Liver Cancer (Hepatocellular Carcinoma)


Definition

  • Hepatocellular carcinoma is cancer of the liver.

Causes, incidence, and risk factors

  • Hepatocellular carcinoma accounts for most liver cancers. This type of cancer occurs more often in men than women. It is usually seen in people age 50 or older.
  • The disease is more common in parts of Africa and Asia than in North or South America and Europe.
  • Hepatocellular carcinoma is not the same as metastatic liver cancer, which starts in another organ (such as the breast or colon) and spreads to the liver.

In most cases,  liver cancer occurs in the setting of scarring of the liver (cirrhosis). Cirrhosis may be caused by:

Patients with hepatitis B or C are at risk for liver cancer, even if they have not developed cirrhosis.


Symptoms

  • Abdominal pain or tenderness, especially in the upper-right part
  • Enlarged abdomen
  • Yellow skin or eyes (jaundice)

Signs and tests

Physical examination may show an enlarged, tender liver.

Tests include:

Patient with cirrhosis should get regular blood tests and ultrasounds to see whether tumors are developing.


Treatment

  • Aggressive surgery or a liver transplant can successfully treat small or slow-growing tumors if they are diagnosed early. However, few patients are diagnosed early.

Chemotherapy delivered straight into the liver with a catheter can help, but it will not cure the disease. Radiation treatments in the area of the cancer may also be helpful. However, many patients have liver cirrhosis or other liver diseases that make these treatments more difficult.



Sorafenib tosylate (Nexavar), an oral medicine that slows tumor growth, is now approved for patients with advanced hepatocellular carcinoma.

 

Expectations (prognosis)

The usual outcome is poor, because only 10 – 20% of hepatocellular carcinomas can be removed completely using surgery.

If the cancer cannot be treated, the disease is usually fatal within 3 – 6 months. However, survival can vary, and occasionally people will survive much longer than 6 months.

Prevention

Preventing and treating viral hepatitis may help reduce your risk. Childhood vaccination against hepatitis B may reduce the risk of liver cancer in the future.

Avoid drinking excessive amounts of alcohol.

People with elevated iron levels may benefit from screening for hemochromatosis.

If you have chronic hepatitis or known cirrhosis, periodic screening with liver ultrasound or measurement of blood alpha fetoprotein levels may help detect this cancer early.