What is Liver Hemangioma?

It is the most common benign liver tumor seen in women aged 30-70 years. They are encapsulated tumors that enlarge like varicose veins and contain vascular structures.

They occur in more than one number in 40% of patients. They can be found equally throughout the liver. They are usually less than 5 cm in diameter. Those larger than 5 cm in diameter are called giant hemangiomas.

In most patients, their dimensions at the time of diagnosis do not change during follow-up. However, rapid growth can be seen in some cases.

They are often seen incidentally during surgery or imaging methods (USG, computed tomography). Giant hemangiomas may cause complaints such as early satiety and jaundice by pressing on the surrounding organs.

In addition, abdominal pain may occur due to the tension created in the liver membrane. Although rare, hemangiomas located close to the liver margins may rupture due to trauma or spontaneously.

In cases where there is no suspicion of cancer, if the patient does not have any complaints, hemangiomas can be followed at long intervals. Those who are symptomatic, those with compression findings and those who grow rapidly should be operated.

Additionally, individuals at risk for trauma (eg, athletes) should be treated surgically.

It is possible to remove them so that the liver tissue is preserved. In rare cases, liver transplantation may be required in giant hemangiomas that cannot be surgically removed.

Is Hemangioma in the Liver dangerous?

Although liver hemangiomas may vary from patient to patient to a certain extent, they are generally considered to be among the non-dangerous disease groups. There is a belief among the people that this disease can cause liver cancer if left untreated. Although this belief is a relatively common belief, no evidence has been found in the medical literature regarding the accuracy of this situation.

Does liver hemangioma turn into cancer?

Although many studies are currently being conducted on this condition, there is no conclusive evidence that untreated liver hemangiomas can lead to liver cancer. People who suffer from liver hemangiomas rarely show any signs of illness and often get better on their own without the need for any treatment. There is no evidence that it causes liver cancer in cases where it does not heal.

Does the hemangioma in the liver go away on its own?

Liver hemangioma disease is generally known as a disease that does not show any symptoms and can be healed without any treatment. This may vary from patient to patient. In some patients, the mass found in their liver may enlarge and treatment may be needed. However, when past data are examined, it can be said that this disease, that is, hepatic hemangioma, tends to heal on its own most of the time.

LIVER ADENOMA

It is a liver disease in which oral contraceptive use and female gender stand out as risk factors. Liver Adenomas are well-circumscribed, soft tumors with areas of necrosis and bleeding on the cross-sectional face.

Approximately 50% of patients complain of abdominal pain. It can cause spontaneous disintegration at a rate of approximately 30% and associated life-threatening intra-abdominal bleeding.

Patients may present with a mass in the liver or they may be detected incidentally in ultrasonography or computed tomography. Biopsy should not be performed due to the risk of bleeding.

The adenoma may shrink with discontinuation of oral contraceptive drugs. However, it should be surgically removed after diagnosis because of the risk of transformation into cancer and life-threatening bleeding.

Focal Nodular Hyperplasia (FNH)

It is the second most common benign liver tumor, usually diagnosed incidentally. They consist of sheathed pale nodules, usually 5 cm. They are younger than 20-30 years old, it is most common in women aged 20-30.

They often do not cause any symptoms. It is blamed for vague abdominal pain in approximately 10% of patients.

If there is no increase in the diameter of the FNH in regular follow-ups and it is smaller than 5 cm, they are not operated.

Lesions that are suspicious for malignant tumors, cause compression findings, and tend to grow should be surgically removed.

Liver Hydatid Cyst

The cause of Liver Hydatid cyst is a parasite named E. Granulosus. It is most commonly located in the liver and most commonly in the right lobe of the liver. It is a public health problem in areas where animal husbandry is intense.

Those who keep pets without providing the appropriate conditions, those who are engaged in animal husbandry and do not provide the necessary hygienic conditions, and those who consume foods that are not related to animals but prepared in unhygienic conditions are at risk for the development of hydatid cyst.

The agent forms a fluid-filled cyst in the liver over time. In the fluid in this cyst, there are ‘daughter cysts’ that can form new cysts wherever the cyst reaches, in case of rupture. Cysts can open into the abdomen, biliary tract, and chest cavity.

Simple cysts usually do not cause symptoms, and when they do, the most common complaint is abdominal pain.

When the cyst becomes infected, opens into the abdomen, thoracic cavity, bile ducts or presses on other organs, it causes results ranging from symptoms such as fever, jaundice, chills to life-threatening conditions, which we call shock, in addition to abdominal pain.

Although drug therapy is started first, the main treatment is surgery, since most patients do not respond to drug therapy. The surgical method to be chosen is determined depending on the patient’s condition and the stage of the cyst.

In recent years, especially in some selected and suitable patients who are diagnosed early, successful results have been obtained by evacuating the cyst with the help of a needle inserted through the skin, accompanied by imaging methods, and injecting alcohol into it.

Hydatid cyst emerging by the multilocularis is much more severe. The cyst has no capsule. It has the feature of continuous growth and progression to the surrounding organs.

The liver is completely filled with small and large cysts. Just like a malignant cancer, it grows and spreads to the surrounding organs and bile ducts.

The most important factor in the success of the treatment is the surgical removal of the disease before it progresses to organs other than the liver and biliary tract.

Surgical treatment is extremely difficult. Resection (surgical removal procedure) should be performed in patients with early diagnosis. Liver transplantation is a treatment option in unresectable patients.

Liver Abscess

It is a disease that manifests itself with abdominal pain (on the right upper side of the abdomen), high fever (39-40°C), chills and sweating, sometimes jaundice, loss of appetite, sepsis (advanced infection findings) in delayed patients, and shock associated with it.

It is usually seen in those who have any infection focus in the abdomen (for example, delayed appendicitis), inflammation of the gallbladder or main biliary tract, and parasitic cysts in the liver (hydatid cyst).

Antibiotic therapy should be started as soon as possible after diagnosis. Antibiotherapy alone may be sufficient in patients with amoebic abscesses.

Today, non-surgical catheter placement with ultrasonography is preferred as the first step in draining the abscess. In patients for whom this treatment is not sufficient, it is necessary to surgically drain the abscess as soon as possible.

Liver Metastasis

The spread of cancer in any part of the body from the place of origin (organ) to another place is called metastasis of that cancer. The occurrence of these metastases in the liver is called liver metastasis.

The liver is a large organ that filters the blood. Therefore, cancer cells that enter the bloodstream get stuck in this organ and continue to grow.

Especially since the blood coming from the digestive system (intestines) first passes through the liver, liver metastases of cancers belonging to these regions are common.

Liver metastases are common in cancers of organs such as the large intestine, stomach, pancreas, biliary tract, and small intestine. Metastases from breast cancer, lung cancer and lymphoma are also common.

Diagnosis in Liver Metastases

Diagnosis is easier if there is widespread metastasis in the liver. The liver is enlarged and painful on examination. Some laboratory tests of the liver (alkaline phosphatase and transaminases) are elevated.

The main diagnosis is made by visualization of masses of metastases in the liver by imaging methods. It is easy to diagnose metastasis if the primary focus of cancer is known.

However, if it is not known, it is difficult to distinguish these liver masses from primary liver cancer, for this it may be necessary to take a biopsy from the liver masses.

Treatment of Liver Metastases

Treatment of liver metastases depends on where the spread is from (which organ cancer belongs to), the extent of the event (how many metastases are in the liver), the location of the metastases in the liver, and the spread (whether or not there is metastasis) elsewhere than in the liver.

Lymphomas, in particular, can be treated with certain combinations of chemotherapy. Breast and lung cancers benefit partially from chemotherapy.

In terms of the treatment of liver metastases, it is necessary to separate the metastases of large intestine (colorectal) cancer.

Colorectal cancers frequently metastasize to the liver, and surgical removal of liver metastases is very important in terms of treatment.

What are the symptoms of liver metastases?

Considering the most common symptoms of liver metastasis today, it can be said that these symptoms are generally loss of appetite, weight loss, indigestion, pain, nausea and a feeling of fullness in the abdomen in the early stages. In the later stages of the disease, symptoms such as accumulation of water in the abdomen, dark color in the urine, yellowing of the whites of the eyes, and jaundice in more advanced stages may be seen.

Is liver metastasis operated?

Within the possibilities offered to us by today’s modern medical technologies, significant success can be achieved for liver metastasis, especially with surgical treatment. Thanks to the surgical treatments applied for this disease, the lifespan of the patients can be extended for an average of 4 years to 10 years. It is known that the success rate is thirty percent.

Treatment of Liver Metastases of Colorectal (Large Intestine) Cancers

Colon cancer is a very common type of cancer. Approximately one-third of these patients have metastases to the liver at the time of diagnosis.

In about another third, metastases occur in the liver during the follow-up of the disease. Presence of liver metastases is the most important factor limiting the life of these patients.

Surgical removal of colorectal cancer metastases in the liver is an important form of treatment that significantly prolongs the survival of these patients. However, it is not possible to surgically remove every liver metastasis.

The number, location, distribution of the metastasis in the liver, its diameter, whether it can be removed with a safe margin, the presence of disease outside the liver are effective methods in such a surgical intervention decision.

While the life expectancy is very limited in non-surgical liver metastases (5-year survival approx. 10%), long-term survival (5-year survival 40-50%) is possible in patients whose liver metastasis(s) can be properly removed.

In cases that have been surgically removed, recurrence (recurrence of the disease) may occur in both the liver and liver. In order to prevent such risks, it is necessary to apply an appropriate chemotherapy together with surgery.

Sometimes, when detected, metastases that cannot be surgically removed can be shrunk and retracted into surgical margins with appropriate chemotherapy combinations.

In some suitable cases, part surgery and part other assistive modalities (eg, radiofrequency ablation) may be used. In cases where surgery cannot be performed, the only method is chemotherapy.

This can be done systemically or locally, only for the liver. In this case, the decision should be made by the surgeon, oncologist and patient together.

Surgery in Other Cancer Metastases

Today, only the surgical treatment of liver metastases of colorectal cancers can be mentioned as a standard.

However, in very suitable and well-selected cases, it is possible to successfully remove liver metastases from tumors such as breast, stomach, some pancreatic tumors, some tumors secreting hormones, some tumors originating from the testis and ovary, and some kidney tumors, and prolong the expected life span, in line with the oncology view.

Does liver cancer get better with chemotherapy?

It is known that chemotherapy treatment can be applied successfully for liver cancer, although it may vary depending on the situation. Although surgical methods are generally preferred for this disease, it is known that significant success is achieved when chemotherapy and radiotherapy treatments are applied simultaneously for patients whose cancer has spread or the tumor is in advanced stages.

Metastasis Surgery with Interdisciplinary Joint Planning

Treatment of hepatopancreatobiliary tumors is discussed and planned multidisciplinary. Hepatobiliary surgeon, gastroenterology, medical oncologist, interventional radiologist, radiation oncologist and physicians from diagnostic radiology are all part of this multidisciplinary structure.

For our patients with liver metastases due to colon cancer, surgical treatment of metastases makes a huge difference in life expectancy.

For these patients, planning can be made within the framework of all kinds of oncological-based considerations in order to clear the metastases. Some of these approaches are;

• Simultaneous large intestine and metastasis surgery,
• Metastasis surgery after chemotherapy before surgery

Metastasis surgery after liver volume expander procedures with interventional radiology support in multiple or large metastases

It can be summarized as simultaneous surgical removal of metastases and radiofrequency ablation applications in appropriate patients.

References: YAVUZ, H. S., TAMAM, M. Ö., OZCEVİK, H., YAVUZ, A., & MÜLAZIMOĞLU, M. Karaciğer Hemanjiomu Tanısında Tc-99m İşaretli Eritrosit Sintigrafisinin SPECT/BT ile Değerlendirilmesi. İstanbul Gelişim Üniversitesi Sağlık Bilimleri Dergisi, (19), 98-109.