Liver cancer | Symptoms, diagnosis & treatment options in Turkey

Liver cancer: what is it?

The liver, our largest internal organ, plays a key role in many vital functions. By producing digestive enzymes and bile, the liver facilitates the digestion of fats. It also synthesizes proteins essential for blood clotting and plays a vital role in removing toxic substances from the blood.

However, liver cells can sometimes change and form tumors. These can be benign, such as hemangiomas, or malignant, such as hepatocellular carcinoma. The latter, the most common primary liver cancer, develops from the liver cells themselves.

Cancer can also develop in the bile ducts of the liver, resulting in cholangiocarcinoma. It's important to note that the liver can also be affected by metastasis, which is the spread of cancer that started in another organ. Each type of liver cancer requires specific treatment.

Liver cancer warning signs

The early stages of liver cancer are often asymptomatic. As the tumor grows, it may compress organs or block bile ducts, causing a variety of symptoms. These may include:

• Abdominal pain.
• Loss of appetite.
• Jaundice.
• Tiredness.
• Swelling of the abdomen or limbs.
• Itching.

These symptoms may also be associated with other liver diseases. If you experience any of these symptoms, contact your doctor as soon as possible for an accurate diagnosis and appropriate treatment.

Diagnosis of liver tumors: a process explained

Diagnosing liver tumors, including the early detection of liver cancer, is a process that requires several steps to make an accurate diagnosis and determine the best treatment.
The first steps

If symptoms or routine test results suggest a liver problem, your doctor will do a thorough clinical exam. This will include:

• A detailed questioning about your medical history, symptoms, and risk factors.
• A physical examination to look for abnormalities in your abdomen.

If these initial findings indicate possible liver damage, further tests will be ordered to confirm or rule out the diagnosis.

Additional tests

Several tests may be done:

• Blood tests: These assess liver function and look for the presence of tumor markers, such as alpha-fetoprotein (AFP). However, an elevated AFP level does not systematically indicate liver cancer.
• Medical imaging: Ultrasound, CT, and MRI can be used to visualize the liver and detect abnormalities (tumors, metastases). These tests are often combined with the injection of a contrast agent to obtain more accurate images.
• Liver biopsy: A small sample of liver tissue is removed for microscopic analysis. This allows for a definitive diagnosis and determination of the type of cancer.

Why so many tests?

Diagnosing liver cancer can seem complex and time-consuming. However, each test provides additional information and helps refine the diagnosis. It's also important to rule out other possible causes of symptoms before making a cancer diagnosis.

In Turkey, your doctor and healthcare team will be with you every step of the way. Don't hesitate to ask questions. Early diagnosis is essential for appropriate treatment and a better chance of recovery.

Liver cancer staging

Liver cancer is often staged using systems like the Barcelona Clinic Liver Cancer (BCLC) system, which categorizes the disease from stage 0 (very early) to stage D (end-stage). Each stage considers tumor characteristics, liver function (Child-Pugh score),and the patient's general health (performance status) to determine prognosis and treatment options.

• Stage 0 (Very Early): A single tumor less than 2 cm, with normal liver function and good performance status.
• Stage A (Early): A solitary tumor of any size, or up to three tumors each less than 3 cm, with no vascular invasion, preserved liver function (Child-Pugh A or B) and good performance status.
• Stage B (Intermediate): Multiple tumors, but the cancer has not spread to blood vessels or distant sites, with preserved liver function (Child-Pugh A or B) and good performance status.
• Stage C (Advanced): Cancer that has spread to the main blood vessels of the liver, to nearby lymph nodes, or to other organs, or with impaired performance status.
• Stage D (End-stage): Very advanced cancer with severely damaged liver function or significant symptoms, where curative treatment is generally not possible.

Despite treatment, the cancer may come back: this is called a recurrence. It may be local (in the same place),regional (nearby),or distant (in another part of the body).

If you have questions about the staging of your liver cancer, talk to your healthcare provider. He or she will be able to explain the meaning of your stage and help you understand the different treatment options.

Liver cancer treatments in Turkey

Systemic therapies

Systemic therapies for liver cancer include:

• Chemo-embolization: This technique involves injecting anticancer drugs directly into the artery feeding the tumor, combined with obstruction of that artery to increase the effectiveness of the treatment.
• Targeted therapies: These treatments use drugs that specifically target cancer cells by exploiting their molecular characteristics.
• Systemic chemotherapy: Intravenous administration of anticancer drugs may be used to treat advanced liver cancer or cancer that has spread to other organs.

Risks & side effects of surgery for liver cancer

As with any major surgical procedure, liver surgery can cause complications, including:

• Bleeding: Because the liver is a highly vascular organ, the risk of severe bleeding is a major complication of surgery. Although the liver produces substances that promote clotting, damage sustained during surgery can alter this natural mechanism, increasing the risk of bleeding.
• Infection: Risk of infection of the surgical wound or other organs.
• Anesthesia-related complications: allergic reactions, heart or breathing problems.
• Blood clots: Formation of blood clots in the veins, leading to pulmonary embolism.
• Pneumonia: Infection of the lungs, often associated with postoperative immobilization.
• Tumor recurrence: Even after successful surgery, there is a risk of cancer recurrence. In fact, the underlying disease that led to the development of cancer may persist in the remaining liver tissue.

Because of the complexity of the organ and the risks involved, only surgical teams experienced in liver surgery can perform this type of surgery.