Liver cancer: keys to detection, treatment, and prevention

The most well-known cancers, such as breast and lung cancer, enjoy high social awareness. However, there are other types of cancer that, although less common, are also common. This is the case with liver cancer, which encompasses a heterogeneous group of tumors that develop in this organ. In this type of cancer, liver cells become abnormal, grow uncontrollably, and eventually form a tumor.

Dr. Alba Díaz, a pathologist at Hospital Clínic Barcelona , ​​explains: "There are different types of liver cancer, and this depends on the cell from which it originates." The most common type is hepatocellular carcinoma. In fact, nearly 6,000 new cases are diagnosed in Spain each year, and its incidence continues to rise. Other tumors, such as cholangiocarcinomas, represent less than 10% of primary liver cancers.

Patients with cirrhosis are at greatest risk of developing liver cancer. Doctor Marta Reig Hepatologist at Hospital Clínic Barcelona

How is liver cancer detected and what factors increase the risk of liver cancer?

Hepatocellular carcinoma is a very silent tumor, and its symptoms usually appear when the disease is already advanced. The most common include fatigue, increased abdominal girth due to fluid retention, a yellowish tinge to the skin, continuous, low-intensity abdominal pain, and loss of appetite and weight. To detect the disease early, it is essential to include patients at risk of developing it in early diagnosis programs, such as a biannual abdominal ultrasound. These patients are primarily those with chronic liver disease.

This disease can lead to liver cirrhosis , which in turn increases the risk of developing liver cancer. Dr. Marta Reig, a hepatologist at Hospital Clínic Barcelona, ​​states: "Patients with cirrhosis are at greatest risk of developing liver cancer." This risk is particularly high in patients with hepatocellular carcinoma. In contrast, cholangiocarcinoma can occur in patients without any known risk factors.

What are the therapeutic options for liver cancer?

Liver cancer treatment is based on the stage of the tumor, associated diseases, and the specific technical characteristics of each therapeutic option. Once a diagnosis is made, a multidisciplinary committee evaluates each case to determine the best strategy.

The option with the greatest curative potential is surgery. This is what Dr. Josep Fuster, a surgeon at Hospital Clínic Barcelona, ​​points out: "Surgical treatment of liver cancer is fundamental because it is curative." Among the most commonly used interventions is surgical resection, which aims to completely eliminate malignant cells. This procedure is indicated for patients with a single focus.

Surgical treatment of liver cancer is essential because it has a curative purpose. Dr. Josep Fuster, Surgeon at the Hospital Clínic Barcelona

Another therapeutic option for hepatocellular carcinoma is liver transplantation, indicated when surgical resection is not possible safely or in patients with multiple tumors. However, this procedure is not recommended for cholangiocarcinoma due to the high risk of post-transplant recurrence.

In patients in the early stages, and when both surgical resection and transplantation are contraindicated, percutaneous ablation can be used. This technique destroys the tumor using needles and various energy-delivering technologies. Another surgical option is chemoembolization, which involves administering a chemotherapy agent through the hepatic artery that feeds the tumor. This technique, however, has not been shown to be effective in the treatment of cholangiocarcinoma.

Another therapeutic approach is systemic treatment. Dr. Jordi Bruix, a hepatologist at Hospital Clínic Barcelona, ​​explains: "When the disease is more advanced, we move on to systemic treatment, which attempts to slow disease progression." In these cases, conventional therapy has not demonstrated significant clinical benefit. In contrast, drugs such as sorafenib have demonstrated their ability to slow tumor cell proliferation. In the case of cholangiocarcinoma, the only treatment that has demonstrated significant efficacy is combination chemotherapy with gemcitabine and cisplatin.

How does tumor stage affect the prognosis of liver cancer?

The prognosis for liver cancer depends largely on the stage of the tumor at diagnosis and its response to treatment. When detected in early stages and treated surgically, cure is possible, with five-year survival rates exceeding 70%. In patients with intermediate stages, treatment with chemoembolization allows an average survival of between two and a half and three years. In contrast, in advanced stages, the median survival is usually slightly over one year.

Considering these data, prevention is essential. Adopting healthy habits is key: avoiding obesity, reducing alcohol consumption—one of the main causes of developing chronic liver disease and hepatocellular carcinoma—and maintaining good hygiene practices to avoid contracting hepatitis B and C. These recommendations also apply to people who already have the disease, as they can contribute to a better prognosis.