By Hannah Kerfoot and Pasha Yuen 
Celebrating the awareness week for Less Survivable Cancers, Pharmora would like to contribute to this campaign through a series of blogs. Liver cancer is classed as one of the least survivable cancers, with a survival rate in the UK of only
8% for 10 years or more. Although liver cancer is uncommon in the UK, being only the 17th most common cancer, rates are increasing due to several risk factors.
Risk Factors for Liver Cancer
The most common type of primary liver cancer is Hepatocellular carcinoma (HCC).
Cirrhosis is one of the leading causes of liver cancer, where liver cells have been damaged and replaced by scar tissue. Causes of cirrhosis include increased alcohol consumption or diseases such as non-alcoholic fatty liver disease and Type 2 diabetes. Chronic viral hepatitis can also lead to cirrhosis due to chronic liver infection with either hepatitis B or hepatitis C viruses.
The liver is also a common site of metastasis, where cancerous cells from primary cancer somewhere in the body travel through the bloodstream or the lymphatic system and invade other parts of the body. This is also known as secondary cancer.
Symptoms of liver cancer
Whether the cause is primary liver cancer or a secondary tumour deposit from another type of cancer, symptoms include weight-loss, jaundice, itching, nausea, swollen abdomen, loss of appetite, abdominal pain, a lump on the right side of abdomen, and pain in right shoulder. However, symptoms vary from person to person, so it is imperative to ensure self-diagnosis is minimised and health care professionals are consulted.
With liver cancer, a swollen abdomen can be caused by ascites, which is when fluid builds up in the peritoneal cavity. This symptom can also be seen in other conditions that affect the liver, such as cirrhosis. When seen in liver cancer, ascites tends to be an indicator that the cancer is advanced.
Historical treatments for liver cancer
Tumour resection was once the only treatment for liver cancer, with a risk of postoperative mortality. The rate of postoperative mortality has been minimised to under 1% through joint effort by surgeons around the world, including the development of ultrasound-guided surgery to improve accuracy, and liver transplantation to avoid liver function deterioration.
Thermal ablation is an alternative treatment for patients that are not eligible for surgery, which kills the cancerous cells with extreme temperatures. The most established use of ablations is by radiofrequency or microwaves, which produce heat to destroy the tumour. More recent ablation techniques include cryoablation, ethanol ablation, and irreversible electroporation.
Another alternative is Trans arterial chemoembolisation (TACE). This is a type of chemotherapy where the drug (usually doxorubicin or cisplatin) is injected directly into the liver, ensuring high dose of chemotherapy drug reaches the tumour site. Small particles are then injected into the blood vessel, which helps to block the blood supply and therefore oxygen and nutrients from supplying the tumour. Radiotherapy could also be used for liver cancer treatment, although it is less employed compared to other treatment options.
Despite all these available treatments, potential tumour recurrence remains a major challenge to improve the prognosis of liver cancer.
Recent advances
In 2007 sorafenib was approved and was the standard of care for advanced unresectable HCC, following the landmark results of the SHARP trial. However, following this, no other systemic agents were able to demonstrate any improvement against sorafenib, for over 10 years.
This was until 2020, when atezolizumab and bevacizumab showed positive results in a trial of adjuvant treatment in high-risk HCC. Following this, more trials have been conducted showing similar benefits of the combination in unresectable HCC. Around the same time, a high priming dose of tremelimumab with durvalumab was also shown to have clinical benefits.
Now, the current treatments for liver cancer include:
- Immunotherapy and Targeted cancer drugs (such as sorafenib, lenvatinib, regorafenib, cabozantinib, atezolizumab, ramucirumab, and bevacizumab)
- Taking part in a clinical trial, where a patient might receive new targeted drugs or undergo new surgical techniques.
There are many trials ongoing investigating liver cancer, working on developing new therapies to ensure patients with liver cancer can live the longest and highest quality lives possible. You can find out more about trials conducted for liver cancer in the UK by following this link.
Read more blogs on our website: Thoughts | Pharmora | Global
Reference:
Liver cancer statistics | Cancer Research UK
Chemoembolisation (TACE) for liver cancer | Cancer Research UK
