Liver cancer, also known as hepatic cancer, originates in the cells of the liver, one of the human body’s major organs. The liver performs several functions such as detoxifying, metabolizing lipids, synthesizing proteins, and assisting with digestion.
Stage 4 liver cancer, also known as metastatic liver cancer, is an advanced form of the disease that originated in the liver but has spread to other organs. Cancerous cells can occasionally spread throughout the body through the blood vessels or lymphatic system, invading new organs or tissues in a process known as metastasis.
Causes of stage 4 liver cancer
The development of advanced liver cancer is influenced by several risk factors. These factors include ailments, habits, and other aspects of lifestyle that might contribute to the development of the disease. Hepatitis B and C are thought to be responsible for 40% of cases each, while alcohol consumption is thought to be responsible for the beginning of 11% of cases and other reasons for 10% of cases.
Cirrhosis
Cirrhosis is scarring caused by liver injury. However, there are additional causes besides excessive alcohol consumption that might lead to cirrhosis. Scarring can be brought on by infections, hepatitis B or C, non-alcoholic fatty liver disease, genetic liver illnesses, prolonged use of certain medicines, and persistent heart failure.
Cirrhosis is progressive and develops gradually over time. It is important to note that not everyone who has scarring will develop liver cancer. So regular liver cancer screenings for those with cirrhosis are recommended.
Hepatitis B
One of the main risk factors for liver cancer is chronic hepatitis B infection. It causes a 12-fold increase in cancer risk and can lower liver cancer survival rates even in the absence of cirrhosis.
Hepatitis C
Even in the absence of cirrhosis, chronic hepatitis C infections can result in liver cancer. Patients with hepatitis C are nine times more likely to experience this danger.
Nonalcoholic fatty liver disease (NAFLD)
People with a body mass index (BMI) over 30, type 2 diabetes, increased blood fat levels, or metabolic syndrome are more likely to develop NAFLD. This is the main reason why liver cancer develops and might shortly affect up to 25% of individuals.
Related Conditions
The bile ducts are impacted by a wide range of different diseases, and liver cancer can potentially develop in the liver. These include tyrosinemia, hemochromatosis, alpha-1 antitrypsin deficiency, primary biliary cholangitis, Wilson disease, and porphyria cutanea tarda.
Aflatoxins
These mycotoxins, which are poisonous and carcinogenic (cause cancer), are created by fungus that grow on specific types of crops, such as peanuts, maize, tree nuts, and cottonseed. Exposure to aflatoxin is more frequent in underdeveloped nations. Since these crops are the main food, there is less capacity for food storage without the fear of contamination, which creates the perfect conditions for the fungus to flourish.
Liver injury induced by anabolic steroids
Anabolic steroids are utilized and categorized as “drugs that improve performance and attractiveness.” Both professional and amateur athletes utilize it, even though it is only permitted with a prescription, and it is strongly discouraged to take it to enhance performance.
The anabolic steroids injure the liver and are infrequently linked to the uncommon liver cancer known as angiosarcoma.
Stage 4 liver cancer symptoms
It’s possible that there are no symptoms when liver cancer is in its early stages. Furthermore, the signs and symptoms of liver cancer aren’t necessarily correlated with its stage. Each person’s experience with the condition is particularly individualized.
The signs and symptoms of advanced liver disease may include:
- Abdominal pain.
- Pain in the right shoulder blade.
- Abdominal edema and fluid accumulation in the abdomen (ascites).
- Loss of appetite.
- Feeling full after taking only a little meal.
- Weight loss without trying.
- Generalized itching.
- Liver enlargement (hepatomegaly) felt like a bulge under the ribs on the right side.
- Jaundice (yellowing of the whites of the eyes and the skin).
- Spleen enlargement (splenomegaly) felt like a mass under the ribs on the left side.
- Swelling in legs.
- Nausea or vomiting.
A liver cancer tumor may occasionally begin to manufacture hormones. These hormones may impact various systems and organs in the body in addition to the liver, resulting in signs and symptoms. That may include:
- Gynecomastia (breast enlargement in males).
- Testicle shrinkage.
- High cholesterol levels.
- Erythrocytosis: High red blood cells levels.
- Hypercalcemia: Elevated calcium levels that can make you feel weak, confused, or disoriented, as well as cause constipation or muscular difficulties.
- Hypoglycemia: Low blood sugar levels that can make you feel faint or fatigued.
Stage 4 liver cancer substages
Substages 4A or 4B are given for stage 4 liver cancer. Both classifications relate to a single tumor or a collection of lesions of any size, and the treatment choices vary according to the substage:
- Stage 4A: The cancer has spread to nearby lymph nodes but not to distant parts of the body.
- Stage 4B: Cancer may be present in distant organs, such as the lungs or bones.
Diagnosis of stage 4 liver cancer
Following the completion of a series of tests, liver cancer is identified. When an ultrasound is abnormal, the possibility of liver cancer may sometimes be raised. Ultrasound creates a picture of the organs within the body by using sound waves.
Additional tests are required for confirmation. To confirm the diagnosis and stage, Magnetic Resonance Imaging (MRI) with contrast or Computerized Tomography (CT) are advised.
Using a sequence of X-rays, a cross-sectional picture of the abdomen is produced using computer tomography. Using strong magnets and radio waves, magnetic resonance imaging produces pictures of the abdominal structures.
Blood tests will be done to check the liver’s functioning as well as to check for a tumor marker (alpha-fetoprotein), which is usually linked to liver cancer. A slice of liver tissue may be extracted during a liver biopsy to look for indicators of illness.
What to expect
Most individuals with liver cancer have liver damage, which impairs the organ’s ability to function and may result in further complications. The liver facilitates digestion and creates bile, which eliminates waste and poisons from the body. Due to these reasons, a patient may suffer severe conditions that might be fatal if the liver isn’t working properly.
Patients having stage 4 liver cancer may notice worsening signs and symptoms such as increased jaundice, discomfort, difficulty eating, and extreme exhaustion. To assist them in Living better lives, patients should discuss methods to control these symptoms with their care providers.
Stage 4 liver cancer treatment options
Liver cancer at stage 4 is incurable. However, medication can help control its symptoms and development.
The course of treatment will be heavily influenced by the disease’s stage and the general health of the patient.
There are three different classifications for liver cancer, each of which will determine the potential course of treatment:
- Possibility of resection or transplant.
- Advanced cancer.
- Cancer that is incurable and has not gone beyond the liver.
Medications
Since stage 4 liver cancer is an advanced type, only a few therapies may be available. For instance, stage 4 patients often cannot receive a liver transplant. A stage 4 tumor is likely not susceptible to surgery to remove portions of the liver (such as a segmentectomy or partial hepatectomy).
In most instances, the therapy administered will involve drugs as well as treatments to relieve symptoms including pain, nausea, and appetite loss.
Using drugs that stimulate the patient’s immune system is one type of treatment for stage 4 liver cancer. This is known as immunotherapy. Stage 4 liver cancer may be treated with Tecentriq (atezolizumab) and Avastin (bevacizumab) as the first lines of treatment.
Tecentriq is a medication that can improve the body’s natural immune system’s ability to fight cancer. It could be used with another medication called Avastin, a monoclonal antibody. These drugs are administered intravenously (by infusion) on a regimen that can last for two to four weeks.
Radiation therapy.
Another option for stage 4 liver cancer treatment is the utilization of high-energy particles. Stereotactic body radiation therapy (SBRT) and external beam radiation treatment (EBRT) are two possibilities.
EBRT is like an X-ray. The operation just takes a few minutes, but it might need to be performed every day for a few weeks. The more advanced treatment method known as SBRT may aid in maintaining healthy liver tissue.
Life expectancy with stage 4 liver cancer
The bones and lungs are the most common sites of metastasis for liver cancer. A patient whose liver cancer has progressed to nearby tissue, organs, and/or lymph nodes has a 12 percent chance of surviving for five years. The predicted five-year survival rate is three percent for a patient with liver cancer who has progressed to distant tissue, organs, and/or lymph nodes.