Liver Tumors
 
Liver cancer is a type of cancer that originates from cells in the liver. Liver; It is located in the upper right part of the abdomen below the diaphragm, above the stomach. Many different types of cancer can develop in the liver. The most common type of liver cancer is hepatocellular carcinoma. 18,000 new primary liver cancers are seen annually in America. Other types (such as intrahepatic cholangiocarcinoma, hepatoblastoma) are less common.
Cancers that have spread to the liver are more common than cancers originating from liver cells. Cancer; It begins in another area of ​​the body such as the colon (large intestine), lung or breast, and after it has spread to the liver; liver cancer is called metastatic cancer rather than its name. These types of cancers are referred to by the name of the organ from which they originated (such as "metastatic colon cancer" when cancer originated from the large intestine and spread to the liver). The most common tumors that metastasize to the liver are colon cancers, and although surgery is primarily considered in the treatment, there are also different treatment options for patients who are not suitable for surgery.
 
 
Signs and Symptoms
 
Most people do not show any signs or symptoms in the early stages of primary (liver originating) cancers. When signs and symptoms occur, they may include:
 
Weight loss for uncertain reason
Loss of appetite
Upper stomach pain
Nausea-vomiting
General weakness and fatigue
Abdominal bloating
Yellow discoloration of the skin and whites of the eyes (jaundice)
White, lime-like stools

 

Reasons
 
Liver cancer occurs when changes (mutations) develop in the DNA of liver cells. One consequence of this is that the cells begin to grow out of control and eventually form a tumor, a mass of cancerous cells. As with chronic hepatitis infections, the cause of liver cancer is sometimes known. However, sometimes liver cancer occurs in people who do not have the underlying disease, and it is not clear what causes it.
 
Risk factors
 
Risk factors that increase the risk of primary liver cancer include:
 
Chronic Hepatitis-B (HBV) and Hepatitis-C (HCV) infections.
Cirrhosis.
Some hereditary liver diseases. Inherited liver diseases such as hemochromatosis (a genetic disease with iron accumulation in the liver) and Wilson's disease (a genetic disease with copper accumulation in the liver) can increase the risk of developing liver cancer.
Diabetes (Diabetes). People with blood sugar disorders and irregularities have a higher risk of liver cancer compared to other people.
Non-alcoholic fatty liver disease. Fat accumulation in the liver increases the risk of liver cancer.
Aflatoxin exposure. Aflatoxins are poisons produced by molds growing on poorly stored crops. It can be found in crops such as cereals and nuts.
Excessive alcohol consumption.
 
 
Diagnosis
 
First of all, the patient's history and physical examination are evaluated for diagnosis. Then laboratory tests are requested. (Complete blood count, biochemical parameters, and tumor markers). And radiological imaging tests are applied. These can be ordered as ultrasonography (USG), Computed Tomography (CT), Magnetic Resonance (MR), Positron Emission Tomography (PET). As a result of these examinations, if it is thought that the mass in the liver originates from another organ (metastasis), endoscopy or colonoscopy may be requested. If there is no additional focus, it is thought to originate mainly from the liver.

 

Liver Cysts
 
Liver cysts occur in about 5% of the population. However, only about 5% of these patients develop symptoms. Generally, cysts are thin-walled structures containing fluid. Most cysts are single, but some patients may have several. They are generally benign.
 
 
Symptoms
 
Symptoms associated with liver cysts include a feeling of fullness, discomfort or pain in the upper abdomen. In a small number of patients, bleeding occurs into the cyst, which can cause sudden and severe right upper quadrant and shoulder pain. The bleeding stops spontaneously and the pain resolves over the next few days. Liver cysts do not impair the liver's ability to function.
 
 
Diagnosis
 
Cysts (or cysts) are usually found by ultrasound (USG) or computed tomography (CT).
 
 
Treatment
 
The only group of patients who need treatment for liver cysts are those who show symptoms. Removing fluid from the cyst with a needle is not effective because the cyst fills up again within a few days. The best treatment is to remove most of the cyst wall. This surgical procedure can usually be done by laparoscopic (camera surgery) or open surgery, which consists of only 2-3 small incisions. Most patients recover completely within 2 weeks. The risk of recurrence of the cyst is very low.

 

Cystic Tumors
 
Unlike simple liver cysts, cystic tumors are actually formations that can become malignant over the years. The most common benign cystic tumor is called cystadenoma; its malignant version is called cystadenocarcinoma. Symptoms caused by cystic tumors are the same as those seen with simple cysts; fullness, discomfort, and pain. Liver blood tests usually remain normal unless cancer develops. Ultrasound and Computed Tomography scans are the best imaging studies that show cystic tumors containing both liquid and solid areas. Cystic tumors should be completely removed by an open (laparoscopic / non-camera) surgery due to the possibility of malignancy. Postoperative recurrence rate is very low and the long-term prognosis of the disease is very good.
 
Liver Hydatid Cyst (Ekinococcosis / Dog Cyst)
 
Human echinococcosis is a zoonotic (transmitted from animals to humans) disease caused by parasites, namely tapeworms of the genus Echinococcus. Patients become infected with food and water contaminated with parasite eggs, and the parasite later transforms into larval stages in the internal organs.
 
 
Signs and Symptoms
 
Human infection with echinococcus leads to the development of one or more hydatid cysts, most commonly found in the liver and lungs and less commonly in the bones, kidneys, spleen, muscles, and central nervous system. The asymptomatic (asymptomatic) incubation period of the disease can last for many years until the hydatid cysts become large enough to trigger clinical symptoms; however, about half of all patients who receive medical treatment for infection must receive this treatment within a few years of initial infection with the parasite. When cysts form in the liver, abdominal pain, nausea and vomiting are usually seen. Non-specific symptoms include loss of appetite, weight loss, and weakness.
 
 
Diagnosis
 
Diagnostic ultrasonographic imaging is the first preferred technique. This technique is usually complemented or confirmed by computed tomography (CT) and / or magnetic resonance imaging (MRI) scans. Cysts can be seen incidentally with radiological imaging. Antibodies developed by the body against the parasite are detected by different serological tests (blood tests to detect parasite-specific antibodies) and can support the diagnosis.
 
Treatment
 
Treatment requires extensive surgery, interventional radiological methods and / or long-term drug therapy, depending on the condition of the cysts. There are 4 options for cystic echinococcosis treatment:
 
Percutaneous treatment of hydatid cysts with PAIR (Puncture, Aspiration, Injection, Re-aspiration) technique. (After entering from the outside with a needle and catheter, reaching the cyst and draining the cyst content, parasite-killing fluids are injected and the contents are emptied again)
Surgery (surgical removal of the cyst)
Anti-parasitic drug therapy
"Follow and wait" method. (The progression rate and course of the disease is followed at regular intervals and a treatment strategy is applied according to these conditions)
The choice of treatment should be based primarily on ultrasound images of the cyst with an approach specific to the stage of the disease, as well as existing medical infrastructure and human resources.
 
Early diagnosis and radical (tumor-like) surgery for alveolar echinococcosis; then preventive treatment with albendazole (an anti-parasite drug) remains the key. If the mass-like formation is limited, radical surgery may be curative. Unfortunately, many patients are diagnosed with the disease at an advanced stage. Consequently, frequent recurrences will occur if palliative (supportive or survival-enhancing rather than cure) surgery is performed without complete and effective anti-parasite therapy.