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Hepatocellular carcinoma
Definition
Hepatocellular carcinoma is cancer of the liver.
Alternative Names
Primary liver cell carcinoma; Tumor - liver; Liver cancer; Cancer - liver; Hepatoma
Causes
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. However, the age varies in different parts of the world.
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, the cause of liver cancer is usually scarring of the liver (cirrhosis). Cirrhosis may be caused by:
- Alcohol abuse (the most common cause in the United States)
- Autoimmune diseases of the liver
- Hepatitis B or C virus infection
- Inflammation of the liver that is long-term (chronic)
- Iron overload in the body (hemochromatosis)
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
- Easy bruising or bleeding
- Enlarged abdomen
- Yellow skin or eyes (jaundice)
Exams and Tests
Physical examination may show an enlarged, tender liver.
Tests include:
- Abdominal CT scan
- Abdominal ultrasound
- Liver biopsy
- Liver enzymes (liver function tests)
- Liver MRI
- Serum alpha fetoprotein
Some high-risk patients may 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 blocks tumor growth, is now approved for patients with advanced hepatocellular carcinoma.
Support Groups
You can ease the stress of illness by joining a support group with members who share common experiences and problems. See:
Outlook (Prognosis)
The usual outcome is poor, because only 10 - 20% of hepatocellular carcinomas can be removed completely using surgery.
If the cancer cannot be completely removed, the disease is usually fatal within 3 - 6 months. However, survival can vary, and occasionally people will survive much longer than 6 months.
Possible Complications
- Gastrointestinal bleeding
- Liver failure
- Spread (metastasis) of the cancer
When to Contact a Medical Professional
Call your health care provider if you develop persistent abdominal pain, especially if you have a history of any liver disease.
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. Certain patients 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.
References
National Cancer Institute. Adult primary liver cancer treatment PDQ. Updated July 8, 2010.
National Comprehensive Cancer Network. Hepatobiliary cancers: Pancreatic adenocarcinoma. 2011. Version 2.2011.
Roberts LR. Liver and biliary tract tumors. In: Goldman L, Ausiello D, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 202.
Reviewed By: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; and Yi-Bin Chen, MD, Leukemia/Bone Marrow Transplant Program, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
