Liver cancer

Liver cancer
Specialty	Oncology

Liver cancer is a cancer which starts in the liver, as opposed to a cancer which originates in another organ and migrates to the liver, known as a liver metastasis. For a thorough understanding of liver cancer it is important to have an understanding of how the liver functions. The liver is one of the largest organs in the body. It is located below the right lung and under the ribcage. The liver is divided into two lobes: the right lobe and the left lobe. Protein is obtained by the liver from the portal vein, which carries nutrient-rich blood from the intestines to the liver. The hepatic artery supplies the liver with blood that is rich in oxygen. Several distinct types of tumors can develop in the liver because the liver is made up of various cell types. Tumors that are cancerous are termed malignant and tumors that do not contain cancer cells are termed benign. Liver cancer thus consists of the presence of malignant hepatic tumors—tumors or growths on or in the liver (medical terms pertaining to the liver often start in hepato, or hepatic from the Greek word for liver, hēpar, stem hēpat-). Liver tumors may be discovered on medical imaging, which may occur incidentally to imaging performed for a different disease than the cancer itself, or may present symptomatically, as an abdominal mass, abdominal pain, jaundice, nausea or some other liver dysfunction.

Classification

There are several types of benign liver tumor:

• Hemangiomas: These are the most common type of benign liver tumor. They start in blood vessels. Most of these tumors do not cause symptoms, they do not need treatment. Some may bleed and need to be removed if it is mild to severe.
• Hepatic adenomas: These benign epithelial liver tumors develop in the liver and are also an uncommon occurrence. They are, in most cases, located in the right hepatic lobe and are frequently seen as solitary. The size of adenomas range from 1 to 30 cm. Symptoms associated with hepatic adenomas are all associate with large lesions which can cause intense abdominal pain. Over the last few decades there has been an increase with occurrences of this specific type of adenoma. The prognosis for these tumors has still not been mastered. Some correlations have been made such as malignant transformation, spontaneous hemorrhage, and rupture.
• Focal nodular hyperplasia: Focal nodular hyperplasia (FNH) is the second most common tumor of the liver. This tumor is the result of a congenital arteriovenous malformation hepatocyte response. This process is one in which all normal constituents of the liver are present, but the pattern by which they are presented is abnormal. Even though those conditions exist the liver still seems to perform in the normal range.

The American Liver Foundation founded 33 years ago; it gives great resources and support to patients and families battling with this prognosis. The American Liver Foundation claims that liver cancer is among the ten major causes of death. Knowing what the liver does and how important it is to human bodies can help to understand how serious liver cancer is, and ways people can help themselves be less likely to have this diagnosis.

Cancers that start in the liver

• Hepatocellular carcinoma (HCC): Patients who develop this cancer normally are in the younger population. This tumor also have 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. The cancers arised from the blood vessel cells in the liver are known has hemangioendotheliomas.
• Hepatoblastoma: Most of these tumors form in the right lobe. Children primarily develop hepatoblastoma.

Cholangiocarcinoma (bile duct cancers): Cholangiocarcinomas 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.

Causes

A 2009 study suggested that l-carnitine deficiency is a risk factor for liver cancer, and that supplementation with it could reduce the risk.

Japan being member of International Cancer Genome Consortium is leading efforts to map liver cancer's complete genome.

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.

Epidemiology

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

  no data

  less than 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

  more than 110

External links

• The Liver Cancer Web Page at Johns Hopkins University
• Liver cancer at Mayo Clinic
• Blue Faery: The Adrienne Wilson Liver Cancer Association