liverThe liver is a vital organ that carries some 500 different functions, which include detoxification, protein synthesis and production of molecules for digestion, to name just a few.  The liver is an absolutely necessary organ, and there is no way to truly compensate for its long-term absence from the body.  Liver dialysis continues to be used for the short term until a liver transplant can be done.

There are thousands of patients waiting for liver transplants and unfortunately many will die before they have the chance to get a liver.  However, this may change in the not so distant future.  Researchers are developing a man-made liver dubbed the HepaMate.  The HepaMate uses liver cells from pigs to take over lost function in a diseased liver.  The HepaMate has the ability to filter blood and remove toxins, buying some time while a patient waits for a donor.  The HepaMate is currently in clinical trials and is estimated to become available within five years.

Liver Synthesis Function

The liver is responsible for most of amino acid synthesis (making amino acids out of other molecules).  It is involved in carbohydrate metabolism as in gluconeogenesis (making glucose from other molecules like amino acids and fatty acids), glycogenolysis (breakdown of glycogen into glucose) and glycogenesis (forming glycogen from glucose).   It is involved with protein metabolism (synthesis and degradation) and lipid metabolism (cholesterol and triglyceride synthesis).  Most of the lipoproteins are made in the liver as well.   The liver makes a number of coagulation factors (clotting) such as fibrinogen and prothrombin.  It produces and secretes bile needed to emulsify fats in the small intestine and helps absorb vitamin K from the diet.   The liver also produces insulin-like growth factor (protein hormone important in childhood and adult growth).  It also makes thrombopoietin, a hormone that regulates production of platelets by bone marrow.

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Liver Breakdown function

The liver breaks down insulin (and other hormones) and toxic substances including drugs (it is the detox organ) and it converts ammonia to urea (urea cycle) and glucoronidates (adds glucuronic acid) to bilirubin facilitating its excretion into bile.

Other functions

The liver houses a number of molecules such as glucose (in glycogen form), vitamin A (1-2 year supply), Vitamin D (1-4 month supply), Vitamin B12 (1-3 year supply), Vitamin K, iron and copper.  The liver also produces albumin, which is important for maintaining blood serum osmolarity.  It contains a number of immunologically active cells that filter antigens from blood and the liver makes angiotensinogen, a hormone that raises blood pressure when activated by renin.

Liver Diseases

The liver is an extremely important organ as it supports just about every organ in the body and given its more than 500 different functions makes it vulnerable to many diseases.  The most common diseases include hepatitis A, B, C, D, E, fatty liver, cirrhosis, alcohol damage and drug damage.  The liver is particularly sensitive to acetaminophen and various cancer drugs.

Do You Have Liver Cancer or Cancer of Another Tissue?

It is not uncommon for cancer from other tissues such a colon, lungs, breasts, etc. to spread (metastasize) to the liver.  When cancer spreads from another tissue to the liver, you do not have liver cancer.  In this case the cancer you have in the liver is named after the organ or tissue where it began.  For example, colon cancer that spread to the liver is referred to as metastatic colon cancer, not liver cancer.

This article is about cancer of the liver, meaning, cancer started in the liver (primary liver cancer).

In the U.S., metastatic cancer in the liver is far more common than primary liver cancer.  Keep in mind that medical treatment options are different for primary liver cancer versus metastatic liver cancer.

What are Cancer Cells?

Cells are the fundamental units of life and they make up tissues and organs of the body.  Some cells have the ability to divide and create daughter cells (clones of themselves that go through the process of mitosis) to build tissue during development and replace tissue in the adult.  Some cells become post-mitotic early in development, meaning they cannot create daughter cells (although they can repair themselves) as is the case with neurons in the brain, heart muscle cells and skeletal muscle cells.  Sometimes, cellular reproduction goes awry and out of control often due to mutations in genes that control the cell cycle such as proto-oncogenes and tumor suppressor genes.  Proto-oncogenes increase cellular reproduction whereas tumor suppressor genes speed up cellular reproduction.  It is a balance between these genes that keeps the cell cycle healthy.  Mutations in proto-oncogenes turn these genes into oncogenes, which are now cancer causing genes, which causes these cells to rapidly create daughter cells that also contain the cancer genes.  This creates a tumor that with time can metastasize and spread to other parts of the body.  Bear in mind that not all tumors are cancerous and some cancers can be cured by your immune system.

Benign Tumors

Benign tumors are generally not cancerous and rarely a threat to life.  Often they can be removed without fear of growing back.  They generally become walled off by the immune system locally so they don’t spread to other tissues.

Malignant Tumors

Malignant tumors may become a threat to life.  They can be removed, however, they may return and it is possible for malignant tumor cells to spread to other tissues.  Most primary liver cancers originate in hepatocytes (liver cells) and this form of cancer is referred to as hepatocellular carcinoma (malignant hepatoma).  These cancer cells can spread by entering blood vessels within the liver or the lymphatic system ending up in other tissues or lymph nodes, respectively.  There are other cell types within the liver besides hepatocytes, which are responsible for other functions.

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Factors That Put You at Risk of Liver Cancer

Anytime someone is diagnosed with cancer, they wonder how it happened, what caused it.  Sometimes, the cause can be determined and other times it can’t.  However, there are certain risk factors that you may have that make you more susceptible to that disease.  Listed below are some risk factors for liver cancer that have been well researched.

  • Hepatitis infection:  This is the case if you have a hepatitis B or C infection.  It is possible for liver cancer to develop with long-term infection of these two viruses.  Hepatitis B or C is listed as the main cause of liver cancer globally.  Hepatitis B and C are contagious and easily passed from person to person through blood when sharing needles or having sexual contact.  You cannot get liver cancer from another person.  Liver cancer is not contagious!
  • Alcohol consumption:  It is reported that if you have two or more alcoholic drinks per day, this increases the risk of liver cancer.
  • Mold exposure:  There are certain types of toxins made by molds in particular aflatoxin that can cause liver cancer.  Aflatoxin is commonly found on crops such as peanuts, corn, coffee, cocoa, etc. This is more of problem in certain parts of Asia and less so for the U.S.  The FDA has set safety limits for aflatoxin.
  • Excess Iron:  There are certain individuals who have iron storage disease, which causes too much iron to be stored in the liver as well as other organs.  High levels of iron are toxic.
  • Cirrhosis:  This disease develops when hepatocytes are badly damaged and replaced with scar tissue.  Many things can cause cirrhosis from hepatitis B and C, alcohol abuse, drugs and parasites.
  • Diabetes and obesity: Studies indicate that diabetes and obesity may increase the risk of liver cancer.

It is generally understood that the greater the number of risk factors an individual carries, the greater the probability for developing liver cancer.  However, keep in mind that many individuals carry a number of known risk factors and never get liver cancer.

Know the Signs of Liver Cancer

As is the case with some other cancers, early forms of liver cancer may not demonstrate symptoms.  As the cancer begins to progress, patients may notice one or several of the symptoms below. Just because someone may be experiencing some of these systems doesn’t mean they have liver cancer:

  • Fever and fatigue
  • Weight loss with loss of appetite and feelings of fullness
  • Bloating with pain on the right side of the abdomen
  • Nausea and/or vomiting
  • Yellow skin/eyes and dark urine

The next step is for individuals to report these symptoms to your healthcare provider.

Liver Cancer, or something else?

For Individuals who have either presented with physical symptoms or have blood tests that indicate a possible liver issue, their doctor will try to find out what’s causing the problem.  He/she may use one or more of the following tests to gather more information.

  • Presenting with physical symptoms:  In this case, an individual will need to have a physical exam and blood tests. 
  • Physical exam and blood test previously done:  This is when some type of scan would be used such as CT scans (computerized tomography, X-ray), MRI (magnetic resonance imaging) or Ultrasound.
  • Biopsies:  This is generally not done, but in some cases it may be needed.

Liver Cancer Treatment

Once it has been determined that someone has liver cancer and what stage of development in the disease they are at, there are a number of treatment options, which include surgery, ablation, transplant, embolization, radiation and chemotherapy.  Often, certain combinations of therapies are applied if needed.  What treatment is administered depends on how many tumors are present, tumor size and actual location(s) within the liver.  It also depends on how well a person’s liver is currently functioning, if they have cirrhosis, and if the cancer has metastasized.  Liver cancer can only be cured if found early.

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Note: BioNews Texas does not provide medical advice, diagnosis or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.

DISCLAIMER: BioNews Texas is a publishing company that occasionally focuses on the clinical trials industry. The information provided in this article is designed to help educate patients on clinical trials that may be of interest to them, based on the topic of the story, and to help patients contact the centers conducting the research. BioNews Texas is neither promoting this research nor involved in conducting any of these trials. Some study summaries have been edited for clarity purposes to make them easier to understand.