The liver is an organ with myriad functions, among them filtering toxins that accumulate in the blood, producing proteins and hormones, and breaking down complex molecules. The liver is essential for survival.
Hepatocellular carcinoma (HCC), also known as primary liver cancer, occurs when a tumor develops within the liver. This cancer differs from metastatic liver cancer, which emerges elsewhere in the body and spreads to the liver through the bloodstream. (Many more patients acquire liver cancer this way.)
HCC is the fifth most common cancer in the United States, where its incidence has risen in recent years, a trend projected to continue through the next decade. HCC’s incidence is much higher, however, in countries where hepatitis is more prevalent.
Worldwide, hepatitis types B and C are blamed for more than 80 percent of primary liver cancer. In the United States, primary liver cancer is caused mostly by chronic hepatitis C and alcoholism and related cirrhosis. Research suggests that HCC’s recent increase is due in part to more cases of obesity and diabetes.
Alcoholism, hepatitis, drug abuse and other liver infections are highly associated with cirrhosis – the advanced scarring of liver tissue. Cirrhosis develops over decades, during which time damage to the liver becomes significant. Often this damage is unrecognized because symptoms are absent.
Primary liver cancer’s mortality rate is high, and early detection is crucial. All patients with cirrhosis, regardless of its cause, should undergo screening for hepatocellular carcinoma.
Data suggests that the median survival rate is 11 months among all HCC patients, and 16 to 24 months for patients receiving two drug therapies. Survival rates are improving as treatment modalities improve over time.
HCC is more common in men, by about a 3:1 ratio with women. It is diagnosed at a median age of around 60, but can affect patients of a wide range of ages.
Radiographic studies including ultrasound, computed tomography (CT) scan and magnetic resonance imaging (MRI) typically detect this cancer. The presence of classic findings on CT or MRI scans is adequate to diagnose hepatocellular carcinoma in most cases, although sometimes a biopsy is necessary. Blood tests, notably alpha-fetoprotein, can help to detect this cancer, though they are not always helpful.
The most appropriate treatment for HCC depends upon the size and number of tumors, and on the severity of the underlying liver disease. Potential treatments include:
- Hepatectomy (surgical resection of a portion of liver)
- Radiofrequency ablation (destruction of the tumor by waves of electrical energy)
- Percutaneous ethanol injection (needle injection of ethanol into liver tumor tissue)
- Transarterial embolization (the implantation of tiny particles into the tumor tissue to halt blood flow, killing the tumors)
Interventional radiologists, surgical oncologists and medical oncologists typically provide these treatments. In some cases, patients with HCC are candidates for liver transplantation, which may provide the best long-term disease-free survival.
Liver cancer may grow unnoticed for years. When symptoms emerge, jaundice – yellowing of the skin and eyes – is common. This symptom stems from the liver’s failure to remove bilirubin, a waste product, from blood.
HCC also reveals itself through the following symptoms:
- loss of appetite or weight
- pain in the abdomen
- bloated abdominal cavity from accumulation of fluids
Chronic infection with hepatitis B and C viruses cause about 80 percent of cases worldwide. In the United States, alcohol-related cirrhosis is another prominent cause of HCC. Other causes include:
- Chronic infection with hepatitis B and C viruses cause about 80 percent of cases worldwide. In the United States, alcohol-related cirrhosis is another prominent cause of HCC. Other causes include:
- Drug-related cirrhosis
- Hemochromatosis, an inherited condition in which the body cannot adequately rid the body of excess iron
- Fatty liver disease
This disease is usually linked to hepatitis B or cirrhosis of any cause, and affected patients typically experience symptoms only after the disease has reached a later stage. When symptoms – abdominal pain, weight loss, jaundice – are recognized, blood workup may reveal abnormal levels of several proteins that mark hepatocellular carcinoma (HCC) and liver imaging may reveal a mass.
Regular monitoring of patients identified as high-risk for HCC may result in earlier recognition of these cancer markers. Studies have shown that surveillance of cirrhotic patients (with ultrasound and alpha-fetoprotein test) at six-month intervals improves survival.
Two radiological methods reliably confirm tumor presence:
- three-phase magnetic resonance imaging (MRI), enhanced with dynamic contrast
- three-phase, helical computed tomography (CT) scan
With either method, specific criteria of results are sufficient to generate a formal diagnosis of HCC. Imaging with CT and MRI is highly accurate with tumors of 2 cm or greater, but far less accurate in revealing smaller tumors). MRI is more expensive than CT.
Underlying liver disease can obscure findings. If studies are suggestive but inconclusive, a needle biopsy may assist with diagnosis.
Liver tumors may be solitary or multiple in number. They may invade the blood vessels of the liver and/or spread outside of the liver (metastasis).
The disease’s main complications relate to worsening of liver function. Additionally, medical or surgical treatment of tumors can lead to complications. For example, studies suggest that:
- Hepatectomy (surgical removal of the tumor and part of the surrounding liver) may result in infection, excessive bleeding, injury to another abdominal structure, pneumonia and urinary infection. Additionally, abdominal surgery can lead to blood clots in the legs, which can circulate to the lungs and cause a pulmonary embolism, a very serious and potentially fatal condition.
- Chemo-embolization (a catheter-based procedure that aims to block blood flow to the tumor by injecting material soaked with chemotherapy drugs into the tumor) is associated with blood-vessel damage, infection, abdominal pain, fever and vomiting, and can worsen liver function.
- Radiofrequency ablation of tumors may result in peritoneal bleeding, blood accumulating in the pleural cavity, tumor spread and jaundice.
- Chemotherapy may result in nausea, fatigue, short-term reduced immunity to infection, hair loss, and anemia.
Cancer patients frequently experience weight loss and a change in dietary interests and sensitivities. Patients should try to maintain a healthy diet that is low in sodium and provides adequate protein intake.
- Stop smoking
- Discontinue alcohol use
- Exercise gently
- Find something to make you laugh every day