Liver Cancer June 2025

Hepatocellular carcinoma (HCC) is a significant global cancer, ranking as the 6th most diagnosed and 4th leading cause of cancer-related deaths. Survival rates are low, but rates are increasing in certain regions. Incidence varies geographically, with a higher occurrence in men.

Risk factors include hepatitis B and C, iron overload, environmental carcinogens (aflatoxins), alcohol, tobacco, NAFLD, diabetes, obesity, and genetic predispositions.

Protective factors include vaccination for hepatitis B, treatment for hepatitis B or C, statins, aspirin, metformin, coffee, a healthy diet, and physical activity.

Symptoms of liver cancer include unintentional weight loss, abdominal pain, early satiety, palpable mass, loss of appetite, fatigue, nausea, vomiting, abdominal swelling, jaundice, and white stools. Paraneoplastic syndromes can cause hypoglycemia, erythrocytosis, hypercalcemia, diarrhea, and cutaneous features.

Screening involves liver function tests, CBC, CMP, renal function tests, prothrombin time, albumin, tumor markers, and serology for hepatitis B and C. High-risk patients should undergo ultrasound surveillance every 6 months. Lesions >1cm require further evaluation with dynamic MRI or CT with contrast.

AFP levels >400 mcg/L are considered diagnostic, but HCC is often diagnosed at lower levels. Diagnosis for at-risk patients involves ultrasound for lesions <1 cm and dynamic MRI or CT for lesions >1 cm.

Staging is based on the TNM system. Treatment algorithms consider tumor size, location, extrahepatic metastases, and underlying liver function. Conventional treatments include liver transplantation, thermal ablation (RFA, MWA, cryoablation), percutaneous ethanol or acetic acid ablation, irreversible electroporation, TACE, TARE, EBRT, molecularly targeted therapies, immunotherapies, and systemic chemotherapy.

Chemotherapy is relatively chemo-resistant. Post-treatment monitoring includes AFP, MRI or US every 6 months, and annual chest and abdominal CT. The Child-Pugh classification system assesses hepatic reserve to guide therapeutic options. The Liver Imaging Reporting and Data System (LI-RADS) categorizes liver lesions for diagnosis and action.

Prognosis is generally poor, with median survival ranging from 6-20 months. Integrative medicine approaches include diet, exercise, stress management, physical medicine, herbs, homeopathy, pharmaceuticals, and surgery. The Mediterranean diet and herbal formulas like Galium aparine and Taraxacum officinale are recommended. Homeopathic remedies such as Arsenicum album and Carduus marianus are also used.