– Hepatocellular carcinomas are the most prevalent of the primary liver tumors, although cholangiocarcinomas, angiosarcomas, and hepatoblastomas also are seen.
Causes and Incidence
Chronic hepatitis B virus is a known etiologic agent. Hepatitis C virus, cirrhosis, and hemochromatosis are also associated with the development of liver cancer. Risk factors include ethanol abuse, anabolic steroid abuse, pesticide and herbicide exposure, and ingestion of food contaminated with fungal aflatoxins. The incidence of primary liver cancer in the United States is low, with approximately 15,000 cases diagnosed each year. Most of these individuals have underlying cirrhosis. In certain areas of Africa and Southeast Asia, however, liver cancer is the leading malignancy and one of the leading causes of death. Most are associated with hepatitis B infections.
Most cancer cells originate in the parenchyma and rapidly form a tumor that extends and invades adjacent structures such as the stomach and diaphragm. Metastasis occurs to the regional nodes, lung, bone, adrenal gland, and brain.
Abdominal pain, right upper quadrant mass, epigastric fullness, and weight loss are the most common presenting signs and symptoms. Systemic metabolic signs may include hypoglycemia, hypercalcemia, hyperlipidemia, and erythrocytosis.
The prognosis in liver cancer is grim; the survival rate is only about 5%. Complications include liver failure, gastrointestinal hemorrhage, and cachexia.
The alpha-fetoprotein blood value is elevated in 70% of cases; ultrasound and computed tomography scans can help visualize masses. A biopsy is needed for definitive diagnosis.
Resection of tumor is only a potentially curative modality.
Chemotherapy is experimental and not particularly effective to date.
Radiation cannot be given in sufficient doses to be effective; radiolabeled antibodies have been used, with limited success.