Liver tumours

Liver Tumours

Liver Cyst

Overview

Liver cysts are collections of clear fluid within the liver and can range from a few mm to the size of a football. They are usually benign (non-cancerous) growths that typically don’t cause significant symptoms unless they become very large or infected. The liver can continue to function normally, even if cysts are present.

Signs and symptoms

Small cysts are common in healthy people and usually don’t cause any symptoms. However, as they get bigger, the patient may develop abdominal pain and bloating in the upper right quadrant.

Causes and risk factors

Liver cysts are of several types. The commonest type are simple liver cysts and can be seen in normal healthy people who have routine scans. Some cysts may be related to infection with a parasite present in pet dogs. This is called a hydatid cyst and can grow within the patients liver. Occasionally, abnormalities in the growth of bile ducts can lead to the development of cysts in the liver called biliary cystadenoma.

Complications

Large cysts can get complicated by infection or bleeding. Hydatid cysts can grow and form daughter cysts within the liver. Around 5% of liver cysts develop into cystic tumours. In that case, complete cyst removal might be recommended. Cystic tumours can occasionally turn malignant and spread beyond the liver.

Diagnosis

Imaging investigations such as an ultrasound or a CT scan is used to diagnose liver cysts.

Treatment and Surgical Interventions

Small, simple liver cysts usually do not require treatment. However, if the cyst grows and becomes painful, the doctor may recommend surgical procedures for drainage or complete removal of the cyst. Complete removal with surgery is usually recommended for hydatid cyst and biliary cystadenoma. Polycystic Liver Disease (PLD), where a congenital defect causes a huge number of cysts can cause severe symptoms of pain, breathing difficulty and may rarely need a liver transplant.

Prevention

Liver cysts cannot be prevented. However, any cysts identified on routine scans should be carefully studied by a liver surgeon to determine their nature and decide on a course of action.

Liver Adenoma

Overview

Hepatic Adenoma or Liver adenoma is a non-cancerous tumour that develops on the liver. It is rare, occurs more commonly in women and is linked to the use of some birth-control pills.

Signs and symptoms

Liver adenoma may cause pain and nausea if large. If a liver adenoma ruptures, it results in severe abdominal pain and internal bleeding.

Causes and risk factors

The use of birth control pills is linked to the formation of liver adenomas. Pregnancy can also increase the risk.

Complications

Spontaneous rupture is the biggest risk with liver adenoma. The risk is more in large tumors or those present on the liver’s surface. A rupture would cause intense pain, internal bleeding and low blood pressure. Large liver adenomas can also turn cancerous.

Diagnosis

The diagnosis begins with patient medical history and a physical exam. A panel of blood tests may also be required. If a liver tumour is suspected, the doctor may require imaging tests (Ultrasound scan, CT scan or MRI) to confirm the presence of the adenoma. A biopsy is needed very rarely when the exact nature is unclear on scans.

Treatment and Surgical Interventions

For small adenomas within the liver, periodic observation is recommended. Large tumours are more likely to result in rupture, so the doctor may recommend surgical liver resection.

Prevention

Risk of adenoma can be reduced by avoiding oestrogen-based birth control pills and avoiding anabolic steroid intake for muscle building.

Liver Haemangioma

Overview

A liver haemangioma is a mass in the liver made of a tangle of blood vessels. Small liver haemangiomas are common on scans. They usually cause no symptoms and require no treatment. Liver haemangiomasarenon-cancerous.

Signs and symptoms

Liver haemangioma, when large, can cause abdominal pain and discomfort, bloating, nausea and loss of appetite. Occasionally, bleeding and infection can cause symptoms of severe pain.

Causes and risk factors

There are no apparent risk factors though a genetic link is suggested.

Complications

Large haemangioma can rupture, leading to fatal internal bleeding. Occasionally they can get infected or have bleeding within the tumor causing pain.

Diagnosis

Since liver haemangioma causes no symptoms, they are often discovered accidentally during medical imaging tests like ultrasound scans. CT scans or MRIs.

Treatment and Surgical Interventions

Smaller liver haemangioma can be monitored periodically and left alone unless there are symptoms or are increasing in size. Larger haemangioma are treated with corticosteroid medications, selective hepatic artery embolization which cuts off blood supply to the tumour, or a liver resection.

Prevention

Since the cause is uncertain, liver haemangioma cannot be prevented.

Hepatocellular Carcinoma

Overview

Hepatocellular carcinoma is a primary liver cancer, which means it originates in the liver. If diagnosed early, it can be treated and completely cured. However, many patients develop symptoms only when the tumor has grown to an advanced stage, thus limiting treatment options.

Signs and symptoms

In the early stages, hepatocellular carcinoma may not exhibit any symptoms. However, as the carcinoma grows, the patient may experience abdominal pain, heaviness in the upper belly, bloating, loss of appetite, unexplained weight loss, fatigue, nausea, fever, jaundice, chalky stools, and dark urine.

Causes and risk factors

The well-known risk factors for hepatocellular carcinoma are hepatitis B and C infections, alcohol abuse, high cholesterol and obesity. Any patient who develops chronic liver disease or cirrhosis is at risk of developing hepatocellular carcinoma. Exposure to certain toxins can also increase your risk of liver cancer.

Complications

Hepatocellular carcinoma can spread through the liver and involve other organs such as lungs, bones. Tumour rupture and internal bleeding could also occur in some large tumors when they grow rapidly within the liver.

Diagnosis

Hepatocellular carcinoma is diagnosed based on a physical exam, a patient medical history, a panel of blood tests, CT or MRI scans to provide detailed visualisation of the tumours. Current scan technology and blood tests can make a very accurate diagnosis of hepatocellular carcinoma. A biopsy to confirm the diagnosis is very rarely required and should be performed only under careful supervision.

Treatment and Surgical Interventions

A variety of treatments are available for hepatocellular carcinoma. The treatment plan for each patient should be individualised based on the stage of the tumor, condition of the liver and the patient’s overall condition. Surgery to remove the tumor (liver resection) and liver transplantation (complete replacement of the damaged liver) are the best options for long term cure, while effective disease control in advanced tumors may be possible with local therapies and newer anti-cancer medications. The patient is best managed in a multi-disciplinary facility where liver surgery, liver transplantation, interventional radiology, radiotherapy and oncology are all accessible.

Prevention

Hepatocellular carcinoma can be prevented by reducing the risk of liver damage and chronic liver disease. Reduce alcohol consumption and maintain a healthy diet and practice safe sex. Patients with known liver disease should have at least 6 monthly scans and blood tests to diagnose these tumors at an early stage when curative treatments are very effective.

Hepatoblastoma

Overview

Hepatoblastoma is a rare cancerous growth in the liver cells, seen mainly in infants and small children. It is the commonest liver tumor in children. When correctly treated, it has excellent long-term cure rates.

Signs and symptoms

Hepatoblastoma causes an abnormal mass in the abdomen which is usually noted by the baby’s mother. In older children, it may present with pain and loss of weight.

Causes and risk factors

There are no known risk factors for this tumor. However, it is more common in pre-term babies and boys.

Complications

As the tumor grows larger, it can cause weight loss, poor growth. It can also spread to other organs such as the lungs and bones, ultimately leading to death.

Diagnosis

If the child has a lump or abnormal growth in the stomach, the doctor may investigate further by a panel of blood tests, imaging tests to look for abnormal growths and a biopsy of the mass.

Treatment and Surgical Interventions

Hepatoblastoma can be completely cured in over 90% of children when effectively treated. The treatment usually includes pre-operative chemotherapy followed by surgery to remove the tumor. In children with large tumors where surgical removal is not possible, liver transplantation after chemotherapy also has excellent results. However, a small number of tumors, especially in older children, may not respond well to chemotherapy.

Prevention

As the cause is presently unclear, hepatoblastoma cannot be prevented.

Liver Metastases from Bowel Cancer

Overview

Cancer that begins in one organ can spread or metastasize to other organs. Colon cancer can spread to the liver and form liver metastases. The liver is usually the first major organ affected by colon cancer as all blood from the intestines is first filtered through the liver before reaching the heart. While the spread of a tumor to other organs is usually considered as an advanced stage, significant advancements in surgery and chemotherapy have provided new methods to treat this condition, and at least half of such patients can still look forward to a long healthy life.

Signs and symptoms

Patient with bowel cancer may experience symptoms like blood in the stools, abdominal swelling, fatigue and weight loss. In a patient who has liver metastases, pain in the right side of the abdomen, fatigue, weight loss, and jaundice may be the presenting symptoms.

Causes and risk factors

Liver metastases are caused due to the spread of cancer from the bowel. Patients with pre-existing colon cancer develop liver metastases as a complication.

Complications

Liver metastases can grow and involve large parts of the liver affecting liver function. They may also spread to other organs such as lungs and bones.

Diagnosis

The patient’s follow-up CT scans and MRIs would be indicative of the metastases in the liver. The doctor may also require blood tests to check on liver function. A liver biopsy may be performed to test for malignant cells.

Treatment and Surgical Interventions

Liver metastases from colon cancer can be treated in one or a combination of the following ways – Surgical resection, Chemotherapy, Radiation therapy, Targeted therapies like biologics and immunotherapy. Recently, there is increasing interest in the role of liver transplantation as a definite treatment for large liver metastases.

Prevention

No known preventative treatments or measures are available currently.

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