THE LIVER

ABOUT THE LIVER

The liver is an important organ with multiple functions, from the formation of bile to aid digestion to detoxification and production of substances that control clotting.

You cannot live without a liver, but the remarkable thing about this organ is its capacity to regenerate after significant tissue loss. This phenomenon has been described in Greeks mythology; Prometheus was bound to a rock where an eagle fed on his liver each day while it regenerated at night as a form of eternal punishment.

BENIGN LIVER TUMOURS

It is important to remember that many liver lesions are benign, i.e., non-cancerous. The three most common benign liver lesions are haemangiomas (a mass of tangled blood vessels), benign cysts (fluid-filled sacs) and focal nodular hyperplasias (FNHs). They are more common in women of child-bearing age, particularly those on oral contraceptive pills, possibly due to the hormonal effects of oestrogen. Often, they don't cause symptoms and are discovered on scans ordered to investigate other issues. Surgery is rarely necessary for these liver lesions, unless they are large, exhibit suspicious features, or cause symptoms such as pain or jaundice.

Hepatocellular adenomas are rarer but important, as they carry a small risk of transformation to cancer and need close monitoring. In females, adenomas are often harmless and don't need to be removed unless they exhibit high-risk features. Adenomas in males should be resected, as they are more likely to undergo malignant transformation.

The prognosis for true benign liver tumours is often excellent, as they do not affect life expectancy.

LIVER CANCERS

Primary liver cancers

Primary liver cancers are cancers that start in the cells of the liver. The two main types are hepatocellular carcinoma (HCC) and cholangiocarcinoma.

HCC are the most common primary liver cancer and arise from the predominant cell type of the liver, called hepatocytes ("hepato-" meaning liver, "-cyte" meaning cell). HCCs usually occur in the context of chronic liver diseases such as hepatitis B and C, fatty liver disease, and alcoholic cirrhosis. Exposure to certain chemicals and genetic diseases such as haemochromatosis, or alpha 1-antitrypsin deficiency are also risk factors.

The next most common primary liver cancer is cholangiocarcinoma, which grow from the bile duct cells within the liver. Rarer cancers include fibrolamellar carcinoma, angiosarcoma and hepatoblastoma.

Secondary liver cancers

The liver is a common site for metastases (cancer spread from other sites). As the liver drains most of the blood from the small bowel and colon, colorectal cancers often spread to the liver through this route.

Symptoms of liver cancer

Liver cancers often cause no symptoms in its early stages and tend to be found incidentally or on surveillance imaging. If patient experiences symptoms, they are usually related to local mass effects such as fullness, discomfort/pain, a palpable lump, and jaundice (yellowing of the skin or eyes) due to obstruction of a bile duct. Unexplained weight loss, loss of appetite, fatigue weakness can also occur.

Diagnosis of liver cancer

Tests are geared firstly towards reaching a diagnosis and also assessing the underlying health of the liver as this influences how much of the liver can be removed. They consist initially of blood tests (including a hepatitis screen and tumours markers), and scans to visualise the lesion, such as an abdominal ultrasound, CT or MRI. An MRI with hepatocyte-specific contrast (Primovist MRI) can be useful but is usually ordered by a specialist. Rarely, a liver biopsy may be needed, though we try to avoid this due to the risk of cancer cells seeding along the biopsy track.

Life expectancy with liver cancer

Long-term outcomes and survival rates of patients with liver cancer vary significantly based on the type, biological behaviour and extent of the disease.

Questions on survival rates are natural but due to its complexity and sensitivity, it would be more appropriate to discuss this in person with a pancreatic surgeon or oncologist.

TREATMENT OPTIONS FOR LIVER TUMOURS

Treatment for liver cancers is complex, with increasing treatment options and evolving evidence. A treatment plan is best established in a multi-disciplinary team setting consisting of specialists with different expertise - surgeons, oncologists, and radiologists.

Liver resection

Liver resections (hepatectomy) can vary widely, from minor resections to major resections, where a significant proportion of the liver is removed.

Liver resections may be performed as open surgery or laparoscopically (keyhole surgery). The best approach is usually determined by the extent of resection needed and location of the tumour. In fit patients with a healthy liver, up to 75% of the liver volume can be safely removed. However, such extensive resections in less healthy livers e.g., patients with cirrhosis increases the risk of liver failure. Other risks associated with liver surgery include a bile leak, bleeding, and infection. The rates of these complications vary depending on the extent and location of the resection.

Liver transplantation

For patients who meet criteria, liver transplantation may be an option.

Non-surgical treatment

There is an array of non-surgical treatment for liver cancer, including ablation therapies - applying heat (radiofrequency ablation (RFA) or microwave ablation (MWA)), alcohol, or extreme cold via a probe directly into the tumour. Broadly speaking, these are more suitable for smaller lesions or lesions that are difficult to access with surgery.

Chemotherapy, radiotherapy, transarterial chemoembolisation (TACE), selective internal radiation therapy (SIRT) are other treatments for disease control.

RECOVERY AFTER LIVER SURGERY

Recovery from liver surgery vary, depending on the extent of resection. The average hospital stay after a major liver resection without complications is 7-10 days and 3-5 days for minor resections. Full recovery, however, is a gradual process and can take anywhere between 1-3 months. In the initial weeks, it is not unusual to experience fatigue, discomfort and reduced appetite. It is important to rest and be patient while you heal.

RESOURCES FOR PATIENTS AND CAREGIVERS

Liver Foundation of Australia: Offers resources on liver health and support for patients with liver conditions. www.liver.org.au
Cancer Council Australia: Provides information on liver cancer, support services, and helplines. www.cancer.org.au
Hepatitis Australia: Supports individuals with hepatitis B and C, which are major risk factors for liver disease. www.hepatitisaustralia.com

***The content on this website or linked web pages are intended for educational purposes only and should not be relied on to make healthcare decisions in the absence of a consultation with a healthcare professional