Like any other organ in the body, the liver too is vulnerable to a wide range of ailments, including liver disease which results in liver failure if left untreated. Before the person reaches the stage of liver failure, liver disease goes through 5 stages namely – inflammation, fibrosis, cirrhosis, end-stage liver disease (ESLD) and liver cancer. As is clear, cirrhosis and liver cancer are two different conditions, but there is a close relationship between them.
For one, consumption of alcohol is a major risk factor towards developing one or both of these conditions. Almost 70% of all people who have or had liver cancer, also had cirrhosis. This means that cirrhosis caused by some diseases can progress to cancer. However, 30% of people who have or had liver cancer had not developed cirrhosis. This means cirrhosis is only one of the reasons for developing Liver Cancer. It is important to understand the two conditions as two entities.
Cirrhosis of the Liver
A healthy liver has a smooth external surface with liver-cells or tissues being distributed throughout the interior. In cirrhosis, on examination by hand ( palpation) the surface of liver feels firm, irregular and nodular (bumpy). The liver tissues inside get replaced by fibrous tissue (fibrosis) which greatly reduce the number of healthy cells that are available to carry out the functions of the liver.
Causes and Risk factors:
- Chronic alcohol abuse – the number 1 reason
- Hepatitis B – caused by Hepatitis B virus
- Hepatitis C – caused by Hepatitis C virus
- Autoimmune disorders such as auto-immune hepatitis
- Wilson’s disease (copper build-up in the liver)
- Hemochromatosis (iron build-up in the liver leading to liver damage, skin discoloration and diabetes)
- Budd-Chiari syndrome (veins that drain the liver are blocked by blood-clots)
- Alfa antitrypsin deficiency (deficiency of this vital protein that is generated by the liver and protects the lungs)
- Medication such as methotrexate, methyldopa and amiodarone
Symptoms
- Finger and toe-nails may be white
- Terry’s nails (the proximal half of nails is white while distal half is red in color)
- Nails have a clubbed shape
- Jaundice
- Parotid swelling (parotid glands in the cheeks swell up, leading to swollen cheeks)
- Gynecomastia or male breast enlargement
- Palmar erythema (palms of the hand turn red in color)
- Dupuytren’s contractures, that leads to bent fingers
- Bilateral pitting ankle edema (ankle gets swollen due to fluid retention, and when pressed leaves a pit behind)
- Testicular atrophy or small testicles
- Enlarged liver in the early stages
Diagnosis
- Blood tests: that will look for liver functions – direct and indirect bilirubin, liver enzymes such as ALT, AST, Alkaline Phosphatase and Gamma GT and most importantly coagulation parameters (concerning bleeding and clotting), and the serum proteins, Albumin and Globulin.
- Related Liver tests: virology for hepatitis, Alfa-antitrypsin, alfa-fetoprotein, auto-antibodies and caeruloplasmin
- Ultrasound scan of the abdomen, Fibro scan, Liver Biopsy
- Kidney function- Blood Urea, serum creatinine
- Full blood count, Blood Sugar and Serum Electrolytes
Treatment
- Treatment of underlying liver disease –eg. interferons, ribavirin, penicillamine
- Factors contributing to alcoholic and Non- Alcoholic Fatty Liver Disease
- Diuretics/ drainage to remove accumulation of fluid in body cavities and spaces: Eg : Excessive fluid ( Ascites) in the peritoneal cavity.
- Supportive management of Chronic Liver Disease and its complications such as Portal Hypertension
- General management: Monitoring of heart rate, daily weight, urine output, serum electrolytes, blood pressure, looking for pleural effusion, abdominal girth and looking for tender abdomen due to peritonitis
Liver Cancer
Cancer is a condition when certain DNA mutations cause body cells to go through uncontrolled or abnormal division, leading to cancerous cells. Cancer can develop in any organ or tissue of the body, including the liver, in which case it is called Hepatocellular carcinoma or HCC. However, most often, HCC is secondary, or it has metastasized from cancer in other parts of the body. Primary liver-cancer or that which originates in the liver is rare. Liver cancer is deadly and the 5-year mortality figure is more than 95%.
Causes and Risk Factors:
- Chronic Viral hepatitis due to Hepatitis B or C viruses
- Cirrhosis of the liver – due to Non-alcoholic fatty liver disease and its variant non-alcoholic steatohepatitis, and Primary biliary cirrhosis
- Aflatoxin – secreted by a fungus that affects agricultural produce like rice, wheat, soybeans, groundnuts and corn
- Alcohol abuse
- Exposure to industrial chemicals such as Vinyl chloride and thorium dioxide (Thorotrast)
- Gender: Men are at more at risk than women
- Race/ethnicity: some ethnic groups are more vulnerable
- Inherited metabolic diseases such as hereditary hemochromatosis
- Tobacco use
- Obesity
- Type-2 diabetes
- Rare diseases such as Porphyria cutanea tarda, Tyrosinemia, Wilson disease, Alpha1-antitrypsin deficiency and Glycogen storage diseases
Symptoms
- Fever and weakness
- Anorexia
- Nausea and vomiting
- Jaundice and its symptoms
- Enlarged liver
- Other symptoms of chronic liver disease
Diagnosis
- Chest X-ray
- CT scan of the abdomen
- Biopsy of the Liver
Treatment
- Surgical resection of solid tumors
- Radiation therapy
- Chemotherapy
Differences between Cirrhosis and Liver Cancer
- Structurally: Cirrhosis is marked by fibrosis in the liver and regeneration of liver cells. Liver cancer like any other cancer is marked by abnormal uncontrolled cell-growth in the liver.
- Location: Cirrhosis spreads throughout the liver or affects the entire liver. Liver cancer is localized initially, before spreading through the liver.
- Distribution: Changes in the liver brought about by cirrhosis are spread uniformly across the liver. Liver cancer spreads as small and random nodular-growths amidst healthy tissue.
- Mutual risk: Cirrhosis is a high risk-factor for liver cancer but not the other way round.
- Surgical removal: Parts of the liver affected by cirrhosis cannot be excised as they are distributed uniformly throughout the liver. Liver cancer cells or nodules can be removed by what is called as partial liver resection.
- Prognosis: Quitting alcohol, the right medication and good general management improves the chances of recovery in cirrhosis patients. Liver-cancer is fatal more often than not.
Outlook
Cirrhosis and Liver cancer can be prevented through lifestyle changes.
- It is good to completely quit consumption of both alcohol and tobacco.
- It is important to eat a nutritious diet rich in complex carbohydrates, lean meat, pulses and lentils, fresh fruits, vegetables and low-fat dairy.
- Adequate water or fluids in the form of soups, juices and beverages must be consumed to prevent dehydration.
- Regular exercise is vital to prevent obesity and diabetes.
- Industrial workers must wear masks when they are exposed to chemicals.
- Finally, it is important to have an annual health checkup that covers liver function tests. This will help expose any liver conditions or the risk for the same.
For more details on the above, consult a reputed, multi-specialty hospital. In addition to a hepatologist (liver specialist), you can consult a dietician or nutritionist at these hospitals. In case you or any of your dear ones are known to abuse alcohol, these hospitals could refer you to a good de-addiction center. Some of these hospitals also conduct awareness talks around liver conditions. Attending such programs will help you take precautionary measures and reduce the risk of liver conditions for you and your dear ones.
Reviewed by Dr Suresh S Venkita, Group Medical Director, Kauvery Hospitals
Kauvery Hospital is globally known for its multidisciplinary services at all its Centers of Excellence, and for its comprehensive, Avant-Grade technology, especially in diagnostics and remedial care in heart diseases, transplantation, vascular and neurosciences medicine. Located in the heart of Trichy (Tennur, Royal Road and Alexandria Road (Cantonment), Chennai, Hosur, Salem, Tirunelveli and Bengaluru, the hospital also renders adult and pediatric trauma care.
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