Liver cancer can be caused by a cancer that originates in the liver cells themselves, or by a cancer that originates elsewhere in the body and then spreads to the liver. This first type of liver cancer is called primary hepatocellular carcinoma, while the second type is called metastatic liver cancer.
The main risk factors for primary liver cancer vary around the world. The risk factors include:
1. Hepatitis B and chronic Hepatitis C
2. Liver flukes (a parasite that invades the liver tissue and liver bile ducts)
3. Alcoholic cirrhosis (the most common risk factor for primary liver cancer in the United States)
4. Aflatoxins (toxins produced by the Aspergillus mold that are found in peanuts, wheat, and other nuts and grains)
Common signs and symptoms of primary liver cancer include:
1. Unintentional weight loss
2. Abdominal pain
3. Abdominal mass in the upper right side of the belly
4. Jaundice (yellow skin) and scleral icterus (yellow eyes) in 50% of people with liver cancer
Metastatic spread of primary liver cancer:
Primary hepatocellular carcinoma usually spreads through one of 2 ways-
1. Lymph system- causing metasteses to the hilar and/or celiac lymph nodes
2. Circulatory system- through the portal vein or hepatic vein causing metastases in the lungs
Diagnosis of primary liver cancer:
When liver cancer is suspected it is diagnosed by abdominal ultrasound or abdominal computed tomography (CT) scan. Levels of a tumor marker called alpha-fetoprotein or AFP will be elevated. This tumor marker may also be used to determine response to treatment and monitor for recurrence of hepatic cancer.
A biopsy of liver tissue is required to microscopically confirm the diagnosis. Biopsies can be taken from the liver using CT guidance or laparoscopically.
Treatment of primary liver cancer:
The treatment of primary hepatocellular carcinoma, also called HCC, often has limited success. In fact, most individuals with primary hepatocellular carcinoma have passed away at one year after their initial diagnosis. The treatment options for this unfortunate type of cancer include:
1. Liver resection- This means that the tumor and nearby tissues are cut out. This option is not possible in those who have extensive disease or in individuals who will have poor residual liver function.
2. Devascularization- Stopping the blood supply to the tumor. Not often successful.
3. Cryotherapy- Freezing the tumor cells directly.
4. Thermal ablation- Using heat locally to destroy the tumor cells.