Cancer can grow in an alkaline environment

Benign liver tumors, liver cancer and liver metastases

Liver tumors: Neoplasms of the liver, benign and malignant. Malignant liver tumors include the Liver cancer (primary hepatocellular carcinoma, hepatocellular carcinoma, HCC), which usually develops from cirrhosis of the liver. Most common malignant tumors of the liver are however Liver metastases, which are mostly daughter tumors of a colon, stomach, pancreas, breast or lung cancer. The most common benign liver tumor is the hemangioma (blood sponges), a new formation of blood vessels in the liver.

Treatment is rarely necessary for benign tumors. Doctors use different measures to combat liver cancer and liver metastases; the prognosis depends on the type and extent of the tumor and in most cases is poor.

Leading complaints

Benign tumors:

  • Mostly none
  • With large tumors, upper abdominal discomfort and a feeling of fullness.

Malignant tumors:

  • Fatigue, fever
  • Right upper abdominal pain with loss of appetite and weight loss
  • With large liver metastases, uncomfortable feeling of pressure in the abdomen and pain
  • Yellowing of the conjunctiva and / or skin.

When to the doctor

In the next few days if

  • the person concerned feels dull and exhausted
  • Added abdominal pain
  • yellowing of the eyelid membranes and / or skin occurs.

The illness

Benign liver tumors

These are among the benign liver tumors Hemangioma, the Liver cell adenoma and the Focal nodular hyperplasia. The cause of all three tumor types is unknown. They are favored by female sex hormones and therefore occur more frequently in women who take the pill. As a rule, all three tumors only show symptoms when they get bigger: Then they cause unspecific symptoms such as upper abdominal discomfort, bloating or nausea.

Liver cancer

Liver cancer is most often caused by long-standing cirrhosis of the liver, less often by hepatitis B and C that had occurred in previous years. B. occurs in diabetics or overweight people, favors its development. Last but not least, poisons such as the aflatoxins of the Aspergillus flavus mold or years of abuse of male hormones (androgens, e.g. during doping) can lead to liver cancer. In those affected, liver cancer makes itself felt with jaundice and non-specific symptoms such as fatigue, weight loss and pain in the upper abdomen.

Liver metastases

Liver metastases are by far the most common liver tumors. If the liver is covered with tumors, the doctor speaks of one Metastatic liver. Due to its detoxification and cleaning function, the liver is particularly at risk of developing metastases. The cancer cells are conducted through the liver via the portal vein circulation, where they find good growth conditions.

Diagnostic assurance

Benign liver tumors. Since benign liver tumors usually do not cause any symptoms, these are almost always incidental findings, e.g. B. as part of a check-up examination. Hemangioma, liver cell adenoma and focal nodular hyperplasia appear similar on ultrasound, but show typical changes in contrast-enhanced imaging methods (computed tomography, MRI, sonography). If the diagnosis is unclear, the doctor must perform a tissue examination.

Liver cancer. The most important laboratory test when liver cancer is suspected is the alpha-fetoprotein (AFP) in the blood. To assess the liver performance, the doctor also determines the liver values ​​such as B. the transaminases, GLDH, Gamma-GT, alkaline phosphatase, bilirubin, albumin and cholinesterase as well as the blood count and the coagulation values. With imaging methods such as abdominal ultrasound, MRI or CT, the doctor can identify the extent and shape of the liver carcinoma and its possible spread in the neighborhood.

Liver metastases. Diagnosis is relatively simple; For every cancer, an abdominal ultrasound is used to check whether the liver has metastases.

Liver metastases discovered during a laparoscopy; in this case the primary tumor was colon cancer.
Georg Thieme Verlag, Stuttgart

treatment

Benign liver tumors

If you have benign liver tumors, your doctor advises you to stop taking the pill. Depending on the tissue type, liver tumors are either checked closely every 3–6 months by ultrasound or - like liver cell adenomas - surgically removed immediately because there is a risk of degeneration. The doctor only removes hemangiomas if they cause discomfort or are very superficial and therefore there is a risk of rupturing and the associated heavy bleeding.

Liver cancer

Depending on the extent of the disease and the patient's condition, different treatment strategies are possible:

Partial liver resection. If the liver values ​​are good and there is no cirrhosis, the doctors can surgically remove the affected part, i. H. resect. Such a partial resection is unfortunately not possible if the cancer is central or has spread widely.

Liver transplant. If a partial resection is not possible and there are no metastases outside the liver, doctors will consider liver transplantation. If the patient is lucky and a transplant occurs, the doctors either transfer an entire organ (cadaver donation) or only part of the liver (split liver transplantation, cadaver donation and living donation possible). The 5-year survival rate is 80%.

Percutaneous injection of ethanol or acetic acid, (PEI). The doctor treats small inoperable tumors with repeated injections of alcohol through the skin into the tumor (percutaneous ethanol injections, PEI). The alcohol causes many of the tumor cells to die. Alternatively, doctors sometimes use acetic acid.

Radiofrequency ablation. Here the doctors insert a probe into the tumor and "cook" the tissue with radio frequency waves. This procedure is performed under short anesthesia and is usually repeated several times.

Transarterial embolization. In this procedure, after applying local anesthesia, the X-ray doctor pushes a catheter over the groin into the hepatic artery that supplies the tumor. He then injects small pieces of plastic into the artery that clog the vessel. This clogs the vessel, oxygen and nutrients are scarce and the tumor cells die. Sometimes doctors also use the catheter to inject chemotherapy into the tumor to kill it (transarterial chemoembolization).

Selective internal radiotherapy. In this new procedure, doctors use an inguinal catheter to insert radioactive beads into the hepatic arteries. Due to the high radiation dose on site, the vessels that supply the tumor are obliterated and the tumor cells die due to supply problems.

Medication. If the tumor is inoperable, doctors use tyrosine kinase inhibitors such as sorafenib. Further active ingredients are currently in clinical trials and research: These include immunotherapeutic agents such as nivolumab or mTor inhibitors such as sirolimus.

Liver metastases

  • If the metastases are single or just a few, and the primary tumor has already been successfully treated, the doctor may consider removing part of the liver. Since the liver has an enormous regenerative capacity, up to 80% of the liver can be removed. The remaining liver grows back so that it compensates for the loss.
  • If the metastases cannot be removed, the doctor will perform chemotherapy. In the liver, this is done in a targeted and high-dose manner via regional chemotherapy. The doctor flushes the hepatic vessels with cytostatics using a catheter inserted into the hepatic artery. Alternatively, therapy with tablets (sorafenib) can be tried.
  • The therapeutic options are particularly poor if the primary tumor cannot be found. Sometimes this is still very small and the metastatic cells are so badly degenerated that a histological classification fails. In this case, it is not possible to estimate which cytostatics the metastases and the primary tumor are most likely to respond to.

forecast

Benign liver tumors. The prognosis for benign tumors is very good; often they do not have to be removed. Only the liver cell adenoma has a 5-10% risk of becoming malignant and is therefore usually removed at diagnosis.

Liver cancer. The 5-year survival rate is 0–60%, depending on the type and stage of the tumor. After a liver transplant, the 5-year survival rate is around 80%.

Liver metastases. Complete healing is only possible in a few cases.

Your pharmacy recommends

Prevention

You can definitely prevent liver cancer:

  • Vaccination against hepatitis B. People with chronic hepatitis B are 100 times more likely to develop liver cancer than people who are not infected.
  • Absolutely abstain from alcohol if you suffer from liver disease. In addition to the hepatitis viruses B and C, alcohol is the most important risk factor for liver cancer.
  • Weight loss, high-fiber and low-fat diets and plenty of exercise for fatty liver. Fatty liver is also a risk factor for the development of cirrhosis and liver cancer. With a strict change to a healthy lifestyle, the development of cirrhosis of the liver can be stopped, and sometimes the pathological changes in the liver even regress.

Further information

  • www.krebshilfe.de - Very informative website of the Deutsche Krebshilfe e. V., Bonn (Ed.): Under the heading "Inform" you will find brochures and information material, including the blue guide No. 15 on cancer of the liver and biliary tract, which you can order or download here free of charge.

Authors

Dr. med. Arne Schäffler, Dr. Bernadette Andre-Wallis in: Health Today, edited by Dr. med. Arne Schäffler. Trias, Stuttgart, 3rd edition (2014). Revision and update: Dr. med. Sonja Kempinski | last changed on at 10:26


Important note: This article has been written according to scientific standards and has been checked by medical professionals. The information communicated in this article can in no way replace professional advice in your pharmacy. The content cannot and must not be used to make independent diagnoses or to start therapy.