Gastrointestinal Cancers

Liver Cancer

Background

Liver cancer, or hepatocellular carcinoma (HCC), is one of the most common cancers in the world, especially in Asia and the Middle East. In the United States, the average age at onset is approximately 60 years old. The disease occurs more frequently in males than females by a ratio of 2 to 1.

There is a strong association between chronic hepatitis B and C viral infections and the development of heptaocellular (liver cell or HCC) carcinoma, which accounts for about two-thirds of all liver cancers. People with any cause of cirrhosis (such as alcoholic) also have an increased risk of liver cancer. Certain molds that produce hepatocarcinogens (aflatoxin) that grow on stored foods are recognized risk factors in parts of Africa and Asia.

About one in five liver cancers is a cholangiocarcinoma, arising from branches of the bile ducts found in the liver. Certain liver parasites are recognized risk factors for this type of liver cancer, especially in parts of Southeast Asia (Clonorchis infection). Most people don't have signs and symptoms in the early stages of primary liver cancer.

Symptoms

When symptoms do appear, they may include:

  • Weight loss (non-intentional)
  • Loss of appetite
  • Upper abdominal pain
  • Nausea and vomiting
  • General weakness and fatigue
  • An enlarged liver
  • Abdominal swelling due to fluid in the abdomen (ascites)
  • Yellow discoloration of the skin and the whites of the eyes (jaundice)

Risk Factors

Factors that increase the risk of liver cancer include:

  • Gender. Men are more likely to develop liver cancer than women.
  • Race and ethnicity. In the United States, liver cancer rates are highest in Asian Americans.
  • Chronic infection with HBV or HCV. The most common risk factor for liver cancer is chronic infection with hepatitis B virus (HBV) or hepatitis C virus (HCV). HBV and HCV lead to cirrhosis of the liver and, because of the prevalence of these infections in many parts of the world, liver cancer is one of the most common forms of cancer worldwide.
  • Cirrhosis of the liver, which occurs when liver cells become damaged and are replaced by scar tissue. Cirrhosis from any cause increases the risk of liver cancer.
  • Certain types of inherited metabolic diseases that can cause cirrhosis and increase the chances of developing liver cancer. Autoimmune liver disease, hemochromatosis, tyrosinemia, alpha1-antitrypsin deficiency, porphyria cutanea tarda, glycogen storage diseases, and Wilson's disease are rare diseases that increase the risk of liver cancer.
  • Diabetes. This is usually in correlation with other risk factors, such as heavy alcohol consumption or hepatitis.
  • Obesity
  • A family history of liver cancer
  • Exposure to aflatoxins, cancer-causing substances made by a fungus that contaminates wheat, corn, soybeans, rice, and some types of nuts. This risk factor is more common in warm and tropical countries.
  • Exposure to vinyl chloride and thorium dioxide can increase the risk of developing a rare form liver cancer called angiosarcoma.

Staging

Stage I: There is one tumor and it has not grown into any blood vessels.

Stage II: One of the following is found:

  • one tumor that has spread to nearby blood vessels; or
  • more than one tumor, none of which is larger than 5 centimeters.

Stage III: This stage is divided into Stages IIIA, IIIB, and IIIC.

    Stage IIIA: one of the following is found:

    • more than one tumor larger than 5 centimeters; or
    • one tumor that has spread to a major branch of blood vessels near the liver.

    Stage IIIB: there are one or more tumors of any size that have either:

    • spread to nearby organs other than the gallbladder; or
    • broken through the lining of the peritoneal cavity.

    Stage IIIC: Cancer has spread to nearby lymph nodes.

Stage IV: Cancer has spread beyond the liver to other places in the body, such as the bones or lungs. The tumors may be of any size and may also have spread to nearby blood vessels and/or lymph nodes.

Treatment

Liver cancer treatment options may include:

  • Surgery to remove a portion of the liver. Your doctor may recommend partial resection to remove the liver cancer and a small portion of healthy tissue that surrounds it if your tumor is small and your liver function is good.
  • Liver transplant surgery. During liver transplant surgery, your diseased liver is removed and replaced with a healthy liver from a donor. Liver transplant surgery is usually for people with early-stage liver cancer who also have cirrhosis.
  • Cryoablation. This involves the use of extreme cold to destroy cancer cells. An instrument (cryoprobe) containing liquid nitrogen is placed directly on the tumors. Cryoablation can be used alone, or it can be used with surgery, chemotherapy, or other standard treatments.
  • Radiofrequency ablation (RFA). Radiofrequency ablation uses electric current to create heat that then destroys the cancer cells. Ultrasound-guided needles are used to deliver RFA directly to the affected area(s).
  • Alcohol injection. Pure alcohol is injected directly into the affected area(s). Alcohol injection is usually reserved for smaller lesions and in patients that may not be operative.
  • Chemoembolization. A type of chemotherapy, this treatment sends strong anti-cancer drugs directly to the liver via a branch of the hepatic artery. The procedure is performed by specialty-trained interventional radiologists who selectively deliver the chemotherapeutic agent, followed by embolization of the small arterial branch supplying blood to the affecting area.

References
National Cancer Institute, Mayo Clinic, Cancer Treatment Centers of America.