Liver cancer is a fast-moving malignant disease with a poor prognosis. Liver cancer patients are usually diagnosed at an advanced stage and miss the opportunity for surgical resection. Chemotherapy and radiofrequency ablation, which are designed for tumor bulk, have shortages in treatment efficacy to date. Liver cancer stem cells (CSCs) are a small fraction of undifferentiated cells existed in liver cancer and believed to initiate liver cancer and metastasis, relapse, and chemoresistance. Understanding liver CSC characteristics and reveal their regulatory mechanism could not only increase our understanding of the pathogenesis of liver cancer, it could also enable diagnostic, prognostic, and therapeutic approach to ultimately improve the clinical management of liver cancer. Liver cancer diagnosed at an early stage has a good chance of being cured through surgical resection, liver transplantation, or some other methods like radiofrequency ablation. There are active studies on some imaging and blood tests aimed at detecting liver cancer early and identifying at risk individuals.
Screening and Surveillance
The National Liver Cancer Screening Trial is an NCI-sponsored clinical trial that compares two liver cancer screens in over 6000 people with cirrhosis or chronic hepatitis B. One half will receive the standard liver cancer screen of liver ultrasound and blood test of the blood-based biomarker alpha-fetoprotein, while the other half will receive the GALAD test, which is based on information of age, sex, and levels of three blood-based biomarkers. People at higher risk for developing HCC who have liver disease such as cirrhosis or NASH, usually get regular liver ultrasound examinations, sometimes with the alpha-fetoprotein blood test as well. Some refer to this level of careful observations as liver cancer surveillance.
Surveillance tests are fraught with difficulties. For instance, physicians may not always be able to identify patients who would benefit from surveillance because they are at high risk for HCC. The test findings aren't usually reliable. Additionally, the cost of surveillance is a hardship. People occasionally find it difficult to travel to a clinic for the examinations. There is conflicting information regarding whether routinely undergoing these tests can save lives from liver cancer, most likely as a result of those difficulties.
Avoidance of Liver Cancer
Although there are other forms of liver cancer that can strike adults, the two most prevalent ones are intrahepatic cholangiocarcinoma (ICC) and hepatocellular carcinoma (HCC). Sometimes referred to as bile duct cancer, ICC is defined as cancer that arises in specific regions of the liver's bile ducts. The most common form of liver cancer in people in the US is HCC. There are notable death rates from both ICC and HCC. The incidence of ICC or HCC may rise in certain circumstances. In an effort to impact prevention and therapy, researchers are assessing a few of these ailments.
Cirrhosis
Cirrhosis is the greatest risk factor for HCC. Cirrhosis means the liver has scarring and cannot work properly. In NCI's HCC Early Detection Strategy Study, a longitudinal study that followed people with cirrhosis, about 2 to 3 of every 100 had HCC develop every year, slowly.
Through NCI’s Cancer Prevention Clinical Trials Network, several studies tested whether medications used to treat other conditions could prevent cirrhosis from developing into liver cancer. For example, in one study, researchers found the best dose of a cancer drug, erlotinib (Tarceva), for follow-up studies of preventing liver cancer. In another study, researchers are awaiting results of a study testing green tea polyphenols. And there is a study currently ongoing that is testing a cholesterol drug (statin).
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Metabolic Dysfunction-associated Steatohepatitis (MASH)
MASH (formerly known as nonalcoholic steatohepatitis (NASH)) is an example of a common liver disease that can progress to cirrhosis and cause liver cancer. MASH is the most severe form of nonalcoholic fatty liver disease and has more fat than typically found in the liver. In 2021, a clinical trial showed the weight loss medication semaglutide resolved MASH in most patients.
Sex Hormones in the U.S., male liver cancer rates are higher than female liver cancer rates, though scientists do not know why this is. Researchers at the NCI have found that higher levels of both androgens and estrogens are associated with liver cancer for males. The findings from this investigation, which included blood samples from over 290000 individuals, supported the results of a previous NCI investigation on the relationship of sex hormones and HCC in females. The relationship of sex hormones and the risk for liver cancer is still being explored. It is often difficult to detect liver cancer early since signs and symptoms may not show until a patient has advanced liver cancer; small liver tumors may be very hard to detect.
Currently, screening tests for liver cancer are not widely recommended for individuals with average risk. (Screening is testing for a disease like cancer in individuals who have no symptoms or history of that disease.) However, screening might be recommended for some individuals at higher risk.
Screening individuals at high risk for liver cancer
Many individuals who are diagnosed with liver cancer have long-standing cirrhosis (scar tissue formation due to liver damage). For individuals, who are at a higher risk of liver cancer due to any cause of cirrhosis, hereditary hemochromatosis, or chronic hepatitis B infection (even in the absence of cirrhosis), some experts recommend screening for liver cancer with alpha-fetoprotein (AFP) blood tests and ultrasound exams periodically every 6 months.
However, although AFP blood tests can identify liver cancer tumor markers, many individuals with early liver cancer have a normal AFP test. In addition, individuals with chronic liver disease may have high levels of AFP without liver cancer and some other cancer types (as well as some benign conditions) can also have elevated AFP levels.
Liver Cancer Treatment : Liver cancer is often diagnosed in an advanced state often. The treatments we have for advanced liver cancer include chemotherapy, targeted therapy, immunotherapy, radiation therapy, embolization, and ablation. Visit our liver cancer page for more information on available treatments. Targeted therapies are drugs that target the molecules involved in the growth, division, and metastasis of cancer cells. For many years, there was only one targeted therapy for patients with advanced HCC, sorafenib (Nexavar), but studies have now produced additional targeted therapies for HCC, such as lenvatinib (Lenvima). Most patients with advanced HCC will die within 5 years of their diagnosis, which is why research scientists continue to develop and test more targeted therapies that target the signaling pathways involved in the growth of HCC cells.
ICC Targeted Treatment When it comes to ICC patients who have specific genetic mutations, immunotherapy treatments exist as do other pathways for targeted treatments. Numerous clinical trials are currently pursuing novel targeted treatments for ICC patients whose cancer cells have specific gene alterations. Multiple drugs have been approved for immunotherapy (to stimulate an immune response against cancer).
With immunotherapy, the drugs may also be used together with chemotherapy and/or targeted therapy, as they can sometimes be more effective in combination than alone. For HCC, First, regarding immunotherapy, currently, numerous immune checkpoint inhibitors have been approved for the treatment of HCC and are also considered the standard treatment.
Second, regarding radiation therapy, the NCI's National Clinical Trials Network (NCTN) is sponsoring two clinical trials of radiation therapy in patients with unresectable HCC.
Conclusion :
Even though liver cancer is a serious condition, early detection and treatment can improve results. Even though there are still obstacles to overcome, a multidisciplinary approach and improvements in treatment modalities can enhance patient outcomes and quality of life. Improved prevention, early detection, and more potent treatments for liver cancer depend on increasing awareness, encouraging screening, and funding research.
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