Understanding and Managing Liver Tumors Effectively

Liver tumors are liver or bile duct damage caused by the uncontrolled growth of altered liver or biliary cells (primary tumor) or altered cells from other locations (metastasis).

Primary liver tumors can be:

• Benign, that is, they grow locally, do not spread at a distance and do not compromise the life of the patient unless they become large or compromise liver function; the most common of which are adenoma, liver hyperplasia, cysts or hemangiomas.
• Malignant, that is, they grow locally producing destruction of the cells and the structure of the liver, they spread at a distance and can compromise the life of the patient, among them the most frequent are hepatocarcinoma or cholangiocarcinoma.

Metastatic liver tumors are by definition malignant since they are lesions from tumors located outside the liver, the most common of which are melanoma, lymphoma, lung, breast, thyroid or prostate cancer.

How does the disease occur

Benign primary liver tumors are associated with inflammation or infection of liver cells by bacteria or parasites (cysts), the growth of blood vessels (hemangiomas), or chronic use of oral contraceptives (adenoma)

Primary malignant liver tumors are associated in most cases with the presence of cirrhosis. Other less frequent causes are liver deposition diseases (such as copper or iron deposits) or alterations in metabolism.

Metastatic liver tumors are due to the arrival of cancer cells from tumors located outside the liver.

Benign or malignant tumors of the bile ducts can be congenital or acquired (for example by parasitic infections, chronic inflammation of the bile ducts, etc.)

Symptoms of the disease

Liver and bile duct tumors can be asymptomatic for many years. When they are symptomatic, the main symptoms that may appear are:

• Fatigue
• Weightloss
• Moderate fever
• Flu syndrome (cough, sneezing, chills, generalized bone or joint pain)
• Itchy skin
• Change in color of the skin and mucous membranes (yellowing)
• Change in color of stool (whitish stool).
• Abdominal pain or discomfort
• Right abdominal mass under the ribs
• Increase in the size of the abdomen due to ascites

Complications related to the presence of cirrhosis (hematemesis, melena, ascites, hepatic encephalopathy, peritonitis).

Diagnosis of the disease

The diagnosis of liver tumor is made by the general practitioner, the internist or the digestive system specialist in the consultation of the medical center or hospital.

In many cases the diagnosis of the disease is made by chance when the patient is studied for other reasons.

The diagnosis is based on the physical examination of the patient, the symptoms that he presents and the result of the complementary studies that are carried out, among which are a blood test that allows detecting alterations in liver and / or biliary function or tumor markers. ; an imaging study by means of an x-ray, ultrasound, CT or MRI of the abdomen that allows to visualize an increase in the size of the liver or to detect the tumor. The confirmatory diagnosis is made by taking a sample of the tumor by biopsy of the liver.

Treatment of the disease

The only curative treatment for liver and bile duct tumors is surgical removal of the tumor.

When complete removal of the tumor is not possible, attempts can be made to reduce its size by techniques such as instillation of alcohol into the tumor mass, embolization of the vessels supplying the tumor, ligation of the hepatic artery, or immunotherapy techniques.

Treatment of multiple liver metastases involves treatment of the primary tumor from which they derive.

Liver transplantation is reserved for patients with non-operable malignant tumors who retain acceptable liver function and who have not developed the complications associated with cirrhosis.

Chemotherapy and radiation therapy are not usually helpful in treating primary liver tumors.

Disease prevention

Liver cancer is closely related to the development of liver cirrhosis due to alcohol abuse, certain toxins or chronic infections due to the hepatitis B and C virus. Avoid the consumption of alcohol and toxins or the transmission routes of the B and C viruses of hepatitis contribute to the prevention of liver cancer.

Dra. Cristina Muñoz Gil Family and Community Medicine Specialist.