Liver Cancer

The liver is located in the upper right side of the abdomen in our body. Its weight is approximately 2% of a person’s body mass. There are various ligaments that keep the liver in place. The falciform ligament, round and coronary ligaments attach the liver to the anterior abdominal wall and diaphragm. Again, the right and left triangular ligaments play a role in the fixation of the liver in the right upper quadrant of the abdomen. The glisson capsule, which has a slippery texture, surrounds the outer part of the liver.

FIGURE: Ligaments of the Liver

Most of the blood entering the liver is through the V.Portae and then divides into portal branches in the liver. Another vein is Arteria Hepatica Communistir and it has a vital role in the nutrition of the biliary tract and liver. The hepatic veins are responsible for transporting the blood in the liver to the heart through the vena cava.

FIGURE: Vascular Anatomy of the Liver

The liver is divided into segments according to Couinaud. These segments are of great importance in liver surgery.

FIGURE: Segmental Anatomy of the Liver According to Couinaud

Approach to Liver Cancer

There are some risk factors for liver cancer. Having Hepatitis B and Hepatitis C virus, smoking, alcohol consumption, having a cirrhotic liver and fatty liver may contribute to the formation of liver cancer.

Symptoms of cancer can vary. It can manifest with various symptoms such as fatigue, weakness, fatigue, jaundice in the eyes, swelling in the abdomen and feet, meaningless speech, itching in the body.

There are some diagnostic scales to detect liver masses. First of all, some blood tests showing the liver function (AST, ALT, GGT, LDH, Albumin, INR, Total Bilirubin, Hemogram, AFP, CEA,

CA 19-9 ) are done and then tests continue with radiological evaluations such as Whole Abdominal Ultrasonography, Whole Abdominal CT, MRI, PET-CT and Endoscopic USG.

There are some benign and malign lesions of the liver.

Classification of Liver Tumors

Primary Benign Tumors

A-Epithelial tumors (Hepatocellular Adenoma, Focal Nodular Hyperplasia, Bile Duct Adenoma, Biliary Cystadenoma)

B- Mesenymal Tumors ( Lipoma, Angiomyolipoma, Hemangioma, Benign Mesothelioma )

C- Mixed Tumors (Mesenchymal Hamartoma, Teratoma)

Primary Malignant Tumors

A- Hepatocellular Carcinoma (Fibrolamels and Nonfibrolamels)

B- Cholangiocarcinoma

C- Hepatoblastoma

D- Mesenchymal Tumors (Angiosarcoma, Mixed Tumors, Rhabdomyosarcoma, Leiomyosarcoma and Neuroendocrine Tumors)

Metastatic (Secondary) Malignant Tumors (Colorectal and noncolorectal origin)

Hepatocellular carcinoma is the most common primary liver tumor, while colorectal carcinomas are the most common metastatic tumors.

FIGURE: PET-CT Liver Metastases

Treatments in Liver Cancers

The best treatment for liver tumors is surgical removal if they can be removed as liver cancers can be quite resistant to chemotherapy drugs. It is important to pay attention to some parameters when deciding on surgery. Clarifying the diagnosis of the masses in the liver of the patient, good physiology of the liver tissue, if the patient has cirrhosis, if yes what stage of cirrhosis the patient is in, if the coagulation system is within normal limits, and if the patient has additional diseases, if they have additional diseases their control can directly or indirectly affect the surgical procedure. In some liver cancers, the patient receives chemotherapy before the operation as a preparation for the surgery. Depending on the pathology of the specimen removed after the operation, systemic adjuvant chemotherapy, TACE and TARE treatments may be required.

Surgical Treatments

The location of the masses, their size and their close adjacency with the vasculars in the anatomical part, the surgeon should complete the surgery according to oncological surgery procedures by using the ultrasonography device during the liver surgery, after making a good evaluation with the radiological tests before the surgery.

Especially in metastatic tumors of the liver, metastasectomy can be performed within the surgical rules for all metastases,