Liver Cancer Diagnosis and Treatment for a 'Silent' Threat
Liver Cancer Diagnosis and Treatment for a 'Silent' Threat

By Jingduan Yang

In our modern world, a fast-paced lifestyle often leads to stress, tension, anxiety, and mental fatigue. The desire and need for good health have become increasingly pressing. In this article, Dr. Jingduan Yang, a renowned Chinese-American psychiatrist from Philadelphia, shares insights into mental and physical health.

Liver cancer is the fastest-growing cause of cancer-related deaths in the United States, claiming the lives of approximately 30,000 adults each year. According to the American Liver Foundation, liver cancer death rates in the United States have more than doubled since 1980, with liver cancer death rates increasing by 43 percent from 2000 to 2016.

In the United States, chronic viral hepatitis is the leading pathway to liver cancer. Many individuals are carriers of the hepatitis B virus, and some may not even be aware of this until it progresses to hepatitis, cirrhosis, or, in some cases, liver cancer.

Why do people develop liver cancer? What treatment options are available, and how can it be prevented? This is a broad topic, but in this and future articles, we will delve into the onset, diagnosis, treatment, and prevention methods related to liver cancer, as well as approaches to prevention and treatment beyond modern medical practices.

The Formation of Liver Cancer

Before delving into other aspects, it is essential to understand the concept of cancer itself. Under normal circumstances, the cells in the human body undergo a regular metabolic process. As cells age and die, new cells replace them. However, cancer occurs when cells undergo a malignant transformation, leading to uncontrolled growth, continuous division, and the loss of normal cell functions. Consequently, this affects organ function, ultimately potentially resulting in death.

What is the relationship between tumors and cancer? Tumors can be benign or malignant, with malignant tumors considered cancerous. Cancer can manifest as visible, solid masses formed by uncontrolled cell division (tumor). It can also manifest as conditions such as leukemia, a type of blood cancer resulting from the malignant transformation of certain white blood cells, and does not lead to the development of solid masses.

Liver cancer, specifically primary liver cancer, is the malignant transformation of liver cells. This leads to uncontrolled growth, the loss of normal liver cell functions, damage to liver function, and, ultimately, liver failure, which can be fatal.

Liver Cancer Early Detection and Diagnosis

Liver cancer is one of the most lethal types of cancer. It has a high mortality rate, primarily due to its often asymptomatic early stages. By the time symptoms become apparent, the cancer is typically in an advanced stage, and in many cases, it has already metastasized, often affecting neighboring organs like the gallbladder. It can also spread through the bloodstream and lymphatic system to distant sites, including the bones, lungs, and brain.

In the early stages of liver cancer, patients often experience symptoms such as fatigue, loss of appetite, and weight loss. As the condition advances, they may develop dark urine, jaundice (yellowing of the skin and eyes), and eventually notice the presence of a lump in the abdomen.

The liver is situated in the right upper abdomen, just below the lower edge of the right ribcage and slightly toward the back. A tumor in the liver can lead to liver enlargement, which may become noticeable during a physical examination. In more severe cases of liver cancer, the accumulation of abdominal fluid, known as ascites, can occur and may lead to conditions like hepatic encephalopathy, resulting in confusion and other neurological symptoms.

The diagnosis of liver cancer typically involves the assessment of clinical symptoms and biochemical tests. One essential marker is alpha-fetoprotein (AFP), which tends to be elevated in liver cancer patients. Additionally, it is crucial to evaluate the extent of liver function damage, which can often be assessed through blood tests.

Furthermore, imaging studies, such as ultrasound, CT scans, and MRI scans, can provide valuable information about the shape and size of the liver and the location of tumors. MRI scans are generally more precise than CT scans. Additionally, whole-body scans, such as positron emission tomography (PET scans), can reveal whether cancer has spread to other areas in the body. These imaging techniques are crucial for assessing the extent of the disease and determining appropriate treatment approaches.

Treatment Options for Liver Cancer

Liver cancer is categorized into early, intermediate, and advanced stages based on the severity of its spread. Since liver cancer is often diagnosed in later stages, treatment primarily focuses on addressing immediate life-threatening factors, managing symptoms such as ascites, regulating biochemical balance, and maintaining fluid and electrolyte equilibrium, with less emphasis on addressing the root causes.

1. Surgery

The first option that often comes to mind for liver cancer treatment is surgical resection due to a liver tumor. However, the patient’s eligibility for surgery must be carefully assessed. Key factors for evaluation include the patient’s physical condition and the extent of tumor spread. If the patient is already frail or the tumor has spread to multiple organs to the extent that it cannot be removed entirely, then even surgery may not be enough. In such cases, surgery is not a favorable treatment option, as the procedure itself can cause pain and carry risks.

People suitable for surgical treatment typically have localized liver cancer with a small tumor and no significant spread to surrounding areas. In such cases, surgically removing the cancerous portion may be possible.

The liver possesses strong repair and regenerative capabilities. Even after removing up to 80 percent of the liver, the remaining healthy liver cells can take on some of the liver’s functions and gradually regenerate to repair the organ. If the cancerous area is too large for local resection but has not spread beyond the liver, liver transplantation may be considered.

Organ transplantation is a sensitive and complex topic. It requires a complete match between the donor and the recipient to minimize the risk of rejection by the recipient’s immune system. Therefore, finding suitable donors can be quite challenging. In the past two decades, China has emerged as a major player in organ transplantation despite lacking a well-established organ donation system or a strong tradition of organ donation. The source of these organs in China has raised significant concerns.

According to official statements, these organs allegedly come from executed Chinese prisoners. However, the number of prisoners executed in China is far below the number of transplants performed. Moreover, there are concerns about the prisoners’ overall health and eligibility for organ donation. To date, Chinese authorities have not provided a convincing explanation, casting a shadow over the entire field of organ transplantation and adding additional worries for patients seeking treatment through transplantation.

2. Ablation

Ablation treatments are available for tumors when they are not very large. Common methods include radiofrequency ablation (RFA) and chemical ablation. Radiofrequency ablation involves inserting a small electrode needle into the cancerous area and using high-frequency heat to destroy cancer cells directly. Chemical ablation, on the other hand, entails injecting chemical agents into the tumor to kill it by causing the proteins within the tumor to coagulate.

3. Transarterial Embolization Therapy

Transarterial embolization therapy is a procedure that involves blocking the artery supplying blood to cancerous cells. This is achieved using a catheter, typically inserted through the leg and advanced to the tumor site, where a substance such as a sponge or other biocompatible material is used to obstruct the artery, effectively cutting off blood supply to the tumor. The tumor will gradually shrink due to reduced blood flow. While this method can somewhat impact the normal part of the liver, blood flow through the hepatic vein mitigates the effect.

Transarterial embolization therapy can be combined with chemical ablation. Before mechanically blocking the artery, a chemical agent is injected into the liver tumor through a catheter. Blocking the artery allows the chemical agent to remain in the tumor area for an extended period, enhancing the treatment’s effectiveness. Another form of ablation involves directly injecting alcohol into the tumor. It is important to note that these treatment methods may lead to side effects or discomfort for patients.

4. Chemotherapy

Traditional chemotherapy involves combining two to three chemotherapy drugs to kill cancer cells. While chemotherapy can effectively suppress cancer cells, it has significant drawbacks, including notable side effects, a painful treatment process, and a substantial impact on a patient’s overall immune function, potentially leading to complications.

Chemotherapy can extend the lifespan of certain patients, but unfortunately, some may succumb to its side effects.

5. Radiation Therapy

Radiation therapy uses directed radiation to treat specific cancer-affected areas, such as particular regions in the brain or specific areas of bone. It can be administered using large external radiation machines that accurately target the tumor site with precise beams of ionizing radiation or by implanting small radiation probes near the tumor to irradiate cancer cells. These treatment methods are typically employed for patients ineligible for surgery or those with early-stage liver cancer.

Radiation therapy affects both cancer cells and nearby healthy tissue, but it generally has a milder impact on the body than chemotherapy.

6. Alternative Therapies

Targeted therapy is a relatively recent approach that employs drugs specifically designed to target liver cancer cells. These drugs can be delivered directly to the tumor site via a catheter, allowing for a more precise and selective elimination of cancer cells. Targeted therapy is still in the process of development but holds promise for the treatment of liver cancer.

In addition to the mentioned treatment methods, various complementary therapies are available for liver cancer patients. Pain is a significant concern for these patients, and it can be managed through medications and nonpharmacological approaches, such as nerve block procedures and radiotherapy. These complementary therapies are designed to alleviate pain and reduce patients’ overall suffering.

Liver cancer patients often experience significant physical exhaustion, particularly after undergoing chemotherapy and radiation therapy. These treatments can affect blood cells, making patients more vulnerable to infections, bleeding, and fatigue. Hence, it is essential to ensure they receive adequate nutrition. Furthermore, many patients experience significant psychological stress and anxiety, which can compromise their nervous, immune, and endocrine functions, further weakening their body’s ability to combat cancer. Therefore, addressing the emotional well-being of patients is also essential.

Our next article will delve into traditional Chinese medicine’s (TCM) perspective and treatments for tumors and liver cancer. Additionally, we will discuss strategies for proactively improving liver health and preventing the onset of liver cancer.

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