End-stage liver cancer

introduction

Liver cancer is a malignant tumor that ranks fifth among the most common tumors worldwide.
Typically, a liver tumor develops from an underlying liver disease, such as cirrhosis of the liver or chronic inflammation of the liver, such as hepatitis. However, the tumor is often recognized very late due to the few symptoms.

End-stage symptoms

Unfortunately, liver cancer itself has very few symptoms and hardly any symptoms in the early stages. This is one reason why, in many cases, liver cancer is only diagnosed at an advanced stage and then quickly progresses to the terminal stage. In the end stage, the impaired or lost function of the liver is the biggest problem. Normally, the liver is used for the formation of many important metabolic products, as well as for detoxification and excretion of all waste products of the body. If this function is lost, the severe symptoms of end-stage liver cancer result.

The most common symptoms experienced by patients with end-stage liver cancer include water in the abdomen or an increase in abdominal girth, itchy or burning skin, weight loss, loss of appetite, tenderness in the right upper abdomen, or yellowing of the skin and eyes. One should always bear in mind, however, that the end stage of liver cancer cannot be identified solely on the basis of symptoms.

For more interesting information about liver cancer and its symptoms even in its earlier stages, read our following article: Liver cancer symptoms

Water in the stomach

Almost all patients with advanced liver cancer have water in their abdomen or, as it is known in technical terms, ascites or ascites during the course of the disease.
In liver cancer, the water in the abdomen is a result of disturbed metabolic processes and a change in the pressure conditions in the abdomen. The water often only causes problems when large amounts accumulate in the abdomen and the abdominal circumference increases significantly. Small amounts of water in the abdomen can be flushed out with the help of medication. However, if patients have a lot of water in their abdomen, or if there is already severe pain due to the increase in abdominal girth, a puncture must be performed through which the abdominal fluid is slowly drained.

Please also read our topic: Puncture water in the abdomen and Pain after a puncture

Yellow skin

The yellowing of the skin and often of the eyes is called jaundice in technical terms.
This jaundice is due to a certain protein in our body, which is stored in the liver under normal circumstances and then excreted through the intestine, the so-called bilirubin. However, if the liver or the biliary tract is diseased, the bilirubin can no longer be excreted. As a result, the bilirubin is deposited in other parts of the body, especially the skin and sclera of the eyes (usually the whites of the eyes), where it is responsible for the yellowing. Jaundice is not a compelling symptom of liver cancer and can occur with other diseases as well. In end-stage liver cancer, however, almost all patients have had jaundice at least once in the course of the disease.

For more information on the subject, read our article: Jaundice

Vomit

Vomiting is a symptom that occurs in a number of diseases and is actually supposed to help the body get rid of toxic substances.
In liver cancer, vomiting is often very strong, as the liver disease also eliminates the detoxification function. As a result, there are many proteins and substances floating around in the body that are harmful to the body and from which it would like to get rid of. These substances and proteins now increasingly irritate the vomiting center in the body and regular and severe vomiting occurs.

Please also read: Anti-vomiting medication

Pain

Liver cancer pain is a typical sign that the disease is progressing and occurs more frequently in the end-stage of the cancer.
The pain is particularly evident in the right upper abdomen and can also radiate from here to other parts of the body. Often times, the pain associated with cancer of the liver is a sign that the cancer has outgrown the liver or is affecting other organs. Metastases from liver cancer, which occur particularly in the end stages, can also cause severe pain. The main focus here are the metastases in the bones, such as in the spine, which can lead to severe back pain.

You might also be interested in this topic: Pain in the upper right abdomen

Life expectancy

The life expectancy of liver cancer is strongly dependent on the stage and accompanying diseases.
In general, the prognosis of liver cancer is rather poor despite the many therapeutic options. Not only the tumor in the liver causes problems, but the loss of liver function that almost always goes along with it, greatly reduces the remaining life expectancy. Even middle-stage liver cancer, for which many treatment options are still available, has a median survival time of approx. 12-18 months. End-stage liver cancer, in which the cancer and the breakdown of the liver are so advanced that only palliative therapy is considered, the median survival is just around three months.

Course of the final stage

The course of the final stage is very individual and basically depends on other illnesses and living conditions. In frequent cases it happens that those affected fall into a so-called liver coma in the end stage. This is another consequence of the loss of liver function. In addition to many other products, the liver also breaks down the protein ammonia in a healthy state, which is otherwise toxic for the body and especially for the brain. If this detoxification process of the liver ceases to exist, more and more potentially toxic metabolic products collect in the body, including ammonia, which gradually leads to damage to the brain. At the beginning, this only manifests itself through poor concentration and increasing tiredness, over time confusion and severe attention disorders often appear. In the end, then, finally, the unconsciousness occurs, which passes into the coma.

What can be done about terminal symptoms?

In the end-stage of cancer, the focus is always on palliative therapy with the principle of so-called "best supportive care".
This means that you do not continue to treat or try to stop the underlying disease, but only alleviate the patient's symptoms and discomfort. In liver cancer, pain and nausea are in the foreground. In addition, drug therapy for the itching and slowly progressing hepatic coma may be necessary.
In addition to drug therapy for the symptoms, palliative therapy always includes psycho-oncological care or pastoral care.

Read about this: Palliative therapy for liver cancer.

Is there a cure?

A cure for liver cancer is possible in some cases if the cancer is found at a very early stage and it is easily accessible in an operation and can therefore be easily removed.
End-stage liver cancer, on the other hand, can no longer be cured. Unfortunately, the cancer and the breakdown of the liver in this case are too advanced to be cured.

More information on this topic: Therapy for liver cancer

Diagnosis

A series of examinations and tests are carried out to precisely classify the stage of cancer in order to find the best possible therapy.
This includes, above all, the blood test. This involves looking for certain proteins that are formed in the liver in order to be able to assess the functional performance of the liver. There is also a certain protein (AFP), which can be regularly determined as a so-called tumor marker and provides information about the progression of the cancer.

In addition to blood tests, imaging tests are also an important part of assessing the stage of liver cancer. In addition to simple procedures such as ultrasound, complex procedures such as computer tomography (CT) or magnetic resonance tomography (MRT) are also used. The exact stage of liver cancer can only be assessed by looking at all of these test results together with the physically perceived symptoms.

Also read our article: Liver values