LIVER CANCER

LIVER CANCER – Definition, Classification, Etiology and Risk Factors, Signs and Symptoms, Diagnostic Tests and Management

DEFINITION

Liver cancer or hepatic cancer is a cancer that originates in the liver. Liver cancers are malignant tumors that grow on the surface or inside the liver.

CLASSIFICATION

  • Primary liver cancer: it can be benign and malignant

Origin                   Benign             Malignant

Hepatocytes    –    Adenoma        Hepatocellular carcinoma

Connective tissue – Fibroma       Sarcoma

Blood vessels –    Hemangioma  hemangioendothelioma

Bile ducts –           cholangioma   carcinoma

  • Secondary (metastatic) liver cancer

Secondary (metastatic) cancer reaches the liver by spreading through the blood system from a primary tumor at a separate site.

  • Mixed tumors: rarer forms of liver cancer include:

Mesenchymal tissue

Sarcoma

Hepatoblastoma is a rare malignant tumor, primarily developing in children. Most of these tumors form in the right lobe

Cholangiocarcinoma

Angiosarcoma and hemangiosarcoma

Lymphoma of liver

ETIOLOGY AND RISK FACTORS

  • Younger population mainly females
  • Chronic liver disease: cirrhosis, HBV and HCV
  • Chemical toxins such as vinyl chloride
  • Carcinogens in herbal medicines
  • Mycotoxins like aflatoxins
  • Oral contraceptives
  • Metastasis

SIGNS AND SYMPTOMS OF PRIMARY LIVER CANCER

Cholangiocarcinoma

  • Sweating
  • Jaundice
  • Abdominal pain
  • Weight loss
  • Hepatomegaly

Hepatocellular Carcinoma

  • Abdominal mass
  • Abdominal pain
  • Emesis
  • Anemia
  • Back pain
  • Jaundice
  • Itching
  • Weigh loss

SIGNS AND SYMPTOMS OF SECONDARY LIVER CANCER

  • Tiredness
  • Loss of appetite
  • Nausea
  • A dragging sensation or heaviness felt up under the lower ribs on the right-hand side
  • Pain in the upper part of the belly, particularly on bending forwards

DIAGNOSTIC TESTS

  • Physical examination and history: the first symptom is usually pain in the right side. Weight loss is common and sometimes patients have episodes of severe pain, fever, and nausea. Rapidly deteriorating health, swelling and jaundice
  • Blood tests: most useful in AFP (alpha-fetoprotein). AFP is a protein produced by the liver, and an elevated level can indicate tumor growth, though some patients with liver cancer have normal AFP levels
  • CEA (carcinoembryonic antigen) test
  • Diagnostic imaging: ultrasound scan, CT and MRI scans are required liver imaging may include a four-phase computed tomography (CT), including spiral CT scans obtained during hepatic arterial and portal venous phases following intravenous contrast administration, or magnetic resonance imaging (MRI). These techniques can accurately demonstrate the number of primary tumors within the liver and their relationship to vascular structures.
  • Image-guided biopsy

MANAGEMENT

The correct treatment of liver cancer can mean the difference between life and death. Not all patients with cancers in the liver are potentially curable. These are some of the treatments available: surgery, chemotherapy, immunotherapy, photodynamic therapy, hyperthermia, radiation therapy and radiosurgery.

Hepatocellular Carcinoma

  • Partial hepatectomy to resect the entire tumor
  • Liver transplantation
  • Cryoablation
  • Chemoembolization
  • Radiotherapy
  • Sorafenib
  • Radiofrequency ablation

Cholangiocarcinoma

  • Photodynamic therapy
  • Brachytherapy
  • Radiotherapy
  • Liver transplantation

Hepatoblastoma

  • Chemotherapy, including vincristine, cyclophosphamide and doxorubicin
  • Radiotherapy
  • Liver transplantation
  • Surgical resection
LIVER CANCER – Definition, Classification, Etiology and Risk Factors, Signs and Symptoms, Diagnostic Tests and Management

LIVER CANCER – Definition, Classification, Etiology and Risk Factors, Signs and Symptoms, Diagnostic Tests and Management

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