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General Surgery

Liver Cancer

Liver and bile duct cancers are types of cancer that develop in very closely related organs but possess different characteristics. The most common primary liver cancer is Hepatocellular Carcinoma (HCC), while Cholangiocarcinoma is the other significant type originating from the bile ducts.

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ℹWhat is Liver Cancer?

Hepatocellular Carcinoma (HCC)

HCC originates from hepatocytes, the main liver cells, and accounts for 75-85% of primary liver cancers. It typically develops on a background of chronic hepatic inflammation. Chronic Hepatitis B and C infections, cirrhosis, excessive alcohol consumption, and hepatic steatosis are the most important risk factors.

Cholangiocarcinoma (Bile Duct Cancer)

Originates from the epithelial cells lining the intrahepatic bile ducts. It constitutes approximately 10-15% of primary liver cancers. Due to its aggressive behavior, a multidisciplinary approach combining surgery, systemic medical oncology, and interventional techniques is typically required.

Common Symptoms

Abdominal Pain
Fullness-type pain in the right upper quadrant (HCC) or upper abdominal pain due to bile duct obstruction (Cholangiocarcinoma).
Jaundice
Yellowing of the sclera and skin, dark urine. The hallmark sign of bile duct obstruction in Cholangiocarcinoma.
Weight Loss and Loss of Appetite
Unintentional rapid weight loss, persistent fatigue, and significant loss of appetite.
Abdominal Swelling (Ascites)
Fluid accumulation in the peritoneal cavity, particularly associated with HCC.
Itching and Stool/Urine Changes
Significant itching of the skin due to the inability of bile to flow, darkening of urine color, and lightening of stool color.
Palpable Mass
Feeling a hard mass under the right ribs.

Diagnosis Methods

Laboratory Blood Tests
AFP (Alpha-Fetoprotein) as HCC tumor marker. CA19-9 and CEA for cholangiocarcinoma. Liver function tests (ALT, AST, GGT, Bilirubin).
Ultrasonography
Used as the initial imaging method and enables early-stage detection.
Dynamic Contrast-Enhanced MRI or CT
In HCC, LI-RADS classification achieves up to 95% diagnostic accuracy. In Cholangiocarcinoma, MRCP shows the bile ducts in detail.
Endoscopic Methods (ERCP)
Bile duct visualization, brush cytology biopsy, and stent placement in Cholangiocarcinoma.
Biopsy
US- or CT-guided needle biopsy in cases where imaging is inconclusive.

Causes

Chronic Hepatitis B and C Infections
Among the most important risk factors for HCC. Chronic inflammation leads to mutagenesis.
Cirrhosis
Chronic damage to liver tissue and its replacement by scar tissue increases the risk of HCC.
Excessive Alcohol Consumption
Prolonged alcohol use can lead to liver damage and eventually the development of HCC.
Hepatic Steatosis
Non-alcoholic fatty liver disease is an increasingly recognized risk factor for HCC.

Treatments

Surgical Resection
Removal of the tumorous tissue (HCC) or segmental/Whipple surgery (Cholangiocarcinoma). It is based on curative and full recovery goals.
Liver Transplantation
Total hepatectomy and transplantation option in early-stage HCC; transplantation after radio-chemotherapy in specific cases of cholangiocarcinoma.
Ablation Therapies
Radiofrequency Ablation (RFA), Microwave Ablation (MWA), and Cryoablation are applied in HCC cases not suitable for surgery.
Regional Therapies (TACE, TARE)
Direct chemotherapy is delivered to the vessel feeding the tumor with TACE. Radioactive microspheres are applied with TARE (Y-90).
Immunotherapy
Atezolizumab + Bevacizumab combination in HCC; Durvalumab or Pembrolizumab in Cholangiocarcinoma.
Targeted Therapy
Sorafenib and Lenvatinib in HCC. FGFR2 fusion and IDH1 mutation-targeted agents (e.g., Pemigatinib) in Cholangiocarcinoma.
Chemotherapy
Gemcitabine + Cisplatin combination is applied as the standard in Cholangiocarcinoma.
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