What is Surgery for Liver Cancer and How is it Performed?

Most of the tumors seen in the liver are the spread of cancer that started in other organs (such as stomach, small and large intestine, pancreas, breast, lung) to the liver. Tumors of the liver itself constitute 10% of all tumors. Approximately 1 million people are diagnosed with liver cancer every year in the world.

Approximately 80% of liver cancers are seen in patients with cirrhosis (all causes of cirrhosis, including hepatitis B and C). In addition, some genetic diseases (trisonemia), metabolic diseases (hemochromatosis, Wilson's disease), and some toxic substances (aflatoxin, vinyl) can cause liver cancer.

There is no early specific finding of liver cancer. Therefore, when diagnosed, it is usually in advanced stages. The symptoms are extremely hidden. Fatigue, loss of appetite, weight loss and pain in the upper right side of the abdomen are the first symptoms of the disease. Since cirrhosis is usually the basis of cancer, these symptoms are usually attributed to cirrhosis. In people known to have chronic liver disease, sudden deterioration of general condition should be evaluated as the first symptom of a developing tumor and should be investigated. Jaundice and swelling of the abdomen due to fluid accumulation are symptoms of the advanced stages of this disease.

Today, it is extremely easy to detect liver cancer with advanced imaging methods. Patients at risk (especially those with cirrhosis) should be followed up with the cheapest and easiest to apply ultrasonography. In addition, computerized tomography (CT), magnetic resonance imaging (MRI), and angiography are other methods that can be used in diagnosis. Alpha fetoprotein (AFP), a tumor marker in the blood, can be determined. Although an increase is not detected in every patient, AFP monitoring is still an important parameter that helps detect tumors in the early stages in patients with cirrhosis.

The results of untreated liver cancer are very poor. 80% of tumors that become symptomatic have lost the chance of being surgically removed. While the average patient survival in tumors that can be surgically removed is 25 months, patients who cannot receive any treatment usually die within 6-9 months. Two important factors for surgical removal of cancer are that the cancer is limited within the liver, that is, it has not spread to another organ, and the stage of the underlying liver disease. Liver cancer that has spread to another organ has lost the chance of surgical treatment.

In the early stages of liver disease, if the number and diameter of the cancer are suitable, surgical removal is the first step. The most important disadvantage of this is the high risk of recurrence of the tumor. In people who are not suitable for surgical removal, especially those with chronic liver disease, liver transplantation should be considered as the first choice, as it also treats the disease that caused the tumor. If the tumor is limited only within the liver, liver transplantation can be successfully performed regardless of its diameter and number. It has been observed that long-term survival can be achieved with liver transplantation, even in advanced-stage tumors. In patients who are not suitable for liver transplantation and surgical removal, radiological methods such as hepatic artery chemoembolization (HACE), radiofrequency ablation (RF) and alcohol injection are other interventions performed to extend the patient's survival.




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