The Liver: Digestive Function of the Liver, Circulatory Function of the Liver, Microscopic Structure of the Liver, Microscopic Structure of the Liver, How Liver Cancer Develops: Carcinogenesis: Initiation, Promotion, Growth of Cancer, How Cancer is Detected, Treatment of Liver Cancer.
The liver is the largest gland in the body weighing approximately 1500 grams and is located in the right hypochondrium i.e. right upper quadrant of the abdomen. It is glossy in appearance and dark red in color due to the rich supply of blood flowing through it. Approximately a quarter of the cardiac output flows to the liver. It performs diverse substantial functions:
1) The uptake, storage, and disposal of nutrients i.e. protein, carbohydrates and fat, drugs and toxins.
2) The production of synthetic proteins (critical for blood clotting).
3) Metabolism of substances produced by the body.
1- Digestive Function of the Liver
Sometimes referred to as the great chemical factory of the body, the liver creates regulates, and stores a variety of substances used by the gastrointestinal system and it serves a number of important digestive functions.
The main digestive chemical synthesized by the liver is bile. During a meal, liver cells secret the bile, which travels through the hepatic duct system into the small intestine where it is used to break down fat molecules.
Between meals, bile is stored in the gall bladder. Bile further serves as a waste disposal system for toxins removed from the blood by the liver.
The liver also plays a major role in the regulation of blood glucose. The liver synthesizes, dissolves, and stores amino acids, protein, and fat. It stores several important vitamins like B12 and Vitamin A. The liver also disposes of cellular waste and breaks down harmful substances, like alcohol.
2- Circulatory Function of the Liver
Though the liver is technically a part of the gastrointestinal system, it also plays an important role in blood circulation too. The liver has been called the antechamber of the heart because it collects and processes all of the gastrointestinal blood through the portal vein and delivers it to the right side of the heart. The liver receives blood through two vascular systems, the portal vein and hepatic artery.
Microscopic Structure of the Liver
When viewed under a microscope, the liver is seen as large network of units called hepatic lobules. The hepatic lobule is very small and looks like a six-sided cylinder.
The lobule itself is surrounded by connective tissue and has 5 to 7 clusters of vessels around its edges. These vessels include a branch of the portal vein, a branch of the hepatic artery, and a bile duct.
A central vein runs through the middle of the lobe and is surrounded by cords of liver cells that radiate out in all directions. Between these cords, there are wide thin-walled blood vessels called sinusoids. All of the blood drains into a hepatic vein, which then circulates throughout the body.
Below is a biopsy from a normal liver. The white arrows demonstrate the hepatic sinusoids and the dark arrow represents the portal pedicle. Blood flows into the liver through the portal pedicle, past the hepatic sinusoids (which contain normal liver cells called hepatocytes) into the central vein and then out of the liver.
How Liver Cancer Develops
Cancer is an uncontrolled replication of damaged cells. This condition usually produces a mass called a tumor. Cancer is the direct result of either a mutation of the cellular DNA or some sort of damage to the cellular DNA. For the cancerous cell to actually develop into a tumor, it must be able to grow and to replicate itself. A cancerous cell that cannot grow or make a copy of it will die or lie dormant for an extended period.
What actually causes genetic mutations or DNA damage is not yet completely understood, but several significant factors that encourage cancer development have been identified.
The liver is a common site of metastases from a variety of organs such as lung, breast, colon and rectum. When liver metastases occur at the time of initial diagnosis of the primary tumor, they are described as synchronous. If detected after the initial diagnosis, they are described as metachronous. The liver is frequently involved since it receives blood from the abdominal organs via the portal vein. Malignant cells detach from the primary cancer, enter the bloodstream or lymphatic channels, travel to the liver, and grow independently. Till now it is not understood the mechanism of how a tumor cell can leave the primary site and grow in specific organs. Virtually, the environment of the liver is suitable to the growth of certain tumor cells. Once a tumor begins to grow in the liver, it receives its blood supply from the hepatic artery and develops.
Carcinogenesis is a multistage process.
It begins when a carcinogen causes a genetic change or damages the DNA in a normal cell. This makes the cell more defenseless to other genetic changes. This stage is called “initiation.” If the process ended here, and the cancerous cell did not grow and replicate, no cancer would form.
The next stage of carcinogenesis is called “promotion.” This occurs when the initiated cell is exposed to an agent that enhances its growth into a larger mass.
When a tumor actually forms, it has all of the same basic needs as a normal cell. Because the tumor cells are genetically damaged, they are inefficient and deprive normal cells of important oxygen and nutrients. In addition, a malignant tumor grows uncontrollably and can eventually interfere with the function of vital organs, such as the liver.
Growth of Cancer
A small tumor no larger than 1 millimeter in diameter can sustain itself in such a manner indefinitely. But it cannot grow any larger unless the tumor itself begins to generate a network of blood vessels to help supply additional nutrients. A clinically detectable tumor is about 1 gram in weight and made up of at least 1 billion cells.
Metastatic tumors form when large progressive tumors shed off the tumor cells. These tumor cells must be able to grow and function apart from the primary tumor. Metastatic tumor cells move throughout the body, usually through the circulatory system or the lymphatic system. These cells often lodge in to a blood capillary, where they may or may not grow. The tumor cells that actually grow are somehow more suited to the new location. Metastatic tumor cells tend to mutate more quickly than normal cells, giving them a greater ability to adapt to their environment as well as a greater ability to resist therapy. These cells are more likely to infect places they can easily reach. Because the liver is close to or actually connected to several significant organs, and because the liver plays an important role in blood circulation by acting as a filter, metastatic liver cancer occurs in over 75% of all terminal cancer patients.
How Cancer is detected
Early stages of cancer can be asymptomatic and may go undetected for months or even years. When symptoms do develop, they are most pronounced as pain.
Pain associated with cancer is a result of several possibilities:
1- Invasion or destruction of normal tissue with cancer cells.
2- Stretching of internal tissue by tumor growth.
3- Pressure of tumor on an organ.
4- Blockage of a vital passageway by the tumor.
5- Infection caused by cancer.
Other symptoms may include loss of appetite, loss of weight, fever of unknown origin, limb weakness, sensory loss, or an absence of tendon reflexes in the limb.
Liver cancer, both primary and metastatic, often exhibits symptoms of general malaise as well as pain and tenderness. The discomfort is usually of a moderate degree and most often in the upper or upper right part of the abdomen. In more advanced cases, symptoms of jaundice, a yellowing of the skin and eyes, may also appear.
Treatment of Liver Cancer
There is no consensus regarding the optimal treatment of patients with liver tumors. This contributes to the pessimistic attitude that many have regarding the treatment of liver cancer. Aggressive treatment strategies can cure or significantly prolong the life of many patients with liver cancer.
1- Cholesterinum (ALLEN) – Description: – Ameke claimed to have derived great advantage from its use in cases diagnosed as cancer of the liver, or in such obstinate engorgements that malignancy was suspected. Burnett claims to have twice cured cancer of the liver with it, and “in hepatic engorgements that by reason of their intractable and slow yielding to well-sel ected remedies make one think interrogationally of cancer.” In such conditions, where the diagnosis is in doubt, especially if the patient has been subjected to repeated attacks of biliary colic, Cholesterinum, he claims, is very satisfactory and at times its action even striking.
For cancer of the liver.
Cholesterinum (BOERICKE)- Obstinate hepatic engorgements. Ameke, who did much to introduce the proximate principles of the tissues as remedies, anticipating the practice now so much in vogue in the old school, recommended Cholesterine as a remedy in cancer of the liver.
Cholesterinum (CLARKE) – Characteristics: – Burnett has recently adduced conclusive evidence in support of the correctness of this assertion; and I have myself cured, mainly with this, a case described to me (I did not see the patient, a man over 50) as in the last stage of liver disease.
He had been given up by his medical attendant, who ordered him to make his will without delay.
Burnett uses the 3x or the 3 trit. and substantial doses.
He commends it in “obstinate hepatic engorgements, which by reason of their obstinacy make one think interrogatively of cancer,” also in “cases in which there appears to be a semi-malignant affection, involving the left lobe of the liver and what lies between it and the pylorus and the pancreas.”
In such cases Burnett gives alternately Cholest. 3x and Iodoform 3x.
Like many other “yellow” medicines, it has a marked action on the liver, causing jaundice and liver enlargement.
Cases of cancer of the liver have been reported cured by it.
Fullness, goneness, and constipation are the leading indications.
Mohr (H. R., xiii. 210) gave Nit. ac. 3x to a man who suffered from cancer of the liver with bloody diarrhoea, followed by constipation; violent pains in stomach and liver; unable to sleep; or unable to take any food without much pain, mostly vomiting. “Burning in liver region” has led to the cure of abscess and even cancer of that organ.
2- Theridion curassavicum (CLARKE) – Characteristics – The symptoms are < by touch; pressure; on ship-board; riding in carriage; closing eyes; jar; least noise.
Lying = pain deep in brain; >> flickering before eyes. < Stooping; rising; motion; exertion, going up or down stairs; walking.
Left : slight heaviness in half of forehead; half of forehead feels higher than right; pain in temple; pain in eye; cancer on side of nose; pain in half of tongue; hard lumps in hypochondrium; pain radiates to shoulder; pain in epigastrium; lobe of liver attached to tumors; fossa supraclavicularis, indurated lymphatic glands; crack in angle of mouth; tumor in breast; dull, heavy pain in scapula; pain in shoulders; tingling in fingers while writing; pimples side of nose.
Continuous vomiting and straining to vomit.
3- Kreosotum (HERING) – Hiccough, Belching, Nausea and Vomiting- Sympathetic vomiting, as of phthisis, of cancer of liver or uterus, of pregnancy, and of chronic kidney disease.
Hepatic region painful to touch. Severe burning pain in cancer of liver (relieved).
Burning : in occiput; in cancer of liver; in abdomen and rectum; in palms and soles; in hypogastrium and uterus; leucorrhoea; in carbuncle on side of chest; in abscess on back of neck; in anthrax between shoulder blades; all over body, irritable spine; of skin.
Dr. Rajneesh Kumar Sharma