurrent liver cancer after transplantation, as host's immune system stimulation may lead to a higher rate of transplanted organ rejection.
Radiation therapy is rarely used for primary liver cancer because liver is not sensitive to radiation. Although, with the help of modern technologies, it is possible to provide tumor targeted radiation, minimizing the dose for the rest of healthy liver tissue. Modern linear accelerators available to our patients allow us to perform intensity modulated radiation therapy (IMRT), rotational (moving radiation) with beam intensity modulation (VMAT), as well as stereotaxic radiation therapy (SRT) and stereotaxic radiosurgery (SRS). Such equipment allows us to effectively fight cancer diseases that were previously considered incurable.
For each patient, the decision about certain therapy methods combination (which methods to start with, what to add next, at what stage of treatment to perform surgery, when and according to which scheme to apply chemotherapy, whether to use targeted drugs or other immunobiological drugs) is made jointly by a team of specialists . Every person and their disease is different, so our doctors, relying on their experience in oncological pathologies treatment, often go beyond the standard protocols, changing treatment regimens and doses of necessary drugs, radiation method in order to get the best possible results for their patients.