Liver cancer

Liver cancer
Classification and external resources
Left lobe liver tumor in a 50 year old male, operated in King Saud Medical Complex, Riyadh, Saudi Arabia
ICD-10	C22.9
ICD-9	155.2
MeSH	D008113

Liver cancer or hepatic cancer (from the Greek hēpar, meaning liver) is a cancer that originates in the liver. Liver cancers are malignant tumors that grow on the surface or inside the liver. Liver tumors are discovered on medical imaging equipment (often by accident) or present themselves symptomatically as an abdominal mass, abdominal pain, jaundice, nausea or liver dysfunction. Liver cancers should not be confused with liver metastases, which are cancers that originate from organs elsewhere in the body and migrate to the liver.

Classification

There are many forms of liver cancer, although many cancers found in the liver are metastases from other tumors, frequently of the GI tract (like colon cancer, carcinoid tumors mainly of the appendix, etc.), but also from breast cancer, ovarian cancer, lung cancer, renal cancer, prostate cancer, etc.

The most frequent liver cancer is hepatocellular carcinoma (HCC) (also named hepatoma, which is a misnomer because adenomas are usually benign). This tumor also has a variant type that consists of both HCC and cholangiocarcinoma components. The cells of the bile duct coexist next to the bile ducts that drain the bile produced by the hepatocytes of the liver. Cancers that arise from the blood vessel cells in the liver are known as hemangioendotheliomas.

As well as mixed tumors, rarer forms of liver cancer include:

• mesenchymal tissue
• Sarcoma
• Hepatoblastoma, a rare malignant tumor, primarily developing in children. Most of these tumors form in the right lobe.
• Cholangiocarcinoma (bile duct cancers), which account for 1 or 2 out of every 10 cases of liver cancer. These cancers start in the small tubes (called bile ducts) that carry bile to the intestine.
• Angiosarcoma and hemangiosarcoma: These are rare forms of cancer that start in the blood vessels of the liver. These tumors grow quickly. Often by the time they are found they are too widespread to be removed. Most patients do not live more than a year after diagnosis.
• Lymphoma of liver: A rare form of lymphoma that usually have diffuse infiltration to liver. It may also form a liver mass in rare occasions.

Signs and symptoms

Cholangiocarcinoma

• sweating
• Jaundice
• Abdominal pain
• Weight loss
• Hepatomegaly

Hepatocellular carcinoma

• Abdominal mass
• Abdominal pain
• Emesis
• Anemia
• Back pain
• Jaundice
• Itching
• Weight loss
• Fever

Causes

Risk factors for adults developing primary liver cancer:

• Hepatitis C is the primary cause of liver cancer.
• Chronic Hepatitis B infection
• Cirrhosis
• Aflatoxin exposure
• Obesity has emerged as an important risk factor as it can lead to steatohepatitis

Risk factors for children developing primary liver cancer:

• Alagille syndrome (associated with HCC)
• Beckwith-Wiedemann Syndrome (associated with hepatoblastoma)
• Familial adenomatous polyposis (associated with hepatoblastoma)
• Glycogen storage diseases (associated with both HCC and hepatoblastoma)
• Hepatitis B infection, associated when contracted in the perinatal period (with transmission at birth) (associated with HCC)
• Low birth weight (associated with hepatoblastoma)
• Progressive familial intrahepatic cholestasis (associated with HCC)
• Trisomy 18, as well as other trisomies (associated with hepatoblastoma)
• Tyrosinemia (associated with HCC)

Prevention

Since hepatitis B or C is one of the main causes of liver cancer, prevention of this infection is key to then prevent liver cancer. Thus, childhood vaccination against hepatitis B may reduce the risk of liver cancer in the future. In the case of patients with cirrhosis, alcohol consumption is to be avoided.

Management

A PET-CT scan may be suggested if doctors are considering surgery as a treatment. It gives more detailed information about the part of the body being scanned. The correct treatment of liver cancer can mean the difference between life and death. Not all patients with cancers in the liver are potentially curable. These are some of the treatments available: Surgery, Chemotherapy, Immunotherapy, Photodynamic Therapy, Hyperthermia, Radiation Therapy and Radiosurgery.

Hepatocellular carcinoma

• Partial hepatectomy to resect all of the tumor.
• Liver transplantation
• Cryoablation
• Chemoembolization
• Radiotherapy
• Sorafenib
• Radiofrequency ablation
• Radiofrequency ablation combined with local chemotherapy See: http://www.clinicaltrials.gov/ct2/show/NCT00617981?term=Thermodox&rank=3

Cholangiocarcinoma

• Photodynamic therapy
• Brachytherapy
• Radiotherapy
• Liver transplantation

Hepatoblastoma

• Chemotherapy, including vincristine, cyclophosphamide, and doxorubicin
• Radiotherapy
• Liver transplantation
• Surgical resection

Epidemiology

Age-standardized death from liver cancer per 100,000 inhabitants in 2004.

  no data

  <7.5

  7.5–15

  15–22.5

  22.5–30

  30–37.5

  37.5–45

  45–52.5

  52.5–60

  60–67.5

  67.5–75

  75–110

  >110

Globally as of 2008 liver cancer is the third leading cause of cancer death at 700,000 per year, after lung cancer (1.4 million deaths) and stomach cancer (740,000 deaths).

External links

• The Liver Cancer Web Page at Johns Hopkins University
• Liver cancer at Mayo Clinic
• Clinically reviewed liver cancer information for patients, from Cancer Research UK