In Israel, about 300 liver cancer patients are diagnosed each year/ShutterStock
Many are familiar with the fact that the liver is responsible for breaking down harmful substances such as alcohol and drugs from the body and excreting them out.
But the liver has other important roles: it is responsible for storing sugars and fats, regulating body temperature, helping with blood clotting and producing important proteins such as albumin and various antibodies.
In addition, the liver is the only organ in the body that is able to regenerate, so much so that in about two weeks it is able to replenish about 30% of its volume.
In Israel, about 300 patients are diagnosed with liver cancer each year.
There are two types of liver cancer - primary liver cancer and secondary cancer, which is actually metastases of cancerous tumors from other places in the body.
Risk factors for the disease
"Unlike other types of cancer, which we do not know on the basis of which they are formed, in the case of primary liver cancer there is a fairly well-known basis for the reasons for which the cancer is formed, and there is also a mechanism that we estimate is what causes cancer in those situations," explains Dr. Ofer Purim, Director of the Gastrointestinal Tumor Service at the Helmsley Oncology Center at Shaare Zedek Hospital.
"These conditions are mainly the result of infection with chronic hepatitis viruses that do not disappear after the acute infection, but are present for a long time in the liver. Infection with the viruses occurs in most cases due to infected blood transfusions, unprotected sex and injecting drugs with contaminated needles."
Dr. Purim explains that in addition to this, in recent years doctors have witnessed new conditions appearing mainly in Western countries, including Israel, which increase the risk of liver cancer. , which occurs with high frequency among people suffering from obesity, diabetes and lipids in the blood," he says. "In addition, excessive alcohol consumption can also lead to liver damage."
All these conditions can lead to chronic inflammation of the liver, which eventually causes scarring called 'cirrhosis' , and according to the assessment, a constant pro-inflammatory environment triggers changes that lead to cancerous transformation in the cells. "In most cases, when a person has liver cancer, we will look for the underlying disease that most likely caused the cancer," explains Dr. Purim.
Liver cancer is usually not accompanied by symptoms in the early stages of the disease/ShutterStock
The disease is usually discovered in late stages
, liver cancer is not accompanied by symptoms in the early stages of the disease.
And as mentioned, some patients develop liver cancer due to chronic liver diseases.
In most cases, the malignant disease is discovered randomly during a routine liver function test, even before the appearance of any symptoms.
"In most cases, this cancer is found on the basis of underlying diseases, and it has no early signs," explains Dr. Purim, "therefore, the group with the underlying diseases that we mentioned, is in a risk group, and must make sure to attend regular medical follow-up," he adds. They do not come to follow-up - either because of socio-economic difficulties or because of the lack of awareness of the risk.
Therefore, in many cases, the cancer is discovered in very advanced stages where it is no longer possible to analyze and remove the tumor from the liver."
What do the symptoms include?
The symptoms of liver cancer are not unique, and they can be interpreted as symptoms of other diseases as well. The symptoms include loss of appetite, rapid weight loss, nausea and vomiting, Weakness and high fever. Some patients also report a feeling of discomfort or pain in the upper right part of the abdomen, in the area of the liver, and ascites (accumulation of fluid in the abdominal cavity) - which is caused by liver dysfunction.
"In most cases where liver cancer develops in the mechanism of cirrhosis, it appears the symptoms are precisely from the cirrhosis that causes liver failure," explains Dr. Purim, "in addition, as soon as the liver stops functioning, a problem arises in the production of a protein that is secreted into the blood and serves as a 'sponge' spring for all the fluids in the body and keeps them in the blood vessels. If the production of this protein is damaged, The patient will develop an ascites."
How do you choose treatment?
"The stages of liver cancer are different from other cancers because of the liver disease in the patient's background. A significant number of patients will not be diagnosed with a metastatic disease, but a local one," explains Dr. Purim. "There is a tool that we use to make treatment decisions.
Using this tool, we refine a number of parameters such as the size of the tumor, the patient's medical condition, the state of his liver function and various other clinical criteria, and based on that we decide on the treatment method.
There are many tools that use different algorithms that help us make a decision as to what is the right way to treat each patient specifically."
In the last three years, there has been a real revolution in light of the perceptual change that has taken place in the way the disease is treated/ShutterStock
A revolution in treatments in recent years
For many years there was no therapeutic breakthrough in liver cancer.
"Although quite a few studies have been conducted and there have been attempts to develop new drugs, no treatment has had a clear success in controlled studies with large populations," explains Dr. Purim. "In the middle of the first decade of the 21st century, the first drug that proved effective appeared.
It was a biological drug that worked to stop the creation of the blood vessels with which the tumor feeds itself.
This is how the treatment managed to prolong the lives of the patients.
About five years ago, another drug appeared with a similar nature that showed similar results.
And it has become the accepted treatment."
In the last three years, there has been a veritable revolution in light of the conceptual change that has taken place in the way the disease is treated. "Nowadays, the common perception is that since the tumor is inflammatory and releases inflammatory substances, then a process similar to a normal infectious process is created," explains Dr. Purim, " That is why trials began using immunotherapy drugs - drugs that activate the immune system and encourage it to attack the cancer cells. In clinical studies, it has been shown that a combination of immunotherapy drugs with targeted drugs can cause the tumors to shrink and stop the disease for a very long time."
At the same time, a theory arose that precisely because of the inflammation, it is better to avoid suppressing the blood vessels, and work only on releasing the brakes from the immune system.
"Studies conducted in recent years found that a combination of immunotherapy treatments with different mechanisms for patients with liver cancer in advanced stages resulted in a significant shrinkage of the tumors," explains Dr. Purim.
These treatments brought some of the patients to a complete response so that the tumor was not observed in any of the tests performed on them. This is an encouraging response Indeed, it is possible that primary liver cancer will become a disease in which patients will live longer than before.
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