What are Liver Tumours?

Liver tumours represent a complex group of malignancies with varying origins, presentations, and prognoses. This article delves into the intricate world of liver tumours, exploring their types, causes, symptoms, and treatment options.

Types of Liver Tumours

Liver tumours are categorized broadly into benign and malignant types. Understanding these distinctions is crucial for effective diagnosis and treatment planning.

Benign Liver Tumours

Benign liver tumours, while non-cancerous, may still require medical attention depending on their size and symptoms. The most common types include:

Hepatic Hemangiomas: These are the most prevalent benign liver tumours, often asymptomatic and found incidentally during imaging studies.
Focal Nodular Hyperplasia (FNH): Typically asymptomatic, FNH is a hyperplastic response of the liver to an anomalous artery.
Hepatocellular Adenomas: These are rare and may cause abdominal pain or discomfort. They have a potential risk of malignancy, especially in cases associated with oral contraceptive use.

Malignant Liver Tumours

Malignant liver tumours are more concerning due to their potential to spread and affect liver function. They include:

Hepatocellular Carcinoma (HCC): The most common primary liver cancer, often associated with chronic liver disease and cirrhosis.
Cholangiocarcinoma: This bile duct cancer is less common but highly aggressive.
Angiosarcoma and Hemangiosarcoma: Rare vascular tumours with a poor prognosis.
Secondary (Metastatic) Liver Cancer: These originate from cancers elsewhere in the body, such as colorectal cancer, and spread to the liver.

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Causes and Risk Factors of Liver Tumours

Liver tumour development is influenced by a variety of factors, both genetic and environmental.

Genetic Predispositions

Some individuals have a genetic predisposition that increases their risk of developing liver tumours. For example, conditions like hereditary hemochromatosis and Wilson's disease can predispose individuals to liver malignancies.

Environmental and Lifestyle Factors

Several lifestyle and environmental factors are implicated in the pathogenesis of liver tumours:

Chronic Hepatitis B and C Infections: These viral infections are leading causes of HCC.
Alcohol Consumption: Excessive alcohol intake leads to liver cirrhosis, a major risk factor for liver cancer.
Non-Alcoholic Fatty Liver Disease (NAFLD): Obesity and metabolic syndrome contribute to NAFLD, which can progress to HCC.
Exposure to Aflatoxins: Found in contaminated foods, aflatoxins are potent carcinogens linked to liver cancer.

Symptoms of Liver Tumours

Symptoms of liver tumours often manifest late in the disease course, making early detection challenging.

Common Symptoms

Abdominal Pain and Swelling: Discomfort or a palpable mass in the upper right quadrant of the abdomen.
Jaundice: Yellowing of the skin and eyes due to impaired bile flow.
Unexplained Weight Loss: A common sign of malignancy.
Fatigue: Persistent tiredness and weakness.
Nausea and Vomiting: Resulting from liver dysfunction.

Advanced Symptoms

As liver tumours progress, symptoms may become more severe, including:

Ascites: Accumulation of fluid in the abdominal cavity.
Hepatic Encephalopathy: Confusion and altered mental status due to liver failure.
Gastrointestinal Bleeding: Resulting from varices due to portal hypertension.

Diagnosis of Liver Tumours

Accurate diagnosis is essential for staging and treatment planning.

Imaging Studies

Ultrasound: Often the first imaging test used, it can identify masses and guide further investigations.
CT and MRI Scans: Provide detailed images and help in assessing the extent of the disease.
Angiography: Evaluates blood supply to the tumour.

Biopsy and Histological Examination

A liver biopsy may be performed to obtain a tissue sample for histological examination, confirming the type and grade of the tumour.

Blood Tests

Alpha-Fetoprotein (AFP): Elevated levels can indicate HCC.
Liver Function Tests: Assess the extent of liver damage and function.

Staging of Liver Tumours

Staging determines the extent of tumour spread and guides treatment decisions.

Tumour-Node-Metastasis (TNM) System

The TNM system is commonly used, considering:

T (Tumour Size and Extent): Evaluates the size and direct invasion of the primary tumour.
N (Lymph Node Involvement): Assesses regional lymph node involvement.
M (Metastasis): Identifies distant spread of cancer.

Barcelona Clinic Liver Cancer (BCLC) Staging

The BCLC staging system incorporates tumour characteristics, liver function, and overall patient performance status.

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Treatment Options for Liver Tumours

Treatment strategies depend on tumour type, stage, and patient health.

Surgical Interventions

Liver Resection: Surgical removal of the tumour and surrounding healthy tissue.
Liver Transplantation: Considered for select patients with early-stage HCC.

Non-Surgical Treatments

Radiofrequency Ablation (RFA): Uses heat to destroy cancer cells.
Transarterial Chemoembolization (TACE): Delivers chemotherapy directly to the tumour.
Targeted Therapy and Immunotherapy: Use of drugs like sorafenib and checkpoint inhibitors.

Palliative Care

For advanced cases, palliative care focuses on symptom relief and quality of life.

Prognosis of Liver Tumours

Prognosis varies significantly based on tumour type, stage, and treatment response. Early detection and intervention are critical for improving outcomes. For instance, HCC detected at an early stage has a better prognosis compared to advanced stages.

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